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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:

Natural Healing of an ACL tear – Healed Case 29

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ACL Online Therapy for natural healing

The case reports of ACL natural healing

Patient Information:

Japanese female, 41 years old. On July 5th, 2022, she experienced a sensation of her right knee dislocating while exerting force on her right leg during a basketball game, rendering her immobile. Although she was able to walk later, she visited a hospital two days after the incident. No joint fluid was aspirated during the examination. An MRI scan was performed on July 12th, revealing the following diagnosis:

Complete right Anterior Cruciate Ligament (ACL) tear (proximal 1/3)
No meniscal damage.

According to the Ihara’s ACL tear classification of ACL injuries, it was classified as a type 2, which is the torn and disrupted type. After the injury, no giving way of the knee was reported. She did not undergo any physiotherapy involving knee extension post-injury. She had a history of a left Achilles tendon rupture surgery 13 years prior.

Starting July 28th, she initiated online therapy with Jun Matsumoto and continued Evo-Devo Exercises for five months. On December 12th, 2022, a second MRI scan was performed.

MRI indicates:

The evaluation of the MRI images indicated that the ruptured anterior cruciate ligament had restored continuity and healed naturally. According to Ihara’s ACL healing classification, it was classified as grade 3, which is thinned healed fiber.

Future Prospects and Considerations:

Having confirmed natural healing through MRI, she initiated full knee extension training and strength training. By the six-month mark post-injury, she had recovered to a level where she faced no issues in daily life. She is currently undergoing further rehabilitation with the aim of returning to recreational-level sports.

References:

Natural Healing of ACL tear 26 – Degenerative healing – case 3

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ACL Online Therapy for natural healing

The case reports of ACL natural healing

Patient information:

55 years old, female, Japanese
On March 7th, 2022, she fell in the snow while skiing. And, then her right ski stuck in the snow, and her body was pushed forward. She was immedeately taken to the hospital and scanned for x-ray, but there was no fracture. At that time, the blood and the fluid in the right knee were extracted by the doctor. One week later, she was scanned for MRI, and the diagnosis was:

Complete ACL tear
No other ligament tear
Bone contusion on posterior tibia

On April 18, she started the Evo-Devo Exercises through the online session with Jun Matsumoto. Since the injury, she did not experienced knee giving way. She continued the Evo-Devo EX. for four months, and she took the second MRI.

The second MRI did not show the clear natural healing of the torn ACL even though she did not feel the instability of the knee any more. She continued the exercises and took the third MRI at the different hospital to have more various pictures.

MRI indicates:

The MRI above doesn’t show the clear continuity of the ACL, however, the middle one shows the clear continuity. It is not the clear and beautiful natural healing, but it is sure that the torn ACL acquired the continuity to stabilize the knee. The MRI below is the one of the coronal slices taken on the same day 2022/11/11. It shows that the ACL is morphologically deformed and does not adhere to the original position. That may be the reason why the MRI in sagital plane does not project the clear continuity.

Future prospects and considerations:

Even though the MRI does not show the expected beautiful healing, the torn ACL finally acquired the continuity. She will try the PRP injection to expect the further natural healing. If the platelet contains the self-healing substances, the blood and the fluid in the knee should not be extracted by injection just after the injury. This ridiculous treatment might have interrupted the natural healing. In the functional meaning, her right knee healed well without feeling any instability, and she already has the normal daily activities.

After PRP injections:

She tried the PRP injections for three times and took the MRI again on Aug.31st, 2023. The slight progress of the ACL healing can be seen on the sagittal plane. At this time, Lachman test was performed, and the result was negative. Her prognosis is relatively good, and she is having a normal daily life.

References:

Crain EH, Fithian DC, Paxton EW, Luetzow WF. Variation in anterior cruciate ligament scar pattern: does the scar pattern affect anterior laxity in anterior cruciate ligament-deficient knees? Arthroscopy. 2005 Jan;21(1):19-24. doi: 10.1016

Kittani M, Haviv B, Shemesh S, Yaari L, Yassin M, Rath-Wolfson L. Morphological and Histological Changes in the Human Anterior Cruciate Ligament after Rupture. Isr Med Assoc J. 2021 Jan;23(1):33-37.

Spontaneous Healing of a Complete ACL Tear – Case 25

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ACL Online Therapy for natural healing

ACL tears heal without surgery

Patient information:

44 years old, Male, Japanese
On April 9th,2022, he was practicing Judo and trying to throw the opponent. Then, his left knee was twisted internally, and he collopsed down to the ground. He went to the hospital, and Lackman’s test was positive. When he turned the direction, he had gaving way syndrome. He took the MRI on April 19th, and the diagnosis was:

Complete ACL tear
MCL tear

He didn’t want to have a surgery, and he was searching the alternative treatment. He found the Natural Healing Therapy by Jun Matsumoto, and he started the online therapy with him from May 24th, 2022. He had the weekly sessions with Jun and continued doing the Evo-Devo Exercises for five momths. He took the second MRI on October 18th.

The MRI indicates:

The MRI shows the continuity of the ACL. His doctor diagnosed this case as the spontaneous healing of the ACL tear. There was still some signal intensity on the MCL.

Future prospects and considerations:

Jun Matsumoto allowed him to start doing more intense exercises such as squatting and lunge. On November 17th, he got drunk and twisted the left knee again. he says that it wasn’t a serious inury though. Let’s see and follow his prognosis from now on.

References:

Spontaneous Healing of a Complete ACL Tear – Case 22

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ACL Online Therapy for natural healing

ACL tears heal without surgery

Patient information:

45 years old, Male, Japanese
He injured her right knee during skiing on February 5th, 2022. On February 10th, she went to the MRI scanning, and the diagnosis was:

Complete ACL tear
MCL tear grade2

On February 21, 2022, he started the online therapy for the natural healing of the ACL tear with Jun Matsumoto. He continued doing Evo-Devo Exercises for six months, and he took the next MRI on August 17th, 2022.

The MRI indicates:

Visible continuity of the ACL

Future prospects and considerations:

According to the new MRI, the visible continuity of the ACL can be seen, even though it is not the perfectly clear one. This morphological healing is classified as the type II of Ihara’s classification, and the healed ACL is the straight band with partial thinning. The patient has healed functionally very well, and he doesn’t feel any pain in the daily activities so far. He will continue the Evo-Devo Exercises and the some strength exercises until he can return to skiing.

References:

Natural Healing of a Complete ACL Tear – Case 21

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ACL Online Therapy for natural healing

ACL tears heal without surgery

Patient information:

41 years old, Female, American
She injured her left knee during skiing on February 4th, 2022. On February 10th, she went to the MRI scanning, and the diagnosis was:

Complete ACL tear

On February 27, 2022, she started the online therapy for the natural healing of the ACL tear with Jun Matsumoto. She continued doing Evo-Devo Exercises for four months, and she took the next MRI on July 5th, 2022.

MRI reports:

Modest signs of suffering are detectable in the anterior cruciate ligament which appears slightly reduced in thickness in the middle-distal III with an inhomogeneous signal that tends to be hyperintense in the T2-weighted sequences for slight edematous imbibition with characteristics compatible with the outcomes of a “strain” suffering with probable parcel laceration and persistence of a tenuous edematous suffering of the residual ligament; the ligamentous structure however remains clearly visible along its entire course with modest surrounding synovial thickening and periligamentous liquid layer in the distal insertion tract.

Future prospects:

According to the report above, the torn ACL starts healing naturally, and it will take a while until healing process ends. Jun Matsumoto permitted her to practice the full range of motion of the affecyed knee and start strengthen the quadriceps muscles. Even though she still feels weakness on the affected knee, there is no othere complication in her daily life activities. Further more, she will contines the Evo-Devo Exercises and strength exercises until she gets ready to return to skiing.

References:

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
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