Summary
The tendon of the rectus femoris muscle appears to be an excellent option for ligament reconstructions around the knee
Abstract
Purpose
To describe the tips and tricks on how to harvest the rectus femoris graft, its size and diameter characteristics, its possible uses and the possible complications of its removal
Methods
A consecutive case series of graft harvesting from the rectus femoris tendon (or superficial quadriceps lamina) was evaluated. The tendon harvest was performed in a minimally invasive manner through an incision in the suprapatellar region. The mean tendon length, mean diameter of the double or triple-folded tendon, indications for use of the tendon, and complications of its harvest were evaluated.
Results
Two hundred and eleven consecutive patients were evaluated. The mean age of the patients was 29.1 years, and 79.1% were male. The most important steps for proper graft harvesting are: separate the rectus femoris from the vastus about 2cm proximal to the patella, sink the scalpel blade only about 3mm, dissect the tendon proximally for about 7/8cm, test whether the tendon is moving freely, without adhesions, before placing the stripper and use a rigid stripper (preferably 8mm aperture). The mean tendon length was 30.8 ± 3.4 cm. Only in two (0.9%) cases did the tendon have a length of less than 24 cm. The mean double tendon diameter was 8.1 ± 0.6 mm, with 51 cases (24.2%) presenting a diameter of less than 8 mm. The triple tendon diameter was 9.3 ± 0.7 mm, with only 3 cases (1.5%) presenting a triple diameter of less than 8 mm. The graft was used for isolated reconstruction of the ACL in 95 cases (45.0%), ACL + anterolateral ligament reconstruction in 106 cases (50.2%), ACL + medial reinforcement in 6 cases (2.8%), and posterior cruciate ligament reconstruction in 4 cases (1.9%). Twenty-four (11.4%) patients presented some degree of complication during removal, the vast majority being of minor importance, including violation of the anterior capsule in 10 cases, hematoma in the anterior region of the thigh in 10 cases, requiring re-approach for drainage in one case, early amputation in 2 cases and superficial infection in two cases.
Conclusion
The tendon of the rectus femoris muscle appears to be an excellent option for ligament reconstructions around the knee. Its length and diameter characteristics appear to be adequate and the complications of its harvest are minor. A learning curve is required for its harvest to be performed properly.