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

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:

• Filbay SR et al. Healing of acute anterior cruciate ligament 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 Tears of the ACL Based on MRI Assessment. J Comput Assist Tomogr.
• Roemer FW et al. ACLOAS: Longitudinal MRI-based whole joint assessment of ACL injury. Osteoarthritis Cartilage.