A Rare Case Of Spontaneous Healing Of An Anterior Cruciate Ligament Tear

Abstract

Anterior cruciate ligament (ACL) injuries are among the most common knee injuries in the United States. The ACL is an intra-articular ligament that resists anterior tibial translation and provides rotational stability. Most ACL injuries occur through non-contact mechanisms and are typically diagnosed based on history, physical examination, and confirmatory MRI. Treatment options include operative and non-operative management, with the latter focusing on restoring functional stability rather than expecting the ACL to heal spontaneously. In this case report, we present a 33-year-old female patient with a sedentary lifestyle who experienced a popping sensation and immediate swelling after twisting her knee while sitting down. She presented to the clinic one week later, reporting knee instability and a dull, aching pain rated 7/10. Physical examination revealed pain with passive knee extension and positive patellar compression, Clarke's inhibition, McMurray's, and Lachman's tests. MRI confirmed a complete ACL tear and a full-thickness cartilage defect in the medial facet of the patella. The patient opted for non-operative treatment, including a crossover knee brace and physical therapy. Over multiple follow-up visits, her range of motion and pain improved. Eleven months post-injury, a follow-up MRI ordered to evaluate a suspected reinjury unexpectedly revealed a completely intact ACL, indicating spontaneous healing. This case highlights a rare instance of spontaneous ACL healing in a sedentary adult who chose conservative management. Although non-operative therapy typically aims to restore function rather than facilitate ligament healing, emerging evidence suggests spontaneous ACL healing is possible, particularly in proximal femoral single-bundle tears. Further research is needed to establish standardized conservative treatment protocols that optimize outcomes and promote ACL regeneration.