Bernardo Garcia Barroso

Recurrent patellar instability may persist after isolated medial patellofemoral ligament reconstruction, particularly in cases with instability beyond early knee flexion. Recent evidence has emphasized the role of the medial patellotibial ligament as a secondary stabilizer contributing to patellofemoral stability at higher degrees of flexion. As a result, combined reconstruction of the medial patellofemoral ligament and medial patellotibial ligament has emerged as a promising strategy to restore more physiologic patellar kinematics. This technical note describes a reproducible technique for combined medial patellofemoral ligament and medial patellotibial ligament reconstruction using a single rectus femoris tendon autograft harvested from the superficial layer of the quadriceps tendon. The technique is soft‐tissue‐based and physeal‐sparing and avoids bone tunnels, making it particularly suitable for skeletally immature patients. The rectus femoris graft provides sufficient length, favorable biomechanical properties, low donor‐site morbidity, and satisfactory cosmetic results through a minimally invasive approach.

Purpose: This narrative review synthesises the anatomical, biomechanical, and clinical evidence on the rectus femoris tendon as an autograft for knee ligament reconstruction. Methods: A literature search was conducted in PubMed and Google Scholar up to June 2026 with no language restrictions. A total of 35 articles describing the rectus femoris tendon as a graft for knee ligament reconstruction were included. Results: Cadaveric studies demonstrated consistent morphometric dimensions, with a mean tendon length of approximately 30 cm and graft diameters ranging from 8 to 11 mm. Biomechanical testing across four independent cadaveric studies showed that the doubled rectus femoris provides load‐to‐failure within the range of established anterior cruciate ligament grafts. Multiple harvesting techniques have been described, using the identification of a fat layer between the rectus femoris and the intermediate layer as the primary landmark. The graft has been applied to isolated anterior cruciate ligament reconstruction, combined anterior cruciate ligament and anterolateral or anteromedial ligament reinforcement, posterior cruciate ligament reconstruction, and revision surgery. Early clinical series reported functional outcomes comparable to hamstring tendon autografts, with low donor‐site morbidity. Isokinetic evaluation showed no difference in extensor performance between rectus femoris and hamstring tendon groups at six months. Intraoperative complications included capsular violations and premature graft amputations, concentrated in initial cases and without clinical repercussions. The current clinical evidence is limited to level III and IV studies, with a maximum mean follow‐up of approximately 3.5 years in revision settings and 3 years in primary reconstruction, demonstrating improvement in patient‐reported outcomes and knee stability. Conclusion: The rectus femoris tendon is a viable autograft for knee ligament reconstruction, with consistent anatomy, adequate biomechanical properties, and early clinical results comparable to hamstring tendon autografts. It should be considered in individualised graft selection. Level of Evidence: Level V.

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.

Background: The rectus femoris (RF) tendon may be an option for combined anterior cruciate ligament (ACL) and anterolateral (AL) reconstruction utilizing a double-stranded (DRF) tendon for the ACL and a single-stranded tendon (SRF) for AL reinforcement; however, biomechanical data remain limited. Purpose/Hypothesis: This study aimed to biomechanically assess the DRF for ACL reconstruction using a patellar tendon (PT) graft and the SRF for AL reconstruction using an iliotibial band (ITB) graft. The hypothesis was that the biomechanical properties of the DRF graft would not differ from those of the PT graft, and the SRF graft would not differ from the ITB graft. Study Design: Controlled laboratory study. Method: Eight fresh-frozen human knees were used: 2 male and 6 female, with a mean age of 49 years (range, 36-64 years). Each knee produced 4 grafts: DRF, SRF, PT, and ITB. Each graft was mounted in a materials test machine. The cross-sectional area was measured using alginate molding. After 10 preconditioning cycles to 250 N, each specimen was extended to failure at 100 mm/min. The Friedman test assessed differences between the 4 graft types using matched samples. The Dunn multiple-comparison test was used to examine differences among graft types. Results: The ultimate strengths (N) of the grafts were as follows: DRF, 1978 ± 338; SRF, 1445 ± 584; PT, 1824 ± 557; ITB, 819 ± 268 (DRF and PT >ITB; P < .01). The elastic moduli (MPa) were as follows: DRF, 272 ± 59; SRF, 617 ± 153; PT, 318 ± 90; ITB, 631 ±4 31 (DRF and PTP < .05). The ultimate tensile stresses (MPa) were as follows: DRF, 51 ± 12; SRF, 89 ± 28; PT, 62 ± 19; ITB, 56 ± 24 (SRF > DRF; P < .05). Conclusion: As hypothesized, the DRF graft exhibits mechanical properties that do not differ from those of the PT graft. Likewise, the SRF graft showed biomechanical properties that do not differ from those of the ITB graft. Therefore, this study supports the use of the RF graft for combined ACL and AL (anterolateral ligament or lateral extra-articular tenodesis) reconstruction. Clinical Relevance: The RF tendon graft is harvested before being merged with other layers, resulting in a longer graft (mean, 273 mm) suitable for folding. This does not create a full-thickness defect through the quadriceps. This approach allows combined ACL + AL reconstruction techniques and additional graft tissue for fixation.

We present a technique for the combined anterior cruciate ligament (ACL) and anterolateral ligament (ALL) reconstruction using the superficial layer quadriceps tendon graft. Anatomic reconstruction is achieved with outside‐in femoral tunnel drilling. The femoral drill guide has an intra‐articular placement at the femoral footprint of the ACL and an extra‐articular placement at the femoral ALL attachment. This surgical technique does not need any special instruments and consists of 3 bone tunnels. The long length and customized superficial quadriceps tendon graft is harvested in a minimally invasive manner and allows an accessible and low‐cost reconstruction of both ligaments. Technique Video: video See video under supplementary data.

OBJETIVO: Avaliar as lesões musculoesqueléticas em atletas de elite da luta olímpica. MÉTODOS: Avaliação retrospectiva de 95 atletas por meio de um questionário estruturado contendo informações sobre lesões prévias e dados clínicos e epidemiológicos. RESULTADOS: Foram relatadas 145 lesões em 81 (85,3%) atletas. As regiões anatômicas mais freqüentemente acometidas foram o joelho (25,5%), o ombro (20%), a coxa (15,2%) e o tornozelo (14,5%). As entorses e as lesões musculares foram as lesões mais comumente relatadas com 34,5% e 30,4%, respectivamente. O tratamento cirúrgico foi necessário em 9% das lesões e a maioria destas lesões (61,5%) localizavam-se nos membros.inferiores. CONCLUSÕES: Lesões do aparelho locomotor são frequentes nos praticantes de luta olímpica e os membros inferiores são o segmento mais acometido.