Manual khalifa therapy improves functional and morphological outcome of patients with anterior cruciate ligament rupture in the knee: a randomized controlled trial

Abstract

Rupture of the anterior cruciate ligament (ACL) is a high incidence injury usually treated surgically. According to common knowledge, it does not heal spontaneously, although some claim the opposite. Regeneration therapy by Khalifa was developed for injuries of the musculoskeletal system by using specific pressure to the skin. This randomized, controlled, observer-blinded, multicentre study was performed to validate this assumption. Thirty patients with complete ACL rupture, magnetic resonance imaging (MRI) verified, were included. Study examinations (e.g., international knee documentation committee (IKDC) score) were performed at inclusion (t 0). Patients were randomized to receive either standardised physiotherapy (ST) or additionally 1 hour of Khalifa therapy at the first session (STK). Twenty-four hours later, study examinations were performed again (t 1). Three months later control MRI and follow-up examinations were performed (t 2). Initial status was comparable between both groups. There was a highly significant difference of mean IKDC score results at t 1 and t 2. After 3 months, 47% of the STK patients, but no ST patient, demonstrated an end-to-end homogeneous ACL in MRI. Clinical and physical examinations were significantly different in t 1 and t 2. ACL healing can be improved with manual therapy. Physical activity can be performed without pain and nearly normal range of motion after one treatment of specific pressure.

Figure 1

Trial flow. Flow chart of the study including randomization procedure and time intervals.

Figure 2

MRI. (a) MRI sagittal view of the knee shows a complete ACL rupture; the arrows point to where the ACL should be. (b) MRI sagittal view of the same patient after Manual Khalifa Therapy and 3 months of follow-up shows a continuous ACL; arrows are pointing out the “new” ACL.

Figure 3

IKDC. (a) Interaction plot of International Knee Documentation Committee (IKDC) Score across three examination dates t ₀ (baseline), t ₁ (day 1 after 1st treatment), t ₂ (3 months after t ₁) of standard group (ST), and standard group + Khalifa therapy; vertical bars denote 95% confidence intervals; (b) IKDC mean scores (standard deviations) and 95% confidence Intervals (lower bound; upper bound) per group.