ACL Case Report #55: 35yo Female Natural Healing

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ACL Case Report #55: Successful Natural Healing with Continuity Preserved Through Evo-Devo Exercise — Return to Functional Lifestyle for a 35-Year-Old Australian Female

Summary:

The patient sustained a right knee ACL rupture while playing netball. Based on a strict consensus of three independent specialists, the initial MRI was classified as Ihara Type III (tear with displaced stumps). Having a history of a left knee ACL reconstruction 9 years prior, she chose to pursue non-surgical natural healing by initiating online therapy with Matsumoto Jun Sekkotsuin, employing Evo-Devo Exercise. She strictly adhered to a rigorous management environment, including a brace restriction set to 30–120° (restricting 0–30° of full extension), a walking limit of 3,000 steps per day, and a home program of Evo-Devo Exercise three times daily for 3 months. After 5 months, the final MRI evaluation revealed successful morphological healing, with all specialists confirming structural continuity matching ACLOAS Grade 1 (thickening/intra-ligament high signal with shape and continuity preserved). Following continuous rehabilitation, she successfully returned to her activities of daily living.

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Patient Information

Age / Nationality: 35-year-old female, Australian
Injured side: Right knee

Mechanism of Injury

Date of injury: 22 July 2023
Context: Sustained an injury while playing netball, twisting her right knee. She did not undergo physical therapy (PT) after the injury. Notably, she has a medical history of an ACL reconstruction on her left knee 9 years ago.

Initial Evaluation (MRI #1)

Date: 7 August 2023
Diagnosis: Right knee complete ACL rupture and MCL Grade 1 injury
Ihara classification: III (Grade 3) — Unanimously confirmed by 3 independent specialists (tear with displaced stumps)

[Ihara classification notes]

I = linear/straight tear; II = curved tear; III = tear with displaced stumps; IV = indistinct/unclear stumps.

Initial Policy & Start of Therapy

Start date: 25 August 2023
Format: Online guidance; initiation of non-surgical management via Matsumoto Jun Sekkotsuin
Brace management: Knee range of motion set to 30–120° (0–30° full extension restricted)
Activity: Walking strictly restricted to ≤3,000 steps/day
Home program: Evo-Devo Exercise performed 3 times daily for 3 months

Final MRI Evaluation (~5 months)

Date: 23 December 2023 (5 months post-injury)
Assessment: ACLOAS Grade 1 (thickening/intra-ligament high signal with shape and continuity preserved) — Unanimously confirmed by 3 independent specialists
Clinical Finding: The final imaging evaluation objectively confirmed excellent structural recovery and robust continuity of the tissue. Following consecutive structural healing, the patient engaged in progressive rehabilitation and successfully restored stability for daily functional life.

[ACLOAS (native ACL) notes]

0 = normal; 1 = thickening/intra-ligament high signal with shape and continuity preserved; 2 = thinning/elongation with continuity preserved; 3 = discontinuity.

Results

Initial: Ihara III (unanimous consensus)
Final: ACLOAS Grade 1 (successful morphological healing with robust continuity preserved)
Clinical status: Satisfactory functional recovery achieving successful reintegration into daily life.

Summary

Injury (2023/07/22): Right knee complete ACL rupture and MCL Grade 1 injury during netball. History of left knee ACL reconstruction. No post-injury PT.
Management: Range of motion restriction (30–120° brace setting restricting 0–30° extension), walking limit of 3,000 steps per day, and Evo-Devo Exercise 3 times daily for 3 months.
Objective Evidence: Successful natural healing with robust structural continuity restored (ACLOAS Grade 1), confirmed by a strict consensus of three independent readers.