05/02/2026
**New study! ACL healing of complete ruptures occurs in around 50% of cases without bracing!! **
Just published ๐ฅ
๐๐ฟ๐ผ๐บ ๐ฅ๐๐ฝ๐๐๐ฟ๐ฒ ๐๐ผ ๐ฅ๐ฒ๐ฐ๐ผ๐๐ฒ๐ฟ๐? ๐๐ผ๐ป๐ด๐ถ๐๐๐ฑ๐ถ๐ป๐ฎ๐น ๐ ๐ฅ๐ ๐๐ป๐๐ถ๐ด๐ต๐๐ ๐๐ป๐๐ผ ๐๐๐ ๐๐ฒ๐ฎ๐น๐ถ๐ป๐ด
๐ In a brand-new longitudinal, pragmatic cohort study (NACOX), Kvist and colleagues (https://www.jospt.org/doi/10.2519/jospt.2026.13397) investigated whether the anterior cruciate ligament (ACL) shows measurable structural โrecoveryโ on high-resolution MRI during the first two years after an acute ACL rupture, and whether MRI signs of continuity
๐ฆต The authors followed 129 patients aged 15โ40 years who sustained a primary ACL injury within the previous six weeks and were managed according to routine Swedish practice: structured, supervised rehabilitation as first-line care (immediate weight bearing, no range of motion restrictions, and criteria-based progression through the different phases of rehabilitation) with ACL reconstruction (ACLR) considered later if needed.
๐ฉป Participants underwent 3-Tesla 3D proton-density fat-saturated MRI at baseline and at 3, 6, 12, and 24 months. ACL morphology was graded using the ACTS system (Continuity, Thickness, Shape), designed to separate true fiber continuity from surrounding synovial or scar tissue; two experienced readers scored scans independently and then reached consensus.
๐ Patient-reported outcomes (e.g., IKDC-SKF), perceived stability, episodes of โgiving way,โ instrumented anterior laxity (KT-1000), quadriceps strength, and activity level were assessed at follow-ups.
๐ Over 24 months, 47% of participants underwent ACLR. Among those with available MRIs prior to any censoring event (ACLR or a new ACL-affecting injury), nearly half showed evidence of ligament continuity at their last MRI: 48% for overall ACL structure and 43% for fiber continuity. Importantly, ACTS grades improved by at least one step in a substantial proportion of patients across follow-ups (reported range 31%โ81%, depending on timepoint and domain).
๐ MRI-defined continuity also mattered clinically. At 24 months, patients with evidence of continuity in overall ACL structure reported fewer giving-way episodes (11% vs 50%), and continuity was associated with lower sagittal laxity at both 12 and 24 months (including fewer patients exceeding a โฅ3 mm side-to-side KT-1000 difference). Fiber continuity was additionally linked to better quadriceps strength symmetry at 24 months. In contrast, associations with broader patient-reported outcomes were uncertain, largely because estimates were imprecise (wide confidence intervals).
๐ก Taken together, the study challenges the traditional assumption that a ruptured ACL cannot regain structural continuity without reconstruction.
โญ At the same time, the authors are careful about inference: follow-up at 24 months was limited (n=43), baseline imaging sometimes occurred relatively late after injury, rotational instability was not assessed instrumentally, and early ACLR truncated MRI follow-up for many patientsโfactors that may blur both the true healing rate and its relationship to symptoms and function.
