This page presents Case 44: a 33-year-old Indonesian woman living in Canada who sustained a complete rupture of the right anterior cruciate ligament (ACL) on landing during bouldering. She did not undergo surgery. With Evo-Devo Exercises (our non-operative protocol), she restored ligament continuity and obtained favorable findings on follow-up imaging.

ACL Online Therapy for natural healing

The case reports of ACL natural healing

Patient information

• Profile: Indonesian, female, 33; residing in Canada
• Date of injury: November 19, 2022
• Mechanism: Twisting the right knee on landing during bouldering
• Initial assessment: Hospital visit; manual testing showed positive Lachman

Initial assessment & change of plan

• First imaging: January 8, 2023. Re-read independently by three imaging specialists: Ihara classification Type II by all three (i.e., a complete tear with a curved, yet continuous band-like fiber appearance).
• Switch of strategy: From January 6, 2023, online care with Jun Matsumoto Clinic; previous rehab (full-extension squats, etc.) was stopped and Evo-Devo Exercises were initiated.

[Ihara classification notes] I = linear/straight tear; II = curved tear (simple complete rupture); III = tear with displaced stumps; IV = indistinct/unclear stumps.

First 3 months (brace & activity)

• Brace management: Wore a knee brace for 3 months with the knee angle limited to 30–120° (avoiding terminal full extension).
• Activity restriction: Walking capped at 3,000 steps/day.
• Home program: Continued Evo-Devo Exercises at home.

Late rehabilitation (graded re-introduction)

After approximately three months of a protected healing phase and once pain, swelling, and instability subsided, she began a graded re-introduction of full-extension range of motion and loaded squats (progressing depth and load stepwise). Trunk/hip coordination and valgus/rotation control were emphasized.

Follow-up imaging

• Date: August 8, 2023
• Findings: All three independent readers rated the native ACL as ACLOAS 1 (i.e., thickened ligament with intraligament high signal, but normal shape and continuity).

[ACLOAS (native ACL) notes] 0 = normal (low signal; regular thickness and continuity) / 1 = thickened and/or intraligament high signal, but shape and continuity are normal / 2 = thinned or elongated, but continuity preserved / 3 = defect or complete loss of continuity.

Discussion

This case likely benefited from a predominantly Ihara Type II pattern (a simple complete rupture that tends to preserve continuity). Early consolidation of care into Evo-Devo Exercises with brace-guided motion limits (30–120°) and moderated ambulation prioritized stump apposition and stability. After this protected period, a graded return to full extension and squats allowed functional recovery while managing tissue stress.

Summary

• Right knee complete ACL rupture on bouldering landing (Lachman positive).
• Initial imaging: Ihara Type II (3/3 readers) — curved but continuous fiber band.
• Switched to Evo-Devo Exercises; brace-limited 30–120° for 3 months; walking moderated.
• After ~3 months, graded re-introduction of full extension and squats.
• Follow-up imaging: ACLOAS 1 (all readers) — normal shape and continuity.

References

• Filbay SR, et al. Healing of acute ACL rupture on MRI and outcomes following non-surgical management with the Cross Bracing Protocol. Br J Sports Med.
• Ihara H, Kawano T. Influence of age on healing capacity of acute ACL tears based on MRI assessment. J Comput Assist Tomogr.
• Roemer FW, et al. ACLOAS: Longitudinal MRI-based whole-joint assessment of ACL injury. Osteoarthritis Cartilage.