Remnant Preservation and Tibial Tunnel Widening After ACL Reconstruction

Remnant Preservation in Anterior Cruciate Ligament Reconstruction: Does Stump Suturing Reduce the Risk of Tibial Tunnel Widening? A CT-Based Study

Anterior Cruciate Ligament (ACL) reconstruction is one of the most commonly performed orthopedic procedures. Tibial tunnel widening is a recognized postoperative complication that may affect graft stability and long-term outcomes. Recent studies have suggested that preserving the ACL remnant may improve biological healing and reduce tunnel widening, but the evidence remains inconclusive.

This prospective randomized study aims to evaluate whether remnant (stump) preservation and suturing during ACL reconstruction can reduce the risk of tibial tunnel widening compared with the conventional stump-resection technique.

A total of 190 patients with recent ACL tears (<6 months) were randomly assigned into two equal groups: Group A underwent arthroscopic ACL reconstruction with remnant suturing, while Group B underwent standard reconstruction with stump resection. All patients were followed for 12 months postoperatively with serial CT evaluations to assess tunnel diameters and positioning.

Inclusion Criteria:

• Age between 18 and 45 years
• Acute ACL injury (<6 months)
• Medically fit for surgery

Exclusion Criteria:

• Age <18 or >45 years
• Old or chronic ACL injuries (>6 months)
• Multi-ligamentous knee injuries
• Failed previous ACL reconstruction
• Associated mal-alignment deformities
• Absence of identifiable ACL stump