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Case 44: Complete ACL Tear—Natural Healing With Evo-Devo Exercises

This page presents Case 44: a 33-year-old Indonesian woman living in Canada who sustained a complete rupture of the right anterior cruciate ligament (ACL) on landing during bouldering. She did not undergo surgery. With Evo-Devo Exercises (our non-operative protocol), she restored ligament continuity and obtained favorable findings on follow-up imaging.

ACL Online Therapy for natural healing

The case reports of ACL natural healing

Patient information

Profile: Indonesian, female, 33; residing in Canada
Date of injury: November 19, 2022
Mechanism: Twisting the right knee on landing during bouldering
Initial assessment: Hospital visit; manual testing showed positive Lachman

Initial assessment & change of plan

First imaging: January 8, 2023. Re-read independently by three imaging specialists: Ihara classification Type II by all three (i.e., a complete tear with a curved, yet continuous band-like fiber appearance).
Switch of strategy: From January 6, 2023, online care with Jun Matsumoto Clinic; previous rehab (full-extension squats, etc.) was stopped and Evo-Devo Exercises were initiated.

[Ihara classification notes] I = linear/straight tear; II = curved tear (simple complete rupture); III = tear with displaced stumps; IV = indistinct/unclear stumps.

First 3 months (brace & activity)

Brace management: Wore a knee brace for 3 months with the knee angle limited to 30–120° (avoiding terminal full extension).
Activity restriction: Walking capped at 3,000 steps/day.
Home program: Continued Evo-Devo Exercises at home.

Late rehabilitation (graded re-introduction)

After approximately three months of a protected healing phase and once pain, swelling, and instability subsided, she began a graded re-introduction of full-extension range of motion and loaded squats (progressing depth and load stepwise). Trunk/hip coordination and valgus/rotation control were emphasized.

Follow-up imaging

Date: August 8, 2023
Findings: All three independent readers rated the native ACL as ACLOAS 1 (i.e., thickened ligament with intraligament high signal, but normal shape and continuity).

[ACLOAS (native ACL) notes] 0 = normal (low signal; regular thickness and continuity) / 1 = thickened and/or intraligament high signal, but shape and continuity are normal / 2 = thinned or elongated, but continuity preserved / 3 = defect or complete loss of continuity.

Discussion

This case likely benefited from a predominantly Ihara Type II pattern (a simple complete rupture that tends to preserve continuity). Early consolidation of care into Evo-Devo Exercises with brace-guided motion limits (30–120°) and moderated ambulation prioritized stump apposition and stability. After this protected period, a graded return to full extension and squats allowed functional recovery while managing tissue stress.

Summary

Right knee complete ACL rupture on bouldering landing (Lachman positive).
Initial imaging: Ihara Type II (3/3 readers) — curved but continuous fiber band.
Switched to Evo-Devo Exercises; brace-limited 30–120° for 3 months; walking moderated.
After ~3 months, graded re-introduction of full extension and squats.
Follow-up imaging: ACLOAS 1 (all readers) — normal shape and continuity.

References

2025年10月9日

Case 42: A 42-Year-Old Singaporean Woman Who Healed a Complete ACL Tear with Evo-Devo Exercises Instead of Surgery

A 42-year-old woman from Singapore chose Evo-Devo Exercises over surgery after tearing her ACL while skiing.

ACL Online Therapy for natural healing

The case reports of ACL natural healing

Patient Information:

Age / Gender / Nationality: 42 / Female / Singaporean
Date of Injury: December 11, 2022
Injury Description: Twisted her left knee while tripping on a mogul during skiing in Japan
First Examination: December 13, 2022 (X-ray: normal, Lachman test: negative)
First MRI: December 22, 2022
Diagnosis: Complete rupture of the left anterior cruciate ligament

Treatment:

Treatment Start: December 27, 2022
Therapy: Evo-Devo exercises (online)
Brace: Extension restricted to 0–30 degrees
Activity Restriction: Walking limited to under 3,000 steps per day
Frequency: 3 sessions per day at home
Treatment Duration: Approx. 5.5 months

Pre-treatment MRI: December 22, 2022

Three independent radiologists assessed the MRI using the Ihara classification.

Ihara Classification: Two radiologists: Type III (rupture with stump displacement); one: Type II (rupture without stump displacement)

Post-treatment MRI: June 1, 2023

Three radiology specialists re-evaluated the MRI based on the ACLOAS scoring system.

ACLOAS Score Definitions:

Score 0: Normal ligament (low signal intensity, normal shape and continuity)
Score 1: Thick ligament and/or high signal, but with preserved continuity and shape
Score 2: Thin or elongated ligament, but with preserved continuity
Score 3: Disrupted ligament with complete loss of continuity

Re-evaluation Result:

ACLOAS Score: All 3 radiologists evaluated the ligament as Score 1 (thick and continuous)

Discussion:

Initially, the patient underwent rehabilitation including extension exercises. However, shortly after, she transitioned to Evo-Devo Exercises with extension restriction. Although the initial MRI showed displaced rupture, all three radiologists evaluated the ligament as Score 1 (continuous and thick) five months after therapy began. This suggests the ligament structurally reconnected through natural healing. In January 2024, while running, she misstepped and felt strong impact on the same knee. Although a re-rupture was suspected, no follow-up MRI was taken. After symptoms stabilized, rehabilitation resumed, and she recovered to a level sufficient for daily activities, recreational skiing, and hiking.

References:

2025年8月1日

Case 38: Complete ACL Tear Healed Naturally Without Surgery

ACL Online Therapy for natural healing

The case reports of ACL natural healing

Patient Profile

A 43-year-old Japanese female presented with a complete ACL rupture following a skiing accident.

Mechanism of Injury

On January 4, 2023, the patient sustained a fall while skiing, resulting in a valgus injury to the left knee. MRI performed the next day confirmed a complete rupture of the anterior cruciate ligament (ACL), classified as Ihara Type II, along with an injury to the medial collateral ligament (MCL).

Diagnosis: Complete rupture of the left ACL (Ihara Type II)
Partial tear of the left MCL

Initial Management

Initial clinical evaluation revealed a positive Lachman test. Hemarthrosis was aspirated twice. Although the patient attended two outpatient physiotherapy sessions, full knee extension was not achieved. No surgical intervention was pursued.

Intervention

Approximately one month post-injury, on February 3, 2023, the patient commenced a structured online rehabilitation program based on natural healing principles. A knee brace was worn during daily activities, and the patient engaged in “Evo-Devo Exercises” focused on dynamic open kinetic chain movements. This regimen was maintained consistently for four months.

Follow-up Imaging

An MRI was performed four months after initiating the natural healing protocol. Three independent musculoskeletal radiologists assessed the image and unanimously assigned an ACLOAS Score of 1—indicating continuity and preserved morphology of the ACL, with mild thickening and increased signal intensity.

Outcome

The ACL, previously diagnosed as fully ruptured, was judged to have healed with sufficient thickness and tension. The patient subsequently progressed to higher-level rehabilitation aimed at returning to pre-injury levels of physical activity.

Discussion

This case illustrates the potential for spontaneous healing in ACL ruptures classified as Ihara Type II. The close approximation of ligament stumps likely contributed to favorable tissue regeneration. This supports the hypothesis that selected complete ACL tears may heal under appropriate biomechanical and rehabilitative conditions.

References

2025年5月24日

Natural Healing of a Re-ruptured ACL After Reconstruction

ACL Online Therapy for natural healing

The case reports of ACL natural healing

Patient Information:

40-year-old, Indian, male

Mechanism of Injury:

In 2004, the patient tore the left ACL and underwent reconstruction surgery in 2008. On October 13, 2022, he twisted his left knee after falling down stairs. An MRI taken on October 17 revealed the following:

Rupture of the reconstructed ACL

Post-Injury Course:

Online therapy began on November 24, 2022. A brace was worn for 3 months with extension limited to 0–30 degrees. Walking was limited to 3,000 steps per day. The patient performed an exercise therapy based on evolutionary developmental movement three times daily for 3 months. In the fourth month, the brace was removed and full range of motion gradually restored. A follow-up MRI was taken on June 6, 2023.

MRI Findings:

The radiologist’s report from India noted:
・Mild damage to the reconstructed ACL and PCL
・Grade 3 tear in the posterior horn of the medial meniscus

Clinical Outcome:

The re-ruptured ACL was judged to have regained sufficient continuity. The patient was instructed to continue rehabilitation toward returning to daily activities.

Discussion:

This is the first reported case in which a re-ruptured reconstructed ACL spontaneously healed through Evo-Devo Exercises. If the graft is fused and fixed within the bone tunnel, appropriate mechanical stress and dynamic movement therapy may allow for spontaneous repair. Accumulation and analysis of further cases is needed.

References:

2025年5月6日

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

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:

2024年11月28日

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

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.

References:

2024年11月15日

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

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.

References:

2024年9月30日

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

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:

2024年9月20日

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

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:

2024年6月26日

Degenerative Healing of an ACL Tear – Case 9

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:

2024年6月20日

タグ: acl tear spontaneous healing

Patient information

Initial assessment & change of plan

First 3 months (brace & activity)

Late rehabilitation (graded re-introduction)

Follow-up imaging

Discussion

Summary

References

Patient Information:

Treatment:

Pre-treatment MRI: December 22, 2022

Post-treatment MRI: June 1, 2023

ACLOAS Score Definitions:

Re-evaluation Result:

Discussion:

References:

Patient Profile

Mechanism of Injury

Initial Management

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