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Case 44: Complete ACL Tear—Natural Healing With Evo-Devo Exercises

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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.

Initial MRI (2023-01-08)

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).
Follow-up MRI (2023-08-08)

[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

Case 42: A 42-Year-Old Singaporean Woman Who Healed a Complete ACL Tear with Evo-Devo Exercises Instead of Surgery

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A 42-year-old woman from Singapore chose Evo-Devo Exercises over surgery after tearing her ACL while skiing.

ACL Online Therapy for natural healing

The case reports of ACL natural healing

Patient Information:

  • Age / Gender / Nationality: 42 / Female / Singaporean
  • Date of Injury: December 11, 2022
  • Injury Description: Twisted her left knee while tripping on a mogul during skiing in Japan
  • First Examination: December 13, 2022 (X-ray: normal, Lachman test: negative)
  • First MRI: December 22, 2022
  • Diagnosis: Complete rupture of the left anterior cruciate ligament

Treatment:

  • Treatment Start: December 27, 2022
  • Therapy: Evo-Devo exercises (online)
  • Brace: Extension restricted to 0–30 degrees
  • Activity Restriction: Walking limited to under 3,000 steps per day
  • Frequency: 3 sessions per day at home
  • Treatment Duration: Approx. 5.5 months

Pre-treatment MRI: December 22, 2022

Three independent radiologists assessed the MRI using the Ihara classification.

  • Ihara Classification: Two radiologists: Type III (rupture with stump displacement); one: Type II (rupture without stump displacement)

Post-treatment MRI: June 1, 2023

Three radiology specialists re-evaluated the MRI based on the ACLOAS scoring system.

ACLOAS Score Definitions:

  • Score 0: Normal ligament (low signal intensity, normal shape and continuity)
  • Score 1: Thick ligament and/or high signal, but with preserved continuity and shape
  • Score 2: Thin or elongated ligament, but with preserved continuity
  • Score 3: Disrupted ligament with complete loss of continuity

Re-evaluation Result:

  • ACLOAS Score: All 3 radiologists evaluated the ligament as Score 1 (thick and continuous)

Discussion:

Initially, the patient underwent rehabilitation including extension exercises. However, shortly after, she transitioned to Evo-Devo Exercises with extension restriction. Although the initial MRI showed displaced rupture, all three radiologists evaluated the ligament as Score 1 (continuous and thick) five months after therapy began. This suggests the ligament structurally reconnected through natural healing. In January 2024, while running, she misstepped and felt strong impact on the same knee. Although a re-rupture was suspected, no follow-up MRI was taken. After symptoms stabilized, rehabilitation resumed, and she recovered to a level sufficient for daily activities, recreational skiing, and hiking.

References:

[Case Report] Case 40: Natural Healing of Anterior Cruciate Ligament (ACL) Rupture in a 49-Year-Old Singaporean Woman

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This page introduces a case in which a 49-year-old woman with a complete anterior cruciate ligament (ACL) rupture achieved natural healing without surgery through Evo-Devo Exercises.

ACL Online Therapy for natural healing

The case reports of ACL natural healing

Patient Information:

On March 6, 2023, while performing a martial arts jump kick, the patient felt a popping sensation in her left knee and fell upon landing. An MRI was performed on March 17, revealing the following findings:

March 17, 2023: ACL Rupture (Ihara Grade IV)

After the injury, the patient performed several sessions of knee extension exercises under the guidance of a physical therapist. Knee buckling occurred for about 10 days. From March 28, she began Naturalization Therapy through Jun Matsumoto’s online rehabilitation program. No brace was used, and walking was limited to under 3,000 steps per day. During a trip to Japan in April, she used a wheelchair and minimized walking.

July 29, 2023: ACLOAS score 2

ACLOAS Score Evaluation:
Score 2 (Posterolateral fibers healed / Anteromedial fibers not healed)

Discussion:

This case involved a complex tear categorized as Ihara Grade IV, with frayed ligament stumps, making natural healing typically difficult. Inappropriate activity restrictions in the early stage and the absence of bracing may have influenced healing. Follow-up interviews revealed no major issues in daily life, but the patient felt knee instability during high-impact or pivoting movements. Full functional and muscular recovery required more than one year of rehabilitation.

References:

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:

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:

Natural Healing of an ACL tear – Healed Case 29

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ACL Online Therapy for natural healing

The case reports of ACL natural healing

Patient Information:

Japanese female, 41 years old. On July 5th, 2022, she experienced a sensation of her right knee dislocating while exerting force on her right leg during a basketball game, rendering her immobile. Although she was able to walk later, she visited a hospital two days after the incident. No joint fluid was aspirated during the examination. An MRI scan was performed on July 12th, revealing the following diagnosis:

Complete right Anterior Cruciate Ligament (ACL) tear (proximal 1/3)
No meniscal damage.

According to the Ihara’s ACL tear classification of ACL injuries, it was classified as a type 2, which is the torn and disrupted type. After the injury, no giving way of the knee was reported. She did not undergo any physiotherapy involving knee extension post-injury. She had a history of a left Achilles tendon rupture surgery 13 years prior.

Starting July 28th, she initiated online therapy with Jun Matsumoto and continued Evo-Devo Exercises for five months. On December 12th, 2022, a second MRI scan was performed.

MRI indicates:

The evaluation of the MRI images indicated that the ruptured anterior cruciate ligament had restored continuity and healed naturally. According to Ihara’s ACL healing classification, it was classified as grade 3, which is thinned healed fiber.

Future Prospects and Considerations:

Having confirmed natural healing through MRI, she initiated full knee extension training and strength training. By the six-month mark post-injury, she had recovered to a level where she faced no issues in daily life. She is currently undergoing further rehabilitation with the aim of returning to recreational-level sports.

References:

ACL Healing without surgery – Healed Case 28

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ACL Online Therapy for natural healing

The case reports of ACL natural healing

Patient information:

37 years old, Female, Kazakh living in the U.S.
On February 26th, 2022, he twisted her left knee during skiing. She went through the MRI scan, and the diagnosis was:

Complete ACL tear

According to the Ihara’s classification, this type of ACL tear is classified as disrupted or unclear type. And, this type has been reported as the most difficult type to heal spontaneously.

After the injury, she had been doing some rehabilitation exercises such as strengthening the muscles and 10 min stationary bike under the supervision by a physiotherapist.

On April 29th, she started the Evo-Devo Exercises through the online sessions with Jun Matsumoto, and continued the sessions only for two months. During these months, she stopped doing any strength trainning and focused on the Evo-Devo EXercises. After doing two momths, she started strength training again.

On November 18th, she took the second MRI as poseted below.

MRI indicates:

The MRI shows the clear continuity of the ACL. This healing type can be classified as grade I of the Ihara’s classification, and it is the taut and straight band type of healing.

Future prospects and considerations:

Even though this type of ACL tear has been reported as the most difficult type to heal spontaneously, it has heald upto the best type of healing.

References:

ACL Healing without surgery – Healed Case 27

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ACL Online Therapy for natural healing

The case reports of ACL natural healing

Patient information:

25 years old, Male, Indian
On April 13th,2022, he twisted this right knee during playing soccer. On April 15th, he went through the MRI scan, and the diagnosis was:

complete ACL tear
tear of the anterior root of the lateral meniscus
mild grade1 tear of the body of the medial meniscus
sprain of the mecial and lateral collateral ligaments

complete ACL tear
medial meniscus tear
anterior root tear of the lateral meniscus

On May 24, he started the Evo-Devo Exercises through the online session with Jun Matsumoto. He had four online sessions in a month, and after that he continued the Evo-Devo EX by himself for three months. On October 2nd, he took the second MRI.

healing into the taut and striaight band
medial meniscus tear remains
anterior root of lateral meniscus remains

MRI indicates:

It can be seen that the completely torn ACL grows into the taut and straight band. And, this morphological type of healing is classified as the type 1 by Ihara’s classification. Although the ACL has been healing into the best morphology, the meniscus tears still remain and have even deteriorated further.

Future prospects and considerations:

Regarding to horizontal tear of meniscus, it could be asymptomatic in many cases. However, it is, of course, better to be healed than not to be healed. There is a need to improve existing treatments to make it heal the unhealed meniscus tears.

References:

Natural Healing of ACL tear 26 – Degenerative healing – case 3

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ACL Online Therapy for natural healing

The case reports of ACL natural healing

Patient information:

55 years old, female, Japanese
On March 7th, 2022, she fell in the snow while skiing. And, then her right ski stuck in the snow, and her body was pushed forward. She was immedeately taken to the hospital and scanned for x-ray, but there was no fracture. At that time, the blood and the fluid in the right knee were extracted by the doctor. One week later, she was scanned for MRI, and the diagnosis was:

Complete ACL tear
No other ligament tear
Bone contusion on posterior tibia

On April 18, she started the Evo-Devo Exercises through the online session with Jun Matsumoto. Since the injury, she did not experienced knee giving way. She continued the Evo-Devo EX. for four months, and she took the second MRI.

The second MRI did not show the clear natural healing of the torn ACL even though she did not feel the instability of the knee any more. She continued the exercises and took the third MRI at the different hospital to have more various pictures.

MRI indicates:

The MRI above doesn’t show the clear continuity of the ACL, however, the middle one shows the clear continuity. It is not the clear and beautiful natural healing, but it is sure that the torn ACL acquired the continuity to stabilize the knee. The MRI below is the one of the coronal slices taken on the same day 2022/11/11. It shows that the ACL is morphologically deformed and does not adhere to the original position. That may be the reason why the MRI in sagital plane does not project the clear continuity.

Future prospects and considerations:

Even though the MRI does not show the expected beautiful healing, the torn ACL finally acquired the continuity. She will try the PRP injection to expect the further natural healing. If the platelet contains the self-healing substances, the blood and the fluid in the knee should not be extracted by injection just after the injury. This ridiculous treatment might have interrupted the natural healing. In the functional meaning, her right knee healed well without feeling any instability, and she already has the normal daily activities.

After PRP injections:

She tried the PRP injections for three times and took the MRI again on Aug.31st, 2023. The slight progress of the ACL healing can be seen on the sagittal plane. At this time, Lachman test was performed, and the result was negative. Her prognosis is relatively good, and she is having a normal daily life.

References:

Crain EH, Fithian DC, Paxton EW, Luetzow WF. Variation in anterior cruciate ligament scar pattern: does the scar pattern affect anterior laxity in anterior cruciate ligament-deficient knees? Arthroscopy. 2005 Jan;21(1):19-24. doi: 10.1016

Kittani M, Haviv B, Shemesh S, Yaari L, Yassin M, Rath-Wolfson L. Morphological and Histological Changes in the Human Anterior Cruciate Ligament after Rupture. Isr Med Assoc J. 2021 Jan;23(1):33-37.