Remnant preservation and stump suturing in anterior cruciate ligament reconstruction reduce tibial tunnel widening without compromising tunnel placement: A computed tomography-based randomised controlled trial.
- 1Department of Orthopaedic Surgery, Faculty of Medicine Cairo University Cairo Egypt.
Abstract
Tunnel widening remains a concern following anterior cruciate ligament reconstruction because it may adversely affect graft incorporation and complicate revision surgery. Remnant preservation has been proposed as a strategy to reduce tunnel widening, but its effect on postoperative tunnel remodelling remains uncertain. This study aimed to determine whether remnant preservation with tibial stump suturing reduces tunnel widening without compromising tunnel placement accuracy. In this prospective randomised controlled trial, 179 patients undergoing primary anterior cruciate ligament (ACL) reconstruction were randomised to remnant-preserving reconstruction with tibial stump suturing (n = 88) or conventional stump resection (n = 91). Standardised three-dimensional computed tomography was performed at 2 weeks and 1 year postoperatively. Tibial and femoral tunnel widening were calculated as the percentage change in tunnel diameter between scans, and tunnel placement accuracy was assessed using the computed tomography-based quadrant method. The incidence of clinically significant tunnel widening (>20%) was also compared. Baseline tunnel diameters were comparable between groups. At 1-year follow-up, remnant-preserving ACL reconstruction resulted in significantly less tibial tunnel widening than stump resection (14.58 ± 4.49% vs. 19.74 ± 4.36%, p < 0.001), with a lower incidence of clinically significant widening (>20%) (11.4% vs. 25.3%; relative risk, 0.45; p = 0.016). Femoral tunnel widening was similar between groups (18.23 ± 2.92% vs. 18.35 ± 2.59%, p = 0.766). No clinically relevant differences in tunnel placement were observed between groups. Remnant-preserving ACL reconstruction with tibial stump suturing selectively reduces tibial tunnel widening at 12 months without compromising anatomic tunnel placement accuracy. These findings support the use of remnant preservation when preservation of tibial tunnel integrity is a surgical consideration. Level I. ClinicalTrials.gov, NCT07236593; registration date: November 15, 2025 (retrospectively registered).
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BibTeX
@article{eldesouky2026remnant,
title = {{Remnant preservation and stump suturing in anterior cruciate ligament reconstruction reduce tibial tunnel widening without compromising tunnel placement: A computed tomography-based randomised controlled trial.}},
author = {Mahmoud El-Desouky and Ahmed Samir Elkalyoby and Amr Samir Rashwan and Amr Ibrahim Gaballah and Begad Hesham Abdelrazek},
journal = {Journal of experimental orthopaedics},
year = {2026},
month = oct,
doi = {10.1002/jeo2.70962},
url = {https://europepmc.org/article/MED/42953369},
note = {CC BY},
}
RIS
TY - JOUR
TI - Remnant preservation and stump suturing in anterior cruciate ligament reconstruction reduce tibial tunnel widening without compromising tunnel placement: A computed tomography-based randomised controlled trial.
AU - Mahmoud El-Desouky
AU - Ahmed Samir Elkalyoby
AU - Amr Samir Rashwan
AU - Amr Ibrahim Gaballah
AU - Begad Hesham Abdelrazek
PY - 2026
DA - 2026/10/28
JO - Journal of experimental orthopaedics
DO - 10.1002/jeo2.70962
UR - https://europepmc.org/article/MED/42953369
AB - Tunnel widening remains a concern following anterior cruciate ligament reconstruction because it may adversely affect graft incorporation and complicate revision surgery. Remnant preservation has been proposed as a strategy to reduce tunnel widening, but its effect on postoperative tunnel remodelling remains uncertain. This study aimed to determine whether remnant preservation with tibial stump suturing reduces tunnel widening without compromising tunnel placement accuracy. In this prospective randomised controlled trial, 179 patients undergoing primary anterior cruciate ligament (ACL) reconstruction were randomised to remnant-preserving reconstruction with tibial stump suturing (n = 88) or conventional stump resection (n = 91). Standardised three-dimensional computed tomography was performed at 2 weeks and 1 year postoperatively. Tibial and femoral tunnel widening were calculated as the percentage change in tunnel diameter between scans, and tunnel placement accuracy was assessed using the computed tomography-based quadrant method. The incidence of clinically significant tunnel widening (>20%) was also compared. Baseline tunnel diameters were comparable between groups. At 1-year follow-up, remnant-preserving ACL reconstruction resulted in significantly less tibial tunnel widening than stump resection (14.58 ± 4.49% vs. 19.74 ± 4.36%, p < 0.001), with a lower incidence of clinically significant widening (>20%) (11.4% vs. 25.3%; relative risk, 0.45; p = 0.016). Femoral tunnel widening was similar between groups (18.23 ± 2.92% vs. 18.35 ± 2.59%, p = 0.766). No clinically relevant differences in tunnel placement were observed between groups. Remnant-preserving ACL reconstruction with tibial stump suturing selectively reduces tibial tunnel widening at 12 months without compromising anatomic tunnel placement accuracy. These findings support the use of remnant preservation when preservation of tibial tunnel integrity is a surgical consideration. Level I. ClinicalTrials.gov, NCT07236593; registration date: November 15, 2025 (retrospectively registered).
SN - 2197-1153
ER -