AccScience Publishing / STI / Volume 46 / Issue 1 / DOI: 10.36922/sti.0402
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RESEARCH ARTICLE

Clinical and Functional Outcomes of Trans-Septal Remnant-Preserving versus Conventional Posterior Cruciate Ligament Reconstruction in Competitive Athletes

Sharat Balemane1 ,  Hishanil Rasheed Nayanveetil Kakkarakandy2 ,  Fardeen Shariff1 ,  Ashique Rahman Abdul Rasheed3 ,  Anand Pillai4 ,  Linish Baalan5 ,  Ram Sudhan Subramaniyan6*
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1 Department of Orthopaedics, Yenepoya Medical College Hospital, Ullal, Karnataka, India
2 Department of Orthopaedics, Kannur Medical College, Kannur, Kerala, India
3 Department of Orthopaedics, Yenepoya Specialty Hospital, Kodailbail, Mangalore, India
4 Department of Orthopaedics, KAHM Hospital, Kasargod, Kerala, India
5 Department of Orthopaedics, Iqraa International Hospital & Research Centre, Kozhikode, Kerala, India
6 Department of Orthopaedics, P.K. Das Institute of Medical Sciences, Vaniamkulam, Kerala, India
STI 2026, 46(1), 0402 https://doi.org/10.36922/sti.0402
Received: 24 November 2025 | Revised: 21 January 2026 | Accepted: 4 February 2026 | Published online: 13 May 2026
© 2026 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
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Abstract

Background: Posterior cruciate ligament (PCL) reconstruction techniques have evolved to include remnant-preserving approaches, yet comparative evidence in competitive athletes remains limited.

Objective: This study aims to compare the clinical and functional outcomes of trans-septal remnant-preserving PCL reconstruction with conventional methods in competitive athletes.

Methods: This prospective comparative study enrolled 37 competitive athletes (Teg­ner score >5) who underwent PCL reconstruction between January 2019 and Janu­ary 2023. Patients were randomized to trans-septal remnant-preserving (n = 17) or conventional (n = 20) PCL reconstruction group. All procedures were performed by a single surgeon. Primary outcomes included pain assessment using visual analog scales, range of motion, and instability. Secondary outcomes included the Lysholm score, the Tegner activity scale, and the International Knee Documentation Committee (IKDC) score, and return-to-sport duration. Evaluations were conducted at 3, 6, 12, and 18 months postoperatively.

Results: Baseline demographics were comparable between groups. The remnant-pre­serving group demonstrated significantly superior Lysholm and IKDC scores at six months with 83.12 ± 6.25 vs. 75.54 ± 7.54 (p < 0.001) and 80.0 ± 9.1 vs. 67.9 ± 11.3 (p < 0.05), respectively. Return-to-sport duration was shorter in the remnant-perserv­ing group, with a 1.6-month earlier return than the conventional group (9.8 ± 2.4 vs. 11.4 ± 3.1 months; p = 0.12). However, by 12 and 18 months, functional scores con­verged with no significant differences in range of motion, Lysholm scores, IKDC scores, or Tegner activity levels.

Conclusion: While the remnant-preserving group demonstrated significantly better functional scores during the early follow-up intervals, these advantages converged by 12–18 months without apparent clinical significance. However, the potential for en­hanced outcomes remains evident, as evidenced by the shorter return-to-sport duration in the remnant-preserving group.

Keywords
Posterior cruciate ligament reconstruction
Remnant preservation
Athletes
Posterior cruciate ligament
Return-to-sport duration
Trans-septal portal
Funding
The corresponding author truly and with the best of knowledge affirms that this manuscript or any of its authors were not funded by any spon¬sors or corporations.
Conflict of interest
The authors declare that they have no conflict of interest.
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Surgical Technology International, Electronic ISSN: 1090-3941 Published by AccScience Publishing
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