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Natural Healing of ACL Tear -case 37- Be careful of the opposite knee!

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ACL Online Therapy for natural healing

The case reports of ACL natural healing

Patient Information:

44 years old, Male, Croatian

Mechanism of Injury:

On November 5, 2022, during a tennis match, he twisted his left knee. An MRI was performed on November 9, leading to the following diagnosis:

ACL Tear (Simple Complete Tear (Ihara Classification II))

Progress After Injury:

After the injury, he did not undergo physical therapy and rested. Starting from November 13, he began an online therapy program with our clinic and continued “Evo-Devo Exercises” at home for three months. On February 14, 2023, a second MRI was performed.

MRI Results:

The torn ACL had regained continuity. However, on the MRI, the ligament appeared pale and had not fully regained its thickness. He continued the “Evo-Devo Exercises,” and a third MRI was performed three months later.

MRI Results:

The ACL appeared darker and thicker compared to the previous MRI.

Subsequent Progress:

The ACL was deemed sufficiently healed, and the patient was cleared to return to sports. He gradually increased his activity levels and eventually played tennis at the same level as before the injury. However, around August 2024, he felt discomfort in his opposite (right) knee during tennis. He rested for a week, but the discomfort persisted even after resuming tennis. An MRI was conducted on October 1, 2024.

MRI Results:

The MRI showed a partial tear in the right ACL but retained continuity overall.

Discussion:

The initially injured left ACL healed naturally, and the patient returned to sports successfully. However, he subsequently injured the opposite ACL. Research suggests a significant likelihood of injuring the contralateral ACL after an initial ACL tear. This case underscores the importance of maintaining balance and minimizing asymmetry to prevent future injuries. Ongoing training to stabilize and balance the body is recommended.

References:

Natural Healing of an ACL Tear: Case Study of a 30-Year-Old Chinese Businessman

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ACL Online Therapy for natural healing

The case reports of ACL natural healing

Patient Information:

30 years old, male, Chinese-Australian

Mechanism of Injury:

On February 19, 2023, he twisted his left knee while skiing. X-ray at the hospital showed no abnormalities. On March 2, MRI was performed, and the following diagnosis was made:

ACL Tear (curved and continuous fiber (Ihara Classification II))

Post-Injury Progression:

After the injury, he wore a brace for only one day and then engaged in rehabilitation, including knee extension exercises. From March 10, he began our online treatment and performed Evo-Devo Exercises three times a day for two months. During this period, all other rehabilitation exercises were strictly prohibited. On May 4, a follow-up MRI was conducted.

MRI Results:

The torn ACL had regained continuity with sufficient thickness (ACLOAS Score 1).

Discussion:

Although the MRI was taken relatively early at the patient’s request—two months into treatment—the ACL’s continuity was sufficiently confirmed. The simple complete tear (Type II) of the ACL may have been a factor in the early healing observed. Despite including knee extension exercises in the rehabilitation, there was no adverse effect on natural healing in this case.

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An Indian Highschool Boy’s Natural Healing of ACL Tear -case 35

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ACL Online Therapy for natural healing

The case reports of ACL natural healing

Patient Information:

17 years old, male, Indian

Mechanism of Injury:

On October 19, 2022, during a soccer match, he twisted his right knee while attempting to tackle an opponent. A snapping sound was heard from his right knee when twisted. The next day, an MRI scan was performed, resulting in the following diagnosis.

Complete Tear of the Anterior Cruciate Ligament (ACL) of the Right Knee (the ligament ends separated (Ihara Classification III))

Progress After Injury:

After the injury, knee buckling occurred several times. After wearing a brace, no further knee buckling occurred. Rehabilitation exercises, including full knee extension, were started at a hospital in India. On November 3, an online consultation was started with Jun Matsumoto. The online treatment and at-home Evo-Devo Exercises were continued for 5 months, and a second MRI scan was performed on March 31, 2023.

MRI Results:

The torn ACL had regained its continuity and retained some degree of tension. However, the ligament at about one-third from the femoral attachment remained thin. (Ihara Healing Classification B)

Subsequent Course:

Subsequently, muscle strength training and range of motion recovery exercises were conducted, and he recovered to the point of living a normal daily life without issues. On November 3, 2023, one year after starting treatment, a third MRI scan was performed.

MRI Results:

The results of the third MRI were similar to those of the second one, with the ligament at the tear site remaining thin.

Discussion:

In this case, despite a complete rupture with separation of ligament ends, Evo-Devo Exercises allowed the continuity of the ACL to be restored, achieving natural healing. However, the healed form showed remaining thinning of the ligament, which raises concerns about the patient’s return to sports. Many doctors instruct early rehabilitation, including full knee extension, after ACL injury. In this case as well, the patient had started incorrect rehabilitation early. It is thought that the presence or absence of full knee extension exercises after injury can affect treatment outcomes, and we will continue to collect statistical data on treatment outcomes.

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A Panamanian gentleman’s Natural Healing of ACL Tear -case 34

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Natural Healing of ACL Tear

ACL Tear Natural Healing Case Studies

Patient Information:

32 years old, male, Panamanian

Mechanism of Injury:

On August 21, 2022, during a basketball game, he felt a popping sound in his left knee when he jumped off his left foot. He could not move and was transported to the hospital. An MRI was performed the same day, leading to the following diagnosis. The Lachman test was positive.

ACL Tear (unclear stump (Ihara Classification IV))

Post-Injury Progress:

From September 13, 2022, he began Natural Therapy with Jun Matsumoto through online treatment. He continued with online therapy and Evo-Devo Exercises at home, and after four months of treatment, a follow-up MRI was performed.

MRI Results:

Although the torn ACL did not regain enough tension, its continuity had recovered. Fibers near the femoral attachment were thin, but the distal part was sufficiently thick. (Ihara’s Healing Classification B)

Discussion:

This ACL tear had an unclear stump, a type of tear considered difficult to heal naturally (Ihara’s classification). Contrary to expectations, MRI taken five months after the injury showed that the continuity had been restored, yielding relatively favorable results. After continued rehabilitation, he recovered enough to perform daily activities without issues and could engage in light exercises like jogging.

References:

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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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: