This page presents Case 45: a 49-year-old Hungarian man who sustained a complete rupture of the left anterior cruciate ligament (ACL) while skiing (popping sound at the final mogul). He did not undergo surgery. With Evo-Devo Exercises (our non-operative protocol), he restored ligament continuity and obtained favorable findings on follow-up MRI.

ACL Online Therapy for natural healing

The case reports of ACL natural healing

Patient information

• Profile: Hungarian, male, 49
• Date of injury: March 18, 2023
• Mechanism: Left knee discomfort while turning right during a ski run; continued skiing and heard a distinct popping sound at the final mogul
• Initial assessment: Same-day X-ray with no bony abnormality; Lachman positive
• Initial bracing: 0–90° brace, then changed to 0–60° on March 20

Initial assessment & start of care

• Medication: On an anticoagulant initially; given the potential to hinder natural healing, it was discontinued after ~1 month (in consultation with the attending physician)
• Start of therapy: From March 27, 2023, online care at Jun Matsumoto Clinic using the Evo-Devo Exercises.
  
  
  • Range of motion: 30–120° permitted (avoid 0–30°)
  
  
  • Walking: ≤ 3,000 steps/day
  
  
  • Work: Continued manual labor with the brace on (strict avoidance of 0–30°)
  
  
  • Home program: Evo-Devo Exercises (belly crawl, hands-and-knees crawl; open-chain focused) 3×/day
  
  

Imaging assessment (three independent radiologists)

MRI #1 (April 1, 2023)

• Ihara classification: Type II by 1 radiologist; Type III by 2 radiologists → Majority: Type III (complete rupture with displaced stumps predominant)

[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: Maintain 0–30° strict avoidance and 30–120° permission to promote stump approximation
• Activity restriction: Walking capped at ≤3,000 steps/day to enhance circulation/metabolism/fiber alignment while minimizing hyperextension and shear

MRI #2 (July 28, 2023)

• ACLOAS: Grade 1 (adequate thickness with restored 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.

Results

• Outcome: Initially a complete rupture with displacement (Ihara III), which progressed over several months on MRI to restored continuity with adequate thickness (ACLOAS 1)
• Key point: Even under challenging conditions (unable to take time off manual labor), adherence to avoiding 0–30°, step limitation, and home-based Evo-Devo Exercises led to re-establishment of ACL continuity

Discussion

Without prolonged immobilization, combining angle design (avoid 0–30°) with low-level open-chain mechanical stress (Evo-Devo Exercises) may facilitate the sequence of stump approximation → re-continuity → fiber alignment. Early discontinuation of the anticoagulant likely optimized the healing environment. Even while working with a brace, natural healing appears achievable when range-of-motion and loading design are properly followed.

Summary

• Left knee complete ACL rupture while skiing (Lachman positive)
• Initial MRI favored Ihara III (majority of three independent radiologists)
• Avoid 0–30°, allow 30–120°, ≤3,000 steps/day, Evo-Devo Exercises 3×/day
• Follow-up MRI at ~4 months: ACLOAS 1 (restored continuity with adequate thickness)
• No surgery; continuity restored

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.