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A high school Skateboarder’s Natural Healing of ACL tear -case 33

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Patient Information:

17 years old, male, American

Mechanism of Injury:

On June 11, 2022, he twisted his right knee after a failed landing from a skateboard jump. An MRI was performed on June 25, and the following diagnosis was obtained:

ACL Tear (unclear tear ends (Ihara Classification IV))
Lateral Collateral Ligament sprain

Post-Injury Progress:

Starting August 3, 2022, he began Jun Matsumoto’s natural therapy through the online sessions. He continued with online treatment and at-home Evo-Devo Exercises, and an MRI was performed five months after the start of treatment. The patient did not use any functional braces.

MRI Results:

The torn ACL had recovered its continuity with a thick and tense form (Ihara Healing Classification A).

Discussion:

ACL tears in younger individuals often have unclear tear ends due to the softness of their fibers. This case also had unclear tear ends, making natural healing seem difficult. Additionally, the treatment started eight weeks after the injury, which also reduced the likelihood of successful natural healing. However, contrary to expectations, the ACL naturally healed with a thick and tense form. According to the Ihara Healing Classification, this is the highest grade, A. Unfortunately, during the treatment period, the patient sustained mild injuries to the medial and lateral meniscus. The patient was not wearing any functional braces, and I had not instructed him to do so. Considering such cases, starting from 2023, I have instructed all patients to wear braces.

References:

A Professional Footballer’s Natural Healing of ACL Tear -case 32

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ACL Online Therapy for natural healing

The case reports of ACL natural healing

Patient Information:

38-year-old male, Japanese

Mechanism of Injury:

On September 11, 2022, during a soccer match, an opponent collided with him from the left. At that time, he twisted his right knee unnaturally when he braced with his right foot. He went to the hospital the same day and had an MRI the next day, receiving the following diagnosis:

ACL tear (mid-section tear with retracted ends (Ihara Classification III)

Post-Injury Progress:

On September 15, he visited another hospital. The Lachman test was positive. On September 19, joint fluid was extracted through joint aspiration. After that, there was no swelling, and the knee could flex up to 90 degrees.

On October 3, he visited our clinic. Lachman test was positive, lever arm test was positive, and pivot shift was negative. He started Evo-Devo exercise therapy and continued it daily at home. Another MRI was performed on October 18.

Natural healing of the torn anterior cruciate ligament was confirmed. He continued the naturalization exercises, and MRIs were performed again on December 15 and January 19 of the following year.

The continuity of the anterior cruciate ligament was sufficiently confirmed, and the looseness was also improved.

Discussion:

The patient was a former top athlete in the Japanese national beach soccer team. He wished to continue playing soccer at a competitive level and frequently had MRI scans to closely monitor the healing process. Despite recommendations for surgery from doctors and all related soccer personnel, he chose natural healing, which was a bold decision. The healing level as per imaging diagnosis was Grade II four months post-injury. Although there were concerns about his return to high-level soccer, he underwent rehabilitation and returned to soccer after several months.

References:

Degenerative Healing of an ACL Tear – Case 9

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ACL Online Therapy for natural healing

The case reports of ACL natural healing

Patient Information:

30 years old, male, Hong Kong resident

Injury Mechanism:

On August 20, 2023, during a soccer match, while dodging an opponent’s tackle while dribbling, he twisted his left knee. At that moment, he heard a tearing sound.

Post-Injury Course:

The next day, he visited a family doctor and it was determined that an MRI was necessary. He underwent an MRI on September 12, receiving the following diagnosis:

ACL complete Tear (proximal tear with retraction of the ends (Ihara classification III)
Grade I MCL injury
Grade I LCL injury

After the MRI, he continued functional recovery training instructed by a physical therapist for eight days. The prescribed exercises included an exercise bike, knee extension exercises, and squats. From September 23, he began the online therapy online with Jun Matsumoto. On December 27, he had his second MRI scan.

Based on the MRI images, the torn ends had adhered to the PCL. On December 28, he had an in-person consultation in Hong Kong where both the Lachman test and pivot shift test were both negative. Subsequent MRIs were performed on February 2 and April 27 of the following year.

According to the radiologist’s opinion on the MRI from April 27, the torn ACL displayed a loose and weakened structure with ligament fiber reconstruction. On May 4, the patient resumed playing soccer but heard a painless tearing sound when he slipped during play.

Discussion:

The outcome of this case was deformity healing with adhesion to the PCL. Two possible causes for the deformity healing are proposed. One is that not only were the torn ends separated, but they were also unclear. The other is that rehabilitation for surgery had already been implemented before starting the natural healing therapy. Exercises involving full knee extension are considered to hinder natural healing. In the future, we plan to compare the healing results between groups that performed full knee extension exercises and those that did not.

References:

Degenerative Healing of an ACL Tear – Case 8

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ACL Online Therapy for natural healing

The case reports of ACL natural healing

Patient Information:

55 years old, female, Japanese

Mechanism of injury:

On March 7, 2022, while skiing, she fell with her right ski stuck in the snow.

Progress after injury:

She was taken to an emergency hospital on the day of the accident, where X-rays showed no fractures. The next day, she visited a local orthopedic clinic, where joint fluid was removed through aspiration. An MRI on March 15 revealed the following diagnosis:

Complete ACL tear of the right knee (proximal 1/3 tear with separation of the torn ends, classified as Type III according to Ihara’s classification).

From April 18, 2022, she started online therapy with Jun Matsumoto. She received regular online treatments for four months, and a follow-up MRI was conducted on August 17. During this period, she did not wear any functional braces.

The second MRI did not show clear healing of the torn ACL. However, the tension in the tibial side suggested possible healing at a non-original location. Therapy continued, and a third MRI was conducted on November 11.

The third MRI also did not show clear natural healing of the torn ACL. However, a comprehensive examination of the sagittal and coronal images suggested that the tibial end had healed to the lateral wall of the intercondylar notch. Online treatment was stopped, and PRP injection therapy was started. Another MRI was conducted on August 31, 2023.

Since the ACL had already healed to the lateral wall, natural healing to its original location could not be confirmed.

Discussion:

In this case, the torn ACL could not heal naturally in an ideal manner. The result was a deformed healing to the lateral wall of the intercondylar notch. Functionally, the knee joint was stable, and the patient reported no issues in daily life. Despite not recommending braces for this patient, braces are now recommended for all subsequent patients.

References:

Degenerative Healing of an ACL Tear – Case 7

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ACL Online Therapy for natural healing

The case reports of ACL natural healing

Patient Information:

Age: 13 years
Gender: Female
Nationality: Japanese

Mechanism of Injury:

Date of Injury: June 10, 2023
Details: Twisted the left knee during a practice basketball game.

Progress after injury:

MRI Date: June 12, 2023
Diagnosis: Complete rupture of the left anterior cruciate ligament (ACL) with curved ends (Ihara Classification II).

Despite fresh trauma being confirmed by imaging, the patient had felt the knee dislocate several times over the past two years, but these symptoms quickly resolved each time. No joint fluid was aspirated during the examination. Post-injury, there were no knee collapses. Without undergoing hospital rehabilitation, the patient started our natural therapy on June 24, 2023, continuing for four months. A follow-up MRI was performed on October 25, 2023.

Results:

The second MRI showed no signs of natural healing of the ruptured ACL.

Discussion:

In this case, natural healing was not observed, and there was minimal deformity or adhesion to other structures like the posterior cruciate ligament. Despite having a tear pattern that typically allows for natural healing, the exact reasons for the failure remain unclear. Two potential reasons are:
1. Research indicates that younger females have a lower success rate of natural ligament healing compared to adults or males of the same age.
2. The issue of commuting to school. Although advised to avoid long-distance walking or cycling, family circumstances sometimes prevented this. Thus, the patient was not always able to avoid these activities.
Future improvements in treatment methods and living environments are necessary to enhance healing rates in younger patients.

References:

Degenerative Healing of an ACL Tear – Case 6

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ACL Online Therapy for natural healing

The case reports of ACL natural healing

Patient information:

46 years old, female, Hungarian

Mechanism of injury:

On January 6, 2023, while skiing downhill, she fell on an ice slope and fell down. She was unable to stand up and she was rescued by rescue teams.

Progress after injury:

She returned to Hungary from Slovakia, where she consulted an orthopedic surgeon. She had her joint fluid removed by arthrocentesis. She had an MRI done on January 9th, and she received the following diagnosis.

Complete ACL tear (displaced stump (Ihara classification III))
Medial collateral ligament injury
Lateral collateral ligament injury

On January 16th, she visited the orthopedic surgeon again. The Lachman test was positive. She then began range of motion exercises, including full knee extension.

On January 20th, she started online therapy with Jun Matsumoto and began Evo-Devo Exercises.

On February 17th, she had another MRI scan. The images were taken with the knee fully extended. The latest MRI images did not confirm her spontaneous recovery. In fact, the distance between the stumps had widened and worsened. The tibial stump remained in a displaced position and had not improved.

After that, she continued Evo-Devo Exercises and had a third MRI scan on May 18th.

Spontaneous recovery was not confirmed in this MRI scan, but the Lachman test conducted by the doctor showed negative result. She then discontinued Evo-Devo Exercises and started physical therapy in Hungary. On September 18th, her fourth MRI was performed.

This MRI showed no major changes. The patient had limited range of motion in his right knee and had residual knee dysfunction. He is continuing exercise therapy to improve his functional impairment. The fifth MRI was performed on February 27, 2024.

The diagnostic imaging specialist’s report determined that the ACL was torn, but that some of the fibers were still connected. Although the patient is able to lead a normal daily life, she still has limited range of motion in his right knee and is currently undergoing physical therapy.

Consideration:

In this case, not only did the torn ACL not heal well, but there was still clear functional impairment, and natural healing could be said to have failed. There are four possible causes of failure. The first is that the distal end of the stum had turned over, making it difficult for it to heal naturally. Second, blood had been removed by arthrocentesis. Third, physical therapy including full extension was performed early after the injury. Fourth, a second MRI was taken in the fully extended position early after the injury. Based on these results, we would like to strive to improve future treatment methods.

References:

Degenerative Healing of an ACL Tear – Case 5

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ACL Online Therapy for natural healing

The case reports of ACL natural healing

Patient information:

52 years old, Japanese, female

Mechanism of injury:

On November 3, 2022, during a beach ball volleyball game, when she landed on his left foot after an attack, her ipsilateral left knee twisted and she collapsed.

Progress after injury:

After her injury, she received treatment including electrical therapy at another orthopedic clinic. She visited an orthopedic surgeon on November 21st, and X-rays were taken, but no fractures were found. At this time, she had her synovial fluid removed with an arthrocentesis. She had an MRI scan on November 26th, and she received the following diagnosis.

anterior cruciate ligament tear
The torn limb is unclear (Ihara classification IV)

Treatment plan:

She started online treatment with Jun Matsumoto on December 3rd and continued her Evo-Devo Exercise therapy three times daily at her home. She had a second MRI scan 4 months after starting treatment. She still did not wear her functional brace on a daily basis.

Follo-up and Outcomes

Her MRI images showed no clear connection between the stumps of her torn ACL. Her distal ACL stump was connected with the PCL. At this time, her doctor’s evaluation of the Lachman test was negative.

She then performed range of motion exercises and strength training, and her condition recovered to a level where she had no problems in her daily life. She gradually returned to playing beach ball in July of the same year. When she played, she twisted excessively to her left and felt instability in her knee, so she played with tape and a brace on.

On July 30th, while she was playing beach ball, she twisted her left knee again. Her knee was swollen for several days, so she was kept on bed rest.

On October 9th, Jun Matsumoto met with the patient and performed a manual examination. He had a pivot shift test (±) and a Lackman test (-).

On December 9th, her third MRI was performed. Her third MRI image showed no major changes compared to the second, suggesting that its morphology remained fixed as the degenerative healing.

Consideration:

In this case, the patient had been treated and supported for about a year, but the expected results were not obtained. I hypothesized that there were three causes that led to this deformity healing. The first is the removal of blood and edema by arthrocentesis. Second, she did not wear a functional orthosis on a daily basis. Third, the rupture pattern of the ACL was unclear, making it difficult for it to heal naturally. After this case, the later patients were instructed to wear a functional orthosis.

References:

Degenerative Healing of an ACL Tear – Case 4

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ACL Online Therapy for natural healing

The case reports of ACL natural healing

Patient information:

33 year old, male, Malaysian

On July 21st, 2022, he was playing badminton. When he put his right foot forward to pick up the shuttlecock that was falling in front of him, he fell to his right side. He went to the hospital but was not referred for an MRI immediately. No joint fluid was extracted through knee arthrocentesis. He underwent acupuncture several times and participated in two weeks of physiotherapy, including knee extension. On September 8, he was scanned for the MRI and diagnosed as:

a complete ACL tear
(ruptured at the proximal part, classified as type I, in which the torn ends are facing each other)
MCL sprain
Lateral meniscus tear

Starting September 17, 2022, he engaged in Evo-Devo Exercises with Jun Matsumoto, continuing for three months without wearing a functional knee brace restricting the range of motion. On May 9, 2023, he was scanned for the second MRI.

MRI evaluation:

The torn ACL had degenerated and no clear continuity could be confirmed.

Consideration and reflection:

Even though the type of the ACL tear is easier to heal naturally, the expected healing failed. There are three possible causes. The first was that he did not wear a functional brace. Second, treatment started two months after the injury, which was relatively late. Third, before starting treatment, physical therapy with full knee extension was performed. Based on this failure, future treatment plans will likely be reconsidered.

References:

Natural Healing of an ACL tear – Healed but chose surgery – Case 31

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ACL Online Therapy for natural healing

The case reports of ACL natural healing

Patient Information:

  • Nationality: Russian
  • Gender: Male
  • Age: 16 years

Incident Description:

On April 4, 2022, the patient was playing football when he experienced a twisting and collapsing incident involving his right knee. An MRI was performed on the same day.

Diagnosis:

  • Primary Diagnosis: Complete tear of the Anterior Cruciate Ligament (ACL), specifically in the middle part, classified as Type 2.
  • Secondary Observations:
    • The meniscus showed no signs of damage.
    • A slight damage was noted in the Posterior Cruciate Ligament (PCL).

Treatment:

The patient commenced online sessions with Jun Matsumoto on May 10, 2022. The treatment plan involved a specific set of exercises known as “Evo-Devo Exercises.” During this therapy, the patient was instructed not to engage in any other forms of exercise. Additionally, he did not use a knee brace during the course of his treatment. After three months of the treatment, he took the next MRI.

MRI evaluation:

In the patient’s subsequent MRI, the healing of the ACL fibers did not progress as anticipated. The fibers appeared thin, and the condition was classified as Grade III. (Ihara’s ACL healing classification) During the Lachman test, the knee’s instability was rated as 2 out of 3. However, there was a positive note in that the quadriceps muscle showed signs of recovery. Given these mixed results, it was decided to continue with the conservative therapy approach.

Accident:

On November 8, 2022, despite his father’s advice against it, the patient began playing basketball. Approximately 15 minutes into the game, he suddenly heard a clicking sound in his knee, followed by severe pain, which led him to stop playing immediately. Subsequently, his knee became swollen. An MRI taken on November 27 showed that there was no complete tear of the ACL, and no significant changes were observed from the previous MRI results.

ACLR surgery:

Given the patient’s young age, the remaining instability in the knee, and the fear of reinjury, the decision was ultimately made to proceed with ACL reconstruction surgery. This choice was influenced by the need for a more stable and definitive solution to ensure the patient’s long-term knee health and functionality.

Consideration and reflection:

The approach of not using a knee brace during treatment raises questions about its impact on the healing process. Additionally, the patient’s early return to playing basketball, which resulted in the accident, suggests the need for a more cautious approach to resuming sports activities post-injury. These aspects highlight the necessity for further study and evaluation of treatment protocols.

References:

Quick Natural Healing of an ACL partial tear – Healed Case 30

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ACL Online Therapy for natural healing

The case reports of ACL natural healing

Patient information:

Japanese, female, 40 years old
On Nov.12th, 2022, she did a jumping kick during kickboxing practice and twisted when she landed on her left foot. She continued her practice for about an hour right after that. She felt her knees give way.

On Nov.21st, she took the first MRI, but the old MRI didn’t show the good resolution for diagnosis. On Dec.6th, she took the second MRI, and it indicates:

Partial tear of ACL

She didn’t feel any problem in having the normal daily activities. She didn’t feel giving way on the knee. However, the injured knee was a bit loose through the anterior drawer test. Therefore, she stopped not only practicing kickboxing but also stopped any other form of exercise. Not only that, but she stopped fully extending her knees.

Starting Dec. 7th, she initiated online therapy with Jun Matsumoto and continued Evo-Devo Exercises for five weeks. On Jan. 16th, 2023, the third MRI scan was performed.

MRI indicates:

The fibers, which had become sagging due to partial rupture, regained their tautness and straightness.

Future Prospects and Considerations:

Despite only five weeks of treatment, her injured anterior cruciate ligament achieved spontaneous healing. The reason was that the anterior cruciate ligament was partially torn, not completely torn. Another reason may be that the injured ligaments were not separated from each other. With proper treatment, patients with partial anterior cruciate ligament rupture are likely to be able to return to normal daily activities or return to sport earlier than cases with complete rupture.

References: