Clinical outcomes in stump-preserving versus stump-sacrificing anterior cruciate ligament reconstruction; a randomized controlled study

Mahmoud Ahmed El-Desouky, Mostafa Ezzat, Begad Hesham Abdelrazek, Mahmoud Ahmed El-Desouky, Mostafa Ezzat, Begad Hesham Abdelrazek

Abstract

Background: Anterior Cruciate ligament (ACL) reconstruction (ACLR) aims to restore the anatomy and function of the knee. Although stump preservation during ACLR could be technically challenging, it may improve the revascularization and proprioceptive function of the graft. In this study, we aimed to compare the functional outcome after ACLR with and without stump preservation.

Methods: One hundred and twenty patients with acutely torn ACL and with intact tibial stump were included in this study. Half of them (60 cases) underwent ACLR with stump preservation. The other half (60 cases) had ACLR after total resection of the tibial stump. One hundred and nine out of 120 cases completed their 2 year-follow-up period. All patients were assessed by Tegner activity, Lysholm, and objective International Knee Documentation Committee (IKDC) scores. The side-to-side difference regarding stability was assessed by KT-1000 instrumented Lachman and proprioceptive function was measured by Passive angle reproduction test.

Results: There was no statistically significant difference between both groups regarding Tegner activity, Lysholm, and IKDC scores. Knee stability measured by KT-1000 and complication rate also showed no significant difference. But there was a significant difference in proprioception favoring stump preservation. On the other hand, the operative time was significantly shorter with stump resection. There was no significant difference in the complications rate between both groups and there were no cases with stiffness in either group.

Conclusion: Stump preservation ACLR is a safe technique that yields equivalent functional outcomes to standard ACLR. However; it provides better proprioception. It is more technically challenging, but in experienced hands; it is easily reproducible.

Trial registration: Registration number: NCT05364398 . 06/05/2022.

Keywords: Anterior cruciate ligament reconstruction; Knee proprioception; Stump preservation; Tibial stump.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Flow chart of the included cases
Fig. 2
Fig. 2
A Arthroscopic view of the right knee showing the guidewire tip at the tibial stump in a case in the stump-preservation group, B Arthroscopic view of the right knee showing the guidewire tip at the tibial footprint in a case in the stump-resection group (MFC; Medial femoral condyle, LFC; Lateral femoral condyle)
Fig. 3
Fig. 3
Arthroscopic view of the right knee showing the tibial stump while it is sutured to the ACL graft in stump-preservation technique, (MFC; Medial femoral condyle, LFC; Lateral femoral condyle)
Fig.4
Fig.4
A Arthroscopic view of the right knee showing reconstructed ACL in the stump-preservation technique, B Arthroscopic view of the right knee showing reconstructed ACL in the stump-resection technique (MFC; Medial femoral condyle, LFC; Lateral femoral condyle)
Fig. 5
Fig. 5
A Instrumented Lachman examination using KT-1000 Arthrometer, B Proprioception measurement by Passive angle reproduction test
Fig. 6
Fig. 6
IKDC scoring preoperatively and postoperatively in group (A) and group (B)

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