Thirty patients undergoing ACL reconstruction were randomized into two groups: stump preservation (n=14) or conventional graft harvesting (n=16). The primary outcome was the anatomical insertion of regenerated tendons. Secondary outcomes included rates of tendon regeneration, cross-sectional areas of regenerated tendons, and the proximal shift of the musculotendinous junction. Outcomes were assessed pre-operatively and at six months post-operatively. Overall, the stump preservation group demonstrated a higher percentage of anatomical insertion at the pes anserinus and a significantly smaller proximal shift of the musculotendinous junction. These findings suggest the stump preservation technique improves anatomical regeneration and limits proximal tendon retraction, potentially enhancing post-operative recovery.