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Case 38: Complete ACL Tear Healed Naturally Without Surgery

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ACL Online Therapy for natural healing

The case reports of ACL natural healing

Patient Profile

A 43-year-old Japanese female presented with a complete ACL rupture following a skiing accident.

Mechanism of Injury

On January 4, 2023, the patient sustained a fall while skiing, resulting in a valgus injury to the left knee. MRI performed the next day confirmed a complete rupture of the anterior cruciate ligament (ACL), classified as Ihara Type II, along with an injury to the medial collateral ligament (MCL).

Diagnosis: Complete rupture of the left ACL (Ihara Type II)
Partial tear of the left MCL

Initial Management

Initial clinical evaluation revealed a positive Lachman test. Hemarthrosis was aspirated twice. Although the patient attended two outpatient physiotherapy sessions, full knee extension was not achieved. No surgical intervention was pursued.

Intervention

Approximately one month post-injury, on February 3, 2023, the patient commenced a structured online rehabilitation program based on natural healing principles. A knee brace was worn during daily activities, and the patient engaged in “Evo-Devo Exercises” focused on dynamic open kinetic chain movements. This regimen was maintained consistently for four months.

Follow-up Imaging

An MRI was performed four months after initiating the natural healing protocol. Three independent musculoskeletal radiologists assessed the image and unanimously assigned an ACLOAS Score of 1—indicating continuity and preserved morphology of the ACL, with mild thickening and increased signal intensity.

Outcome

The ACL, previously diagnosed as fully ruptured, was judged to have healed with sufficient thickness and tension. The patient subsequently progressed to higher-level rehabilitation aimed at returning to pre-injury levels of physical activity.

Discussion

This case illustrates the potential for spontaneous healing in ACL ruptures classified as Ihara Type II. The close approximation of ligament stumps likely contributed to favorable tissue regeneration. This supports the hypothesis that selected complete ACL tears may heal under appropriate biomechanical and rehabilitative conditions.

References

Natural Healing of a Re-ruptured ACL After Reconstruction

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ACL Online Therapy for natural healing

The case reports of ACL natural healing

Patient Information:

40-year-old, Indian, male

Mechanism of Injury:

In 2004, the patient tore the left ACL and underwent reconstruction surgery in 2008. On October 13, 2022, he twisted his left knee after falling down stairs. An MRI taken on October 17 revealed the following:

Rupture of the reconstructed ACL

Post-Injury Course:

Online therapy began on November 24, 2022. A brace was worn for 3 months with extension limited to 0–30 degrees. Walking was limited to 3,000 steps per day. The patient performed an exercise therapy based on evolutionary developmental movement three times daily for 3 months. In the fourth month, the brace was removed and full range of motion gradually restored. A follow-up MRI was taken on June 6, 2023.

MRI Findings:

The radiologist’s report from India noted:
・Mild damage to the reconstructed ACL and PCL
・Grade 3 tear in the posterior horn of the medial meniscus

Clinical Outcome:

The re-ruptured ACL was judged to have regained sufficient continuity. The patient was instructed to continue rehabilitation toward returning to daily activities.

Discussion:

This is the first reported case in which a re-ruptured reconstructed ACL spontaneously healed through Evo-Devo Exercises. If the graft is fused and fixed within the bone tunnel, appropriate mechanical stress and dynamic movement therapy may allow for spontaneous repair. Accumulation and analysis of further cases is needed.

References:

Natural Healing of ACL Tear -case 37- Be careful of the opposite knee!

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ACL Online Therapy for natural healing

The case reports of ACL natural healing

Patient Information:

44 years old, Male, Croatian

Mechanism of Injury:

On November 5, 2022, during a tennis match, he twisted his left knee. An MRI was performed on November 9, leading to the following diagnosis:

ACL Tear (Simple Complete Tear (Ihara Classification II))

Progress After Injury:

After the injury, he did not undergo physical therapy and rested. Starting from November 13, he began an online therapy program with our clinic and continued “Evo-Devo Exercises” at home for three months. On February 14, 2023, a second MRI was performed.

MRI Results:

The torn ACL had regained continuity. However, on the MRI, the ligament appeared pale and had not fully regained its thickness. He continued the “Evo-Devo Exercises,” and a third MRI was performed three months later.

MRI Results:

The ACL appeared darker and thicker compared to the previous MRI.

Subsequent Progress:

The ACL was deemed sufficiently healed, and the patient was cleared to return to sports. He gradually increased his activity levels and eventually played tennis at the same level as before the injury. However, around August 2024, he felt discomfort in his opposite (right) knee during tennis. He rested for a week, but the discomfort persisted even after resuming tennis. An MRI was conducted on October 1, 2024.

MRI Results:

The MRI showed a partial tear in the right ACL but retained continuity overall.

Discussion:

The initially injured left ACL healed naturally, and the patient returned to sports successfully. However, he subsequently injured the opposite ACL. Research suggests a significant likelihood of injuring the contralateral ACL after an initial ACL tear. This case underscores the importance of maintaining balance and minimizing asymmetry to prevent future injuries. Ongoing training to stabilize and balance the body is recommended.

References:

Natural Healing of an ACL Tear: Case Study of a 30-Year-Old Chinese Businessman

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ACL Online Therapy for natural healing

The case reports of ACL natural healing

Patient Information:

30 years old, male, Chinese-Australian

Mechanism of Injury:

On February 19, 2023, he twisted his left knee while skiing. X-ray at the hospital showed no abnormalities. On March 2, MRI was performed, and the following diagnosis was made:

ACL Tear (curved and continuous fiber (Ihara Classification II))

Post-Injury Progression:

After the injury, he wore a brace for only one day and then engaged in rehabilitation, including knee extension exercises. From March 10, he began our online treatment and performed Evo-Devo Exercises three times a day for two months. During this period, all other rehabilitation exercises were strictly prohibited. On May 4, a follow-up MRI was conducted.

MRI Results:

The torn ACL had regained continuity with sufficient thickness (ACLOAS Score 1).

Discussion:

Although the MRI was taken relatively early at the patient’s request—two months into treatment—the ACL’s continuity was sufficiently confirmed. The simple complete tear (Type II) of the ACL may have been a factor in the early healing observed. Despite including knee extension exercises in the rehabilitation, there was no adverse effect on natural healing in this case.

References:

An Indian Highschool Boy’s Natural Healing of ACL Tear -case 35

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ACL Online Therapy for natural healing

The case reports of ACL natural healing

Patient Information:

17 years old, male, Indian

Mechanism of Injury:

On October 19, 2022, during a soccer match, he twisted his right knee while attempting to tackle an opponent. A snapping sound was heard from his right knee when twisted. The next day, an MRI scan was performed, resulting in the following diagnosis.

Complete Tear of the Anterior Cruciate Ligament (ACL) of the Right Knee (the ligament ends separated (Ihara Classification III))

Progress After Injury:

After the injury, knee buckling occurred several times. After wearing a brace, no further knee buckling occurred. Rehabilitation exercises, including full knee extension, were started at a hospital in India. On November 3, an online consultation was started with Jun Matsumoto. The online treatment and at-home Evo-Devo Exercises were continued for 5 months, and a second MRI scan was performed on March 31, 2023.

MRI Results:

The torn ACL had regained its continuity and retained some degree of tension. However, the ligament at about one-third from the femoral attachment remained thin. (Ihara Healing Classification B)

Subsequent Course:

Subsequently, muscle strength training and range of motion recovery exercises were conducted, and he recovered to the point of living a normal daily life without issues. On November 3, 2023, one year after starting treatment, a third MRI scan was performed.

MRI Results:

The results of the third MRI were similar to those of the second one, with the ligament at the tear site remaining thin.

Discussion:

In this case, despite a complete rupture with separation of ligament ends, Evo-Devo Exercises allowed the continuity of the ACL to be restored, achieving natural healing. However, the healed form showed remaining thinning of the ligament, which raises concerns about the patient’s return to sports. Many doctors instruct early rehabilitation, including full knee extension, after ACL injury. In this case as well, the patient had started incorrect rehabilitation early. It is thought that the presence or absence of full knee extension exercises after injury can affect treatment outcomes, and we will continue to collect statistical data on treatment outcomes.

References:

A Panamanian gentleman’s Natural Healing of ACL Tear -case 34

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Natural Healing of ACL Tear

ACL Tear Natural Healing Case Studies

Patient Information:

32 years old, male, Panamanian

Mechanism of Injury:

On August 21, 2022, during a basketball game, he felt a popping sound in his left knee when he jumped off his left foot. He could not move and was transported to the hospital. An MRI was performed the same day, leading to the following diagnosis. The Lachman test was positive.

ACL Tear (unclear stump (Ihara Classification IV))

Post-Injury Progress:

From September 13, 2022, he began Natural Therapy with Jun Matsumoto through online treatment. He continued with online therapy and Evo-Devo Exercises at home, and after four months of treatment, a follow-up MRI was performed.

MRI Results:

Although the torn ACL did not regain enough tension, its continuity had recovered. Fibers near the femoral attachment were thin, but the distal part was sufficiently thick. (Ihara’s Healing Classification B)

Discussion:

This ACL tear had an unclear stump, a type of tear considered difficult to heal naturally (Ihara’s classification). Contrary to expectations, MRI taken five months after the injury showed that the continuity had been restored, yielding relatively favorable results. After continued rehabilitation, he recovered enough to perform daily activities without issues and could engage in light exercises like jogging.

References:

A high school Skateboarder’s Natural Healing of ACL tear -case 33

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Patient Information:

17 years old, male, American

Mechanism of Injury:

On June 11, 2022, he twisted his right knee after a failed landing from a skateboard jump. An MRI was performed on June 25, and the following diagnosis was obtained:

ACL Tear (unclear tear ends (Ihara Classification IV))
Lateral Collateral Ligament sprain

Post-Injury Progress:

Starting August 3, 2022, he began Jun Matsumoto’s natural therapy through the online sessions. He continued with online treatment and at-home Evo-Devo Exercises, and an MRI was performed five months after the start of treatment. The patient did not use any functional braces.

MRI Results:

The torn ACL had recovered its continuity with a thick and tense form (Ihara Healing Classification A).

Discussion:

ACL tears in younger individuals often have unclear tear ends due to the softness of their fibers. This case also had unclear tear ends, making natural healing seem difficult. Additionally, the treatment started eight weeks after the injury, which also reduced the likelihood of successful natural healing. However, contrary to expectations, the ACL naturally healed with a thick and tense form. According to the Ihara Healing Classification, this is the highest grade, A. Unfortunately, during the treatment period, the patient sustained mild injuries to the medial and lateral meniscus. The patient was not wearing any functional braces, and I had not instructed him to do so. Considering such cases, starting from 2023, I have instructed all patients to wear braces.

References:

A Professional Footballer’s Natural Healing of ACL Tear -case 32

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ACL Online Therapy for natural healing

The case reports of ACL natural healing

Patient Information:

38-year-old male, Japanese

Mechanism of Injury:

On September 11, 2022, during a soccer match, an opponent collided with him from the left. At that time, he twisted his right knee unnaturally when he braced with his right foot. He went to the hospital the same day and had an MRI the next day, receiving the following diagnosis:

ACL tear (mid-section tear with retracted ends (Ihara Classification III)

Post-Injury Progress:

On September 15, he visited another hospital. The Lachman test was positive. On September 19, joint fluid was extracted through joint aspiration. After that, there was no swelling, and the knee could flex up to 90 degrees.

On October 3, he visited our clinic. Lachman test was positive, lever arm test was positive, and pivot shift was negative. He started Evo-Devo exercise therapy and continued it daily at home. Another MRI was performed on October 18.

Natural healing of the torn anterior cruciate ligament was confirmed. He continued the naturalization exercises, and MRIs were performed again on December 15 and January 19 of the following year.

The continuity of the anterior cruciate ligament was sufficiently confirmed, and the looseness was also improved.

Discussion:

The patient was a former top athlete in the Japanese national beach soccer team. He wished to continue playing soccer at a competitive level and frequently had MRI scans to closely monitor the healing process. Despite recommendations for surgery from doctors and all related soccer personnel, he chose natural healing, which was a bold decision. The healing level as per imaging diagnosis was Grade II four months post-injury. Although there were concerns about his return to high-level soccer, he underwent rehabilitation and returned to soccer after several months.

References:

Degenerative Healing of an ACL Tear – Case 9

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ACL Online Therapy for natural healing

The case reports of ACL natural healing

Patient Information:

30 years old, male, Hong Kong resident

Injury Mechanism:

On August 20, 2023, during a soccer match, while dodging an opponent’s tackle while dribbling, he twisted his left knee. At that moment, he heard a tearing sound.

Post-Injury Course:

The next day, he visited a family doctor and it was determined that an MRI was necessary. He underwent an MRI on September 12, receiving the following diagnosis:

ACL complete Tear (proximal tear with retraction of the ends (Ihara classification III)
Grade I MCL injury
Grade I LCL injury

After the MRI, he continued functional recovery training instructed by a physical therapist for eight days. The prescribed exercises included an exercise bike, knee extension exercises, and squats. From September 23, he began the online therapy online with Jun Matsumoto. On December 27, he had his second MRI scan.

Based on the MRI images, the torn ends had adhered to the PCL. On December 28, he had an in-person consultation in Hong Kong where both the Lachman test and pivot shift test were both negative. Subsequent MRIs were performed on February 2 and April 27 of the following year.

According to the radiologist’s opinion on the MRI from April 27, the torn ACL displayed a loose and weakened structure with ligament fiber reconstruction. On May 4, the patient resumed playing soccer but heard a painless tearing sound when he slipped during play.

Discussion:

The outcome of this case was deformity healing with adhesion to the PCL. Two possible causes for the deformity healing are proposed. One is that not only were the torn ends separated, but they were also unclear. The other is that rehabilitation for surgery had already been implemented before starting the natural healing therapy. Exercises involving full knee extension are considered to hinder natural healing. In the future, we plan to compare the healing results between groups that performed full knee extension exercises and those that did not.

References:

Degenerative Healing of an ACL Tear – Case 8

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ACL Online Therapy for natural healing

The case reports of ACL natural healing

Patient Information:

55 years old, female, Japanese

Mechanism of injury:

On March 7, 2022, while skiing, she fell with her right ski stuck in the snow.

Progress after injury:

She was taken to an emergency hospital on the day of the accident, where X-rays showed no fractures. The next day, she visited a local orthopedic clinic, where joint fluid was removed through aspiration. An MRI on March 15 revealed the following diagnosis:

Complete ACL tear of the right knee (proximal 1/3 tear with separation of the torn ends, classified as Type III according to Ihara’s classification).

From April 18, 2022, she started online therapy with Jun Matsumoto. She received regular online treatments for four months, and a follow-up MRI was conducted on August 17. During this period, she did not wear any functional braces.

The second MRI did not show clear healing of the torn ACL. However, the tension in the tibial side suggested possible healing at a non-original location. Therapy continued, and a third MRI was conducted on November 11.

The third MRI also did not show clear natural healing of the torn ACL. However, a comprehensive examination of the sagittal and coronal images suggested that the tibial end had healed to the lateral wall of the intercondylar notch. Online treatment was stopped, and PRP injection therapy was started. Another MRI was conducted on August 31, 2023.

Since the ACL had already healed to the lateral wall, natural healing to its original location could not be confirmed.

Discussion:

In this case, the torn ACL could not heal naturally in an ideal manner. The result was a deformed healing to the lateral wall of the intercondylar notch. Functionally, the knee joint was stable, and the patient reported no issues in daily life. Despite not recommending braces for this patient, braces are now recommended for all subsequent patients.

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