The Spontaneous Healing Of A Torn Anterior Cruciate Ligament
Malanga, G. A., Giradi, J., & Nadler, S. F. (2001). The spontaneous healing of a torn anterior cruciate ligament. Clinical journal of sporight medicine : official journal of the Canadian Academy of Sporight Medicine, 11(2), 118–120. https://doi.org/10.1097/00042752-200104000-00010
View Original Source →Abstract
*Department of Sports, Spine and Orthopedic Rehabilitation, Kessler Institute for Rehabilitation, West Orange; and †Department of Physical Medicine and Rehabilitation, UMDNJ–New Jersey Medical School, Newark, New Jersey, U.S.A. Received June 8, 2000; accepted December 20, 2000. Address correspondence and reprint requests to Gerard A. Malanga, MD, Department of Sports, Spine and Orthopedic Rehabilitation, Kessler Institute for Rehabilitation, 1199 Pleasant Valley Way, West Orange, New Jersey 07052, U.S.A.
Case Details
Disease Location
Anterior cruciate ligament (acl) in left knee
Personal Characteristics
45 year-old professional dance instructor
Clinical Characteristics
Initial "pop" feeling when acl tore, pain, swelling, inability to bear weight on left leg; surgical evaluation showed excess laxity and soft end-point with lachman test and valgus loading at 30 degrees of knee flexion; MRI showed complete acl tear from proximal femoral attachment and partial tear of mcl from attachment to medial femoral condyle; during exploration prior to reconstructive surgery 2 months after physical therapy, patient was found to have negative lachman and pivot shift test and arthroscopy showed scarring down of the acl to its femoral attachment so surgery was not performed; 11 month after injury, electrodiagnostic testing showed decreased recruitment of vastus medialis and isokinetic testing showed significant reduction in quadriceps strength; 1 year post-injury, patient compalined of knee instability with descending stairs, unable to dance, examination showed no effusion, full active and passive range of motion, pain over medial femoral condyle with palpation, significant quadriceps weakness with de monthstrable atrophy of vastus medialis obliquus (vmo), and quadriceps avoidance gait, no evidence of acl insufficiency with negative lachman test
Remission Characteristics
7 months post-injury, MRI showed healing of acl and mcl with evidence of chondromalacia patellae, radiographs showed periarticular osteopenia; 1 year examination showed no evidence of acl insufficiency; 19 months postinjury, patient reported significant improvement in quadriceps strength with increased muscle bulk and improved knee stability - with knee brace, able to perform all actiivites of daily living and had resumed dance instruction
Treatment & Mechanisms
Proposed Remission Mechanisms
Injury at bone attachment most likely enhanced ability for healing
Clinical Treatment
Physical therapy for 3 weeks after initial evaluation with sub-opatientimal results - continued pain and swelling and difficulty performing activities of daily living; continued open kinetic chain strengthening exercises continued (due to inability to perform reconstructive surgery) for one year; therapy program adjusted to include greater closed kinetic chain and functional exercise with some specific attention to quadriceps strengthening to address knee instability
Non-Clinical Treatment
None reported discussed