ACL Case Report #56: Natural Healing Without Surgery

ACL Case Report #56: Successful Natural Healing with through Evo-Devo Exercise — Return to Functional Lifestyle for a 37-Year-Old Romanian Male

Summary:

The patient sustained a left knee ACL tear while playing soccer. Based on a strict consensus of three independent specialists, the initial MRI was classified as Ihara Type IV (indistinct/unclear stumps). Seeking to avoid surgery, he chose to pursue non-surgical natural healing by initiating online therapy with Jun Matsumoto, employing Evo-Devo Exercise. He 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 4 months, the final MRI evaluation revealed successful morphological healing, with all specialists confirming structural continuity matching ACLOAS Grade 2 (thinning/elongation with continuity preserved). Following continuous rehabilitation, he successfully returned to his activities of daily living.

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Patient Information

Age / Nationality: 37-year-old male, Romanian
Injured side: Left knee

Mechanism of Injury

Date of injury: 27 July 2023
Context: Sustained an injury while playing soccer with his nephew, twisting his left knee when reaching for the ball with his right foot. He perceived a popping sound at the time of injury. Immediately afterwards, he was unable to walk independently, and episodes of knee giving-way occurred frequently. Later, another giving-way episode occurred while attempting to get into the back seat of a car. A local doctor proposed a full-extension immobilization brace and surgery. He did not undergo physical therapy (PT) after the injury.

Initial Evaluation (MRI #1)

Date: 8 August 2023
Diagnosis: Left knee complete ACL tear
Ihara classification: IV (Grade 4) — Confirmed by a majority of 3 independent specialists (indistinct/unclear stumps) ※2 out of 3 specialists classified it as Type IV, and 1 as Type II.

[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: 26 August 2023
Format: Online guidance; initiation of non-surgical management via Jun Matsumoto
Brace management: Knee range of motion set to 30–120° (0–30° full extension restricted) from 1 September 2023
Activity: Walking strictly restricted to ≤3,000 steps/day
Home program: Evo-Devo Exercise performed 3 times daily for 3 months

Final MRI Evaluation (~4 months)

Date: 4 January 2024 (approx. 4 months post-injury)
Assessment: ACLOAS Grade 2 (thinning/elongation with 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. On 12 February 2024, a physician’s manual examination confirmed a negative pivot-shift test. Following consecutive structural healing, the patient engaged in progressive rehabilitation and successfully restored stability for daily functional life without recurrence of giving-way.

[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 IV (majority consensus)
Final: ACLOAS Grade 2 (successful morphological healing with robust continuity preserved)
Clinical status: Satisfactory functional recovery achieving successful reintegration into daily life.

Summary

Injury (2023/07/27): Left knee complete ACL tear during soccer. Perceived a popping sound and experienced frequent giving-way. A local doctor proposed full-extension immobilization and surgery. 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 2), confirmed by a strict consensus of three independent readers, and a negative pivot-shift test.

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