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
- Filbay, S.R. et al. “Healing of acute anterior cruciate ligament rupture on MRI and outcomes following non-surgical management with the Cross Bracing Protocol.” British Journal of Sports Medicine.
- Ihara H, Kawano T. “Influence of Age on Healing Capacity of Acute Tears of the Anterior Cruciate Ligament Based on MRI Assessment.” J Comput Assist Tomogr. 2017.
- Roemer FW et al. “Anterior Cruciate Ligament Osteoarthritis Score (ACLOAS): MRI-based whole joint assessment of ACL injury.” Osteoarthritis Cartilage. 2014.
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