The Rectus Femoris Tendon Provides Sufficient Anatomical Length for a Quadrupled Graft in All Knees: An MRI Morphometric Analysis with Cadaveric Validation

DOI: 10.70885/hmsj.2026.10.002

Abstract

Background: The isolated rectus femoris tendon (RFT) is an emerging autograft for knee ligament reconstruction due to the limitations of established autografts. Only the superficial layer of the quadriceps tendon is harvested, preserving the deep extensor mechanism.Purpose: To characterize the dimensions of the RFT using MRI and cadaveric dissection and to derive a geometric model for graft configuration planning.Methods: MRI morphometry was performed on 34 thighs (age 16-40 years), measuring total RFT length, width and thickness at the narrowest and widest points. Cadaveric dissection of 8 fresh-frozen thighs included in-situ measurements and harvest simulation using a standard tendon stripper. A geometric model, based on MRI-measured tendon thickness, was compared with published intraoperative and cadaveric measurements to predict achievable graft dimensions from the measured strip parameters.Results: Mean total RFT length was 39 ± 7 cm on MRI and 33.5 ± 2.9 cm in cadavers (p = 0.002). After harvest, graft length was 30.8 ± 1.9 cm (harvest loss 8.1%), yielding a quadrupled graft length of 7.7 cm. The narrowest point was located approximately 5 cm proximal to the patella (width 18 ± 6 mm). Since only a portion of the tendon width is harvested, a strip of 9 mm width yields according to a geometric model a 4-fold graft diameter of approximately 8 mm; a 3-fold configuration with a 12 mm strip leaves approximately 98 mm of remaining graft for combined reconstructions.Conclusion: The RFT consistently provides sufficient dimensions for a quadrupled autograft. These data provide the anatomical basis for preoperative planning: they identify the harvest corridor, quantify the strip width required for an expected quadrupled graft diameter of > 8mm, and localize the zone approximately 5cm proximal to the patella where the tendon is narrowest and thus most vulnerable during harvest.What this study adds: This is the first study to combine in-vivo MRI morphometry with cadaveric validation of the isolated rectus femoris tendon. It shows that the tendon provides sufficient length for a quadrupled graft in all knees examined.How this study might affect research, practice or policy: The data allow surgeons to plan strip width and fold configuration before surgery, including for combined ACL and anterolateral reconstructions. They also provide the anatomical basis for future biomechanical and clinical studies.Study Design: Anatomical studyLevel of Evidence: VKeywords: Rectus femoris tendon; Quadriceps tendon; ACL autograft; Morphometry; Extensor mechanismhttps://doi.org/10.70885/hmsj.2026.10.002

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