Remnant Preservation and Tibial Tunnel Widening After ACL Reconstruction

November 15, 2025 updated by: Mahmoud Ahmed El-Desouky, Cairo University

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.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Study Type

Interventional

Enrollment (Actual)

190

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Egypt
      • Cairo, Egypt
        • Kasr Alainy

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult

Accepts Healthy Volunteers

No

Description

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

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Stump-Suturing ACL Reconstruction
Procedure: Stump-Suturing ACL Reconstruction
Patients in this group undergo arthroscopic ACL reconstruction with preservation and suturing of the native ACL remnant (stump) around the graft. The technique aims to enhance graft revascularization and biological healing, potentially reducing tibial tunnel widening.
Active Comparator: Stump-Resection ACL Reconstruction
Procedure: Stump-Resection ACL Reconstruction
Patients in this group undergo standard arthroscopic ACL reconstruction with complete resection of the ACL remnant (stump) prior to graft placement. This represents the conventional surgical approach for ACL reconstruction.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Time Frame
Rate of Tibial Tunnel Enlargement
Time Frame: 12 months postoperatively
12 months postoperatively

Secondary Outcome Measures

Outcome Measure
Time Frame
Percentage of Tibial Tunnel Enlargement
Time Frame: 12 months
12 months
Tibial Tunnel Positioning (X & Y coordinates)
Time Frame: 2 Weeks
2 Weeks
Femoral Tunnel Diameter Change
Time Frame: 12 months
12 months
Femoral Tunnel Positioning (X & Y coordinates)
Time Frame: 2 Weeks
2 Weeks

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Cairo University

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

July 1, 2021

Primary Completion (Actual)

March 30, 2024

Study Completion (Actual)

March 30, 2024

Study Registration Dates

First Submitted

November 15, 2025

First Submitted That Met QC Criteria

November 15, 2025

First Posted (Actual)

November 19, 2025

Study Record Updates

Last Update Posted (Actual)

November 19, 2025

Last Update Submitted That Met QC Criteria

November 15, 2025

Last Verified

November 1, 2025

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

  • N-473-2021

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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