A new way of grading severity of ACL rupture on acute MRI to consider potential for non-surgical healing with the Cross Bracing Protocol: ACL Acute Rupture Characteristics for Healing (ACL-ARCH) MRI criteria

<h2>Summary</h2> In this paper, we introduce a new way of grading acute ACL rupture on MRI to assess features that are relevant to ACL healing potential, based on experience managing 1080 active individuals and athletes with the Cross Bracing Protocol. We describe the following features of acute ACL injury visible on MRI: i) tibial/femoral attachment integrity; ii) ACL tissue displacement outside the intercondylar notch; iii) the distance between the ends of the ruptured ACL (‘gap distance'); iv) retraction of ACL ends into rounded stumps (‘involution'). We hope these observations inspire further research to assess the potential for these variables to predict an optimal healing outcome and inform treatment decisions.