- Nationality: Russian
- Gender: Male
- Age: 16 years
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.
- 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).
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.
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.
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.
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.
- Ihara H, Miwa M, Deya K, Torisu K. MRI of anterior cruciate ligament healing. J Comput Assist Tomogr. 1996 Mar-Apr;20(2):317-21. doi
- Ihara H, Kawano T. Influence of Age on Healing Capacity of Acute Tears of the Anterior Cruciate Ligament Based on Magnetic Resonance Imaging Assessment. J Comput Assist Tomogr. 2017 Mar/Apr;41(2):206-211. doi
- Pitsillides A, Stasinopoulos D, Giannakou K. Healing potential of the anterior cruciate ligament in terms of fiber continuity after a complete rupture: A systematic review. J Bodyw Mov Ther. 2021 Oct;28:246-254. doi
- Filbay, Stephanie R et al. “Healing of acute anterior cruciate ligament rupture on MRI and outcomes following non-surgical management with the Cross Bracing Protocol.” British journal of sports medicine, bjsports-2023-106931. 14 Jun. 2023, doi:10.1136/bjsports-2023-106931