Do completely torn ligaments heal on their own?

The contact rule, and the ligament that proved it: what the anterior cruciate did when its ends were made to touch

Do completely torn ligaments heal on their own is a question that has been answered for a century with a list, these do and those do not, and the honest page gives the rule behind the list and the ligament that proved the rule, because a reader who knows the rule can place their own injury and a reader who knows only the list cannot. The rule is contact. A completely torn ligament, grade three, every fibre gone, heals on its own if its two torn ends can be brought together, or within a few millimetres of each other, and held there in tissue that has a blood supply, because the cells that heal a ligament are the same cells in every ligament and they bridge a small gap in vascular tissue as reliably as skin closes a cut; and it does not heal if its ends cannot be brought together, because scar does not cross a centimetre of nothing or a sheet of tissue folded between the ends, and the cells that would heal it have nothing to bridge to. The grade, which describes how many fibres are torn, says nothing about this, which is why the grade is a description rather than a verdict, on the grade three page; the address, where the ligament lies and where its ends go when it tears, says everything. The ligament that proved the rule is the anterior cruciate ligament of the knee, which for as long as there have been textbooks has been the example of a ligament that does not heal: it runs through the centre of the knee from the back of the thigh bone to the front of the shin bone, it tears during a pivot or a landing with a pop and a giving-way, and when it tears its ends retract, the thigh-bone end upward and backward, the shin-bone end downward and forward, so that a gap of a centimetre or more opens between them inside a joint full of synovial fluid, which carries almost no blood and which dissolves the clot that every healing response begins with. Reconstruction with a graft became the treatment because the ligament would not heal, and the explanation given was that the cruciate's cells were intrinsically poor healers, a different kind of cell from the medial collateral's. Then a protocol was tried that held the injured knee in deep flexion, bent to around ninety degrees, in a brace for several weeks, a position in which the retracted ends of the torn anterior cruciate are brought back toward each other, and healing of the ligament, continuous tissue from one attachment to the other, was seen on magnetic resonance imaging in most of a selected series of patients, with the knee's stability on examination improving alongside. The longer-term outcomes, the strength and durability of the healed ligament and a randomised comparison against reconstruction, are still awaited, and whatever place the protocol finds in treatment, the finding settled the older question: the anterior cruciate's cells were never poor healers, and its failure to heal had always been a matter of contact and environment, because the moment the ends were made to touch, the same cells healed it. The contact rule is therefore not an inference from the list but a rule the hardest case has confirmed, and it sorts every complete tear a reader can have.

Sorting every complete tear by the rule: where position supplies contact, where a surgeon must, how a reader finds out which they have, and the adjunct

Where position supplies contact, a completely torn ligament heals on its own, and the list of those ligaments is the list a reader hopes to be on. The medial collateral ligament of the knee, the inner-side strap, lies outside the joint in well-supplied tissue, and when it tears completely its ends stay close because the knee's shape holds them there; under a hinged brace that stops the knee opening sideways and progressive loading from the first days, it heals in every grade, which is why surgery for an isolated medial collateral tear is rare, and the two knee ligaments compared on the ligaments fully heal page are the rule's clearest pair. The lateral ligaments of the ankle, the ordinary rolled ankle, heal in most complete tears for the same reason, their ends held close by the ankle's bones and the foot's position, under a functional brace and weight-bearing from the first days, with the trials favouring the brace over a cast and over surgery for most grade three sprains; the ankle's three ligament sets, lateral, medial and the high ankle's, with their three different answers, are on the ankle on its own page. Many isolated tears of the posterior cruciate ligament heal under a brace that stops the shin bone sagging backward, since the sag is what separates the ends and the brace restores contact by position, and the elbow's, wrist's and fingers' ligaments after dislocations that are promptly reduced mostly heal once the joint is back in place and the ends are therefore together. Where position cannot supply contact, a surgeon must, and the list of those is shorter and worth knowing by heart. The anterior cruciate outside the deep-flexion protocol, with its ends retracted into synovial fluid, does not heal and is reconstructed with a graft in those who need a stable knee for pivoting sport or whose knee gives way in daily life, or is managed with rehabilitation and accepted laxity in those who do not. The thumb's ulnar collateral ligament folded back over the edge of the adductor's tendon sheet, the Stener lesion, has a sheet of tissue between its ends that no position removes, and is unfolded and stitched. The lateral collateral ligament of the knee torn with the posterolateral corner structures around it does not stay approximated and is usually repaired or reconstructed. The high ankle sprain that separates the shin bones leaves a gap that weight-bearing widens and is often fixed with a screw or a flexible fixation. In each case the surgeon supplies the contact and the body does the healing, exactly as it does for the medial collateral under a brace. How a reader finds out which they have is an examination rather than a wait: a clinician stressing the joint to feel whether it opens, with an X-ray by the Ottawa rules where a fracture is possible and a scan where the examination is equivocal, in the first days rather than the third month, because the ligaments on the second list have ends that shorten and shrivel while they are waited on. Once contact is made, by position or by surgeon, the healing is the same, and so are the levers: a brace worn as prescribed and no longer, weight-bearing and range of motion as early as the ligament allows, strength and balance work, a return gated by tests, protein, vitamin C, sleep and no smoking, and the months the scar needs. Collagen's one ligament trial, 5g a day for six months in athletes with chronic ankle instability, improved a stability score and cut recurrent sprains in lax ligaments already healed and tested no complete tear healing, so the adjunct sits beside the loading once contact is made at the trial's powder dose, if anywhere. The worked example is that adjunct at habit scale, stated on its true terms: two capsules, 1200mg hydrolysed type 1 marine collagen with 12mg vitamin C at 15% of its reference value plus zinc, 120 for £16.99 at 28p a day, lab tested and UK made, below the 5g trial dose, carrying vitamin C's collagen formation sentence for cartilage and bones and no ligament claim. Do completely torn ligaments heal on their own: when their ends meet, yes, as the ligament that supposedly never heals has now shown, and the reader's question for a clinician is whether theirs do.

What to check on the label