Stump Incorporation for Anterior Cruciate Ligament Reconstruction: A Step Towards a More Anatomical Reconstruction

In most anterior cruciate ligament (ACL) tears, the tear is at the femoral side leaving a robust stump attached to the tibia. Stump-preserving ACL reconstruction carries the advantage of rapid reinnervation and revascularization of the graft. In this technique, the femoral tunnel is created after exposing the femoral footprint. The ACL tibial stump is split and the tip of the ACL tibial guide is introduced through this split to reach the center of the tibial footprint. The tibial tunnel is then created and the ACL stump is bored to allow the passage of the graft. After the passage of the graft inside the stump and femoral and tibial fixation, 1 or 2 sutures are used to suture the graft to the stump by a suture passing device (Expressew II; Depuy Mitek, Raynham, MA). This technique, in addition to preservation of the mechanoreceptors and vascular channels for revascularization and reinnervation of the graft, allows preservation of the shape and surface area of the wide tibial origin of the ACL.