Clinical and Patient-Reported Outcomes of Braganza-Tan (BT) Pass-Through Stump Incision, Stump-Sparing, and Stump-Sacrificing ACL Reconstruction Techniques Among Filipino Patients A Randomized Controlled Trial

Abstract

Background. Anterior cruciate ligament reconstruction (ACLR) aims to restore knee stability and function following ligament injury. Remnant-preserving techniques have gained interest due to their potential benefits in proprioception, graft healing, and early functional recovery.

Objective. To compare the clinical and patient-reported outcomes, knee stability, and complication rates of the Braganza-Tan (BT) pass-through stump incision, the stump-sparing, and the stump-sacrificing techniques in ACLR using hamstring grafts among Filipino patients at the University of Santo Tomas Hospital.

Methodology. A prospective, randomized controlled trial was conducted among 90 Filipino patients aged 18–35 years diagnosed with acute primary ACL tear (<6 weeks from injury) confirmed by MRI. Participants were block-randomized into three groups: BT pass-through stump incision, stump-sparing, and stump-sacrificing (n = 30 each). All underwent hamstring autograft reconstruction and a standardized rehabilitation protocol. Outcomes were assessed preoperatively and at three, six, nine, and 12 months using the International Knee Documentation Committee (IKDC) Scale, Tegner Activity Scale, Lysholm Score, and Hospital for Special Surgery (HSS) Score. Knee stability was evaluated through the Lachman, pivot shift, and anterior drawer tests, and an instrumented arthrometer. One-way ANOVA, Kruskal-Wallis tests, repeated-measures ANOVA, and mixed-effects models were used for analysis.

Results. All groups showed significant improvement from baseline across all functional scores (p <0.001). However, both the BT and stump-sparing groups consistently demonstrated higher IKDC, Lysholm, HSS, and Tegner scores from three to 12 months compared with the stump-sacrificing group (p <0.01). Knee stability tests showed significantly better early and midterm anterior and rotational control in the BT and stump-sparing groups (p <0.05). Complications were lowest in the BT group, with no graft failures recorded, though this difference did not reach statistical significance. By 12 months, stability outcomes became comparable across all groups, although functional scores remained highest in the BT and stump-sparing groups.

Conclusion. The BT pass-through stump incision and conventional remnant-preserving techniques demonstrated superior early clinical outcomes and improved knee stability within the first 12 months compared with stump-sacrificing reconstruction in acute ACL tears. Longer-term follow-up is required to determine sustained graft durability and functional superiority.