Arthroscope-assisted harvesting of the rectus femoris tendon graft: Surgical technique.

Abstract

The rectus femoris tendon is a valuable alternative to hamstring and patellar tendon autografts, providing a long, robust, and consistently sized graft with low donor-site morbidity. With the patient supine and the knee flexed, a vertical incision is made over the lateral third of the quadriceps tendon, approximately 3 cm proximal to the patella. After longitudinal opening of the quadriceps fascia, the rectus femoris tendon is identified and carefully separated from the vastus lateralis, preserving a small rim for closure. Before tendon release and graft extraction, an arthroscope (30°) is introduced to enhance visualization of adjacent structures, confirm the tendon trajectory, and optimize the dissection plane, improving precision and reducing the risk of inadvertent capsular violation, traumatic arthrotomy and graft amputation during harvest. A 10-mm full-thickness tendon strip is harvested above the vastus intermedius, released distally to the superior pole of the patella, and retrieved proximally using a closed tendon stripper to obtain a 27- to 33-cm graft. The final arthroscope inspection confirms integrity of the remaining quadriceps tendon components and excludes iatrogenic arthrotomy. This technique provides reliable graft dimensions while preserving extensor mechanism function and is suitable for isolated anterior cruciate ligament reconstruction as well as multiligament knee reconstruction procedures.