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ACL Tear Heals Without Surgery – Case #58 (German Female, 25)

The patient sustained a right knee ACL tear after falling from a horse. Although she was able to land on both feet, she struck her right knee hard against the ground in the process. Hospital X-rays showed no fracture, but the Lachman test was positive, indicating knee instability. An MRI performed on 12 October 2023 confirmed a tear of the anterior cruciate ligament (Ihara type II). Seeking to avoid surgery, she chose non-surgical natural healing with Jun Matsumoto via online therapy. She performed a daily home program of Evo-Devo Exercise. She also followed a strict management plan. This included a brace set to 30–120° (restricting 0–30° extension) and a walking limit of 3,000 steps per day. The final MRI revealed successful morphological healing after approximately 4 months. All three independent specialists unanimously confirmed ACLOAS Grade 0 (normal ligament — low signal intensity with regular thickness and continuity). After progressive rehabilitation, she returned to her daily activities.

ACL Online Therapy for natural healing ／ The case reports of ACL natural healing／Facebook ACL Patients Group

Patient Information

  • Age / Nationality: 25-year-old female, German
  • Injured side: Right knee

Mechanism of Injury

  • Date of injury: 24 September 2023
  • Context: She fell from a horse while riding. Although she was able to land on both feet, she struck her right knee hard against the ground in the process. She visited a hospital the same day for X-rays, which showed no fracture. The Lachman test was positive, indicating knee instability. An MRI on 12 October 2023 confirmed a tear of the anterior cruciate ligament.

Initial Evaluation (MRI #1)

  • Date: 12 October 2023
  • Diagnosis: Right knee ACL tear
  • Ihara classification: II (Grade 2) — Confirmed unanimously by 3 independent specialists (curved, continuous band)

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

Initial Policy & Start of Therapy

  • Start date: 20 October 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)
  • Activity: Walking strictly restricted to ≤3,000 steps/day
  • Home program: Evo-Devo Exercise performed daily

Final MRI Evaluation (~4 months)

  • Date: 21 February 2024 (approx. 4 months post-injury)
  • Assessment: ACLOAS Grade 0 (normal ligament — low signal intensity with regular thickness and continuity) — Unanimously confirmed by 3 independent specialists
  • Clinical Finding: The follow-up imaging confirmed full structural recovery and normal ligament morphology. The patient progressed with targeted rehabilitation and successfully returned to her daily activities.

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

Results

  • Initial: Ihara II (unanimous)
  • Final: ACLOAS Grade 0 (normal ligament, full recovery of structural continuity)
  • Clinical status: Full return to daily activities.

Summary

  • Injury (2023/09/24): Right knee ACL tear sustained after falling from a horse and striking the knee on the ground. X-rays were unremarkable, but the Lachman test was positive, and MRI confirmed a tear (Ihara type II).
  • Management: Range of motion restriction (30–120° brace setting restricting 0–30° extension), walking limit of 3,000 steps per day, and daily Evo-Devo Exercise via online therapy.
  • Objective Evidence: Three independent readers unanimously confirmed natural healing with a normal ligament (ACLOAS Grade 0). She achieved a full return to daily activities without surgery.

References

  1. 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. 2023.
  2. Ihara H, Kawano T. Influence of Age on Healing Capacity of Acute Tears of the ACL Based on MRI Assessment. J Comput Assist Tomogr. 2017.
  3. Roemer FW, et al. Anterior Cruciate Ligament OsteoArthritis Score (ACLOAS). Osteoarthritis Cartilage. 2014.