{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T05:03:31Z","timestamp":1790139811756,"version":"4.0.1"},"reference-count":55,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T00:00:00Z","timestamp":1785369600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T00:00:00Z","timestamp":1785369600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["esskajournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:label\/>\n                    <jats:p>The quadriceps tendon has gained significant momentum as a graft source for knee ligament reconstruction, with the isolated harvest of its superficial layer\u2014the rectus femoris tendon\u2014rapidly emerging as a popular technical refinement. This shift has been driven largely by practical considerations: the cost and limited availability of proprietary instrumentation promoted for partial quadriceps tendon harvesting, combined with the appeal of a familiar, hamstring\u2010like workflow using standard tendon strippers. As a result, numerous surgical technique descriptions have appeared in recent years. However, the enthusiasm surrounding this graft has outpaced the evidence supporting it. This narrative review critically appraises the current state of knowledge regarding the rectus femoris tendon autograft by evaluating its anatomical basis, biomechanical properties and the first available clinical outcomes. Anatomical studies confirm the rectus femoris tendon as a consistent superficial layer separated from the deep vastus intermedius by a distinct cleavage plane, facilitating reproducible harvest. Biomechanically, the isolated graft demonstrates ultimate stress comparable to the patellar tendon, yet exhibits significantly higher elasticity, raising unresolved questions about long\u2010term graft creep and laxity. Early clinical comparative studies report functional outcomes equivalent to hamstring tendon autografts in primary anterior cruciate ligament reconstruction, and folded soft\u2010tissue quadriceps grafts show promising re\u2010rupture rates in the revision setting. Despite these encouraging findings, the existing literature is predominantly Level III and IV evidence with short\u2010term follow\u2010up, and the heterogeneous definitions of \u2018quadriceps tendon graft\u2019 across studies preclude any formal meta\u2010analysis of this specific graft entity. While the rectus femoris tendon autograft holds considerable potential as a versatile option for primary, revision and complex multi\u2010ligament reconstruction, high\u2010powered randomized controlled trials with long\u2010term follow\u2010up are needed to determine whether it truly represents a paradigm shift or merely a technical variation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level V, narrative review.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ksa.70526","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T09:02:19Z","timestamp":1785402139000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["The rectus femoris tendon autograft in knee ligament reconstruction: Anatomy, biomechanics, clinical applications and results\u2014A narrative review"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-6166-4905","authenticated-orcid":false,"given":"Richard","family":"Glaab","sequence":"first","affiliation":[{"name":"Department of Orthopedics and Sports Medicine crossklinik Basel Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthieu","family":"Ollivier","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, APHM, CNRS, ISM, Institute of Movement Sciences, Sainte\u2010Marguerite Hospital Aix Marseille University Marseille France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wolf","family":"Petersen","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Orthop\u00e4die und Unfallchirurgie, Martin Luther Hospital Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom\u00e1s","family":"Pineda","sequence":"additional","affiliation":[{"name":"Facultad de Medicina, Hospital del Trabajador Universidad Andr\u00e9s Bello Santiago Chile"},{"name":"Facultad de Medicina Hospital el Carmen Universidad Finis Terrae Santiago Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent","family":"Marot","sequence":"additional","affiliation":[{"name":"Centre M\u00e8dic i Quir\u00fargic Hospital Nostra Senyora de Meritxell Escaldes\u2010Engordany Andorra"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1298-3158","authenticated-orcid":false,"given":"Nguyen Quang Ton","family":"Quyen","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Tam Anh General Hospital Hanoi Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abhijit","family":"Sen","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics KPC Medical College and Hospital Kolkata India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jia Ying","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Singapore General Hospital Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zi Yang","family":"Chia","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Singapore General Hospital Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Pettinari","sequence":"additional","affiliation":[{"name":"Clinica Ortopedica, Azienda Ospedaliera\u2010Universitaria Careggi Firenze Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camilo P.","family":"Helito","sequence":"additional","affiliation":[{"name":"Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Cl\u00ednicas HCFMUSP, Faculdade de Medicina Universidade de S\u00e3o Paulo S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,30]]},"reference":[{"issue":"1","key":"e_1_2_13_2_1","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/j.arthro.2005.10.015","article-title":"Residual strength of the quadriceps versus patellar tendon after harvesting a central free tendon graft","volume":"22","author":"Adams DJ","year":"2006","journal-title":"Arthroscopy"},{"issue":"10","key":"e_1_2_13_3_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.eats.2024.103067","article-title":"Combined anterior cruciate ligament and anterolateral ligament reconstruction using the superficial layer quadriceps tendon graft: surgical technique description","volume":"13","author":"Barroso BG","year":"2024","journal-title":"Arthrosc Tech"},{"issue":"2","key":"e_1_2_13_4_1","first-page":"45","article-title":"[2\u2010strip substitution\u2010plasty of the anterior cruciate ligament with the quadriceps 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reconstruction","volume":"13","author":"Dansby J","year":"2025","journal-title":"Orthop J Sports Med"},{"key":"e_1_2_13_8_1","doi-asserted-by":"crossref","DOI":"10.25259\/JASSM_29_2025","article-title":"Comparative functional outcome study of superficial quadriceps tendon versus hamstring tendon autograft in arthroscopic anterior cruciate ligament reconstruction","volume":"7","author":"Dhariwal VH","year":"2025","journal-title":"J Arthrosc Surg Sports Med"},{"issue":"12","key":"e_1_2_13_9_1","article-title":"Double\u2010layered quadriceps tendon autografts provide lower failure rates and improved clinical results compared with hamstring tendon grafts in revision ACL reconstruction","volume":"9","author":"Eggeling L","year":"2021","journal-title":"Orthop J Sports Med"},{"issue":"4","key":"e_1_2_13_10_1","doi-asserted-by":"crossref","first-page":"e509","DOI":"10.1016\/j.eats.2014.06.003","article-title":"Minimally invasive harvest of a quadriceps tendon graft with or without a bone 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the rectus femoris graft\u2010superficial layer of the quadriceps: surgical technique","volume":"14","author":"Martins FS","year":"2025","journal-title":"Arthrosc Tech"},{"issue":"12","key":"e_1_2_13_27_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.eats.2025.103985","article-title":"Continuous bone\u2013quadriceps tendon\u2013rectus femoris autograft for revision anterior cruciate ligament and anterolateral ligament reconstructions","volume":"14","author":"Morin V","year":"2025","journal-title":"Arthrosc Tech"},{"issue":"14","key":"e_1_2_13_28_1","doi-asserted-by":"crossref","first-page":"3531","DOI":"10.1177\/0363546518825340","article-title":"Anterior cruciate ligament reconstruction: a systematic review and meta\u2010analysis of outcomes for quadriceps tendon autograft versus bone\u2013patellar tendon\u2013bone and hamstring\u2010tendon autografts","volume":"47","author":"Mouarbes D","year":"2019","journal-title":"Am J Sports 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