The Rectus Femoris Tendon Graft for ACL Reconstruction: Predictive Anthropometry and Surgical Pearls Based on a Prospective Case Series.

BACKGROUND

The rectus femoris tendon has recently gained attention as a promising soft tissue autograft for anterior cruciate ligament (ACL) reconstruction. However, there is limited information regarding its graft dimensions, harvesting technique, and safety profile.

PURPOSE: To evaluate the dimensions of the rectus femoris tendon graft in patients undergoing ACL reconstruction, identify anthropometric predictors of graft size, describe key technical steps for safe harvesting, and report intraoperative complications.

STUDY

DESIGN

Case series; Level of evidence, 4.

METHODS

A total of 211 consecutive patients undergoing ACL reconstruction with rectus femoris tendon autograft were prospectively enrolled across multiple centers. Graft dimensions-length and diameter in 2- and 3-strand configurations-were recorded intraoperatively. Correlations between graft size and patient anthropometry were assessed, and a multivariable regression model was developed to predict graft length. Intraoperative complications during graft harvesting were also documented.

RESULTS

The mean graft length was 30.8 ± 3.4 cm, with 99.1% measuring ≥24 cm. Mean diameters were 8.1 ± 0.6 mm (2-strand) and 9.3 ± 0.7 mm (3-strand), with only 1.4% of 3-strand grafts measuring <8 mm. Patient height showed the strongest correlation with graft length (r = 0.563). Complications occurred in 11.4% of cases, mostly minor and during the early adoption phase of this technique.

CONCLUSION

The rectus femoris tendon provides consistent and predictable graft dimensions suitable for multistrand ACL reconstruction, including in patients at higher risk of undersized soft tissue grafts. These morphometric findings support its potential as an autograft option and provide a basis for preoperative planning. Clinical outcomes and donor-site morbidity require evaluation in future studies.