Study debunks longstanding medical myth that a torn ACL can’t heal

Personal trainer Danyelle Anderson ruptured the anterior cruciate ligament (ACL) in her right knee during a kickboxing class.

“My whole world came crashing down, pretty much,” she said.

She was told by an orthopaedic surgeon that it wasn’t possible for her ACL to heal and that a surgical reconstruction was needed.

Reluctant to have an operation, she decided to see if her knee would improve with physiotherapy.

Three months later, a follow-up MRI showed her injury had gone from a grade three complete rupture, where the ligament is torn completely in half, to a less severe grade one tear, where some of the fibres are continuous.

“So basically, my ACL has reattached and is healing,” she said.

Ms Anderson’s story comes as no surprise to University of Melbourne researcher Associate Professor Stephanie Filbay.

Stephanie Filbay’s study on ACL injuries has caused a stir in medical circles.(ABC News: Steven Martin)

In a study that has garnered worldwide attention, she re-analysed the results of a Swedish trial involving 120 patients, comparing the MRIs of those who had surgery with others who underwent rehabilitation without surgery.

“What we found, surprisingly, was that two years after injury, in those who’d had rehabilitation only, 53 per cent had signs of healing on MRI,” Dr Filbay said.

“Even more surprising was that those with signs of healing reported better outcomes than those who’d had ACL surgery.”

Evidence of healing was taken to be the presence of continuous ACL fibres where previous MRIs showed a complete disconnect in the rupture zone, as well as the ligament becoming thicker and tauter and taking on a more normal appearance.


The findings have become a hot topic in medical circles, raising questions about whether changes are needed to the way doctors treat ACL injuries.

“Everyone’s heard of incidents where someone’s on a waitlist for surgery with a torn ACL and they get opened up by the surgeon and then the surgeon says ‘well, the ACL is healed’,” Dr Filbay said.

“People thought they were extremely rare, and what the research is suggesting is that this occurs more commonly than we thought.”

Challenging accepted medical wisdom

Some surgeons have reacted to the study with scepticism, pointing to the small number of young, physically fit adult patients involved in the trial, and the difficulties of assessing healing on an MRI.

A model of the bones of a human knee, with someone pointing out the position of the ACL with a pen.

Justin Roe points out the position of the ACL on a model of a knee.(ABC News: Jack Ailwood)

The ACL is a rope-like band of tissue that runs through the middle of the knee, connecting the thigh bone to the shin bone and playing a vital role in keeping the joint stable.

For decades, the accepted medical wisdom has been that the ACL can’t heal because of poor blood supply inside the knee joint.

“It has been a myth that the ACL never heals, something that’s been set in stone,” specialist orthopaedic knee surgeon Justin Roe said.

A man in medical scrubs and a cap sitting down inside a room, across from a journalist.

Justin Roe says it’s a myth that the ACL never heals on its own.(ABC News: Jack Ailwood)

In practice, he said, doctors have observed that ACLs heal in some cases, but not in others.

“And that’s the holy grail — predicting who it does heal in and who it doesn’t,” Dr Roe said.

Surgical reconstruction has been viewed as the gold standard treatment, offering a more predictable outcome.

“We have good surgical techniques that have developed over the years, so we can say with confidence to patients that with a successful ACL reconstruction, they can get back to sport 70 to 80 per cent of the time,” Dr Roe said.

Dr Filbay said her research showed that patients treated non-surgically returned to sport at similar rates.

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Michelle Heyman’s Matildas recall highlights Australian football’s striker problem

When news broke in January that Matildas captain Sam Kerr had torn her ACL, keeping her on the sidelines of the sport for the better part of the next year, a question that had been simmering in the background of Australian women’s football for the past few years suddenly reached boiling-point.

How can the country’s greatest ever goal-scorer be replaced? Which player is ready to step into the 30-year-old’s golden shoes? Who is next in the production-line of Australian strikers?

This question was being asked even when Kerr was fit and healthy. Since the 2019 Women’s World Cup, doubts were festering that the Matildas had become too reliant on the Chelsea forward, and that the team struggled to find the back of the net without her.

Sam Kerr’s ACL injury has put a spotlight on Australian football’s ongoing struggle to develop strikers.(AAP Image: Richard Wainwright)

The 2022 Women’s Asian Cup quarterfinal against South Korea was a case in point: Kerr started that game and had a handful of open-net chances which, for some reason, she failed to finish. The Matildas lost 1-0 and exited the competition at the earliest point in their history.

The question was the subtext to Kerr’s calf injury on the eve of the 2023 Women’s World Cup, too: how on earth would the team perform without their star player? Who else do we have waiting in the wings to take over?

While head coach Tony Gustavsson was able to rapidly shuffle the team’s structure and rely more on other players like Caitlin Foord, Hayley Raso, Mary Fowler and Emily Van Egmond to step up in her place, Kerr’s memorable goal against England in the semifinal — the only bright spark in an otherwise fatigued performance from the rest of the team — left many wondering how much further the Matildas could have gone had she been available the whole time.

But there is no day-by-day countdown clock on Kerr’s return now, as there was last July. Today, we have certainty that she won’t make a miraculously speedy recovery to be fully fit for the Olympic qualifying play-off against Uzbekistan in about two weeks, nor for the Olympic Games in Paris in just five months’ time. The question has now come into full and urgent focus.

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