Bidirectional Tendon Strip: A Rectus Femoris Graft Harvesting Technique for Anterior Cruciate Ligament Reconstruction

In recent years, alternative graft options for anterior cruciate ligament (ACL) reconstruction have gained attention, with the quadriceps tendon and rectus femoris (RF) favored for their biomechanical robustness and biological integration potential. However, traditional retrograde techniques harvesting from the patellar insertion pose technical challenges. These include poor visualization, tight overlying soft tissues and condensation of the quadriceps tendons at the suprapatellar region, and increased risk of capsular breach and donor-site morbidity. We describe the bidirectional tendon strip technique, in which retrograde harvesting is initiated 8 cm proximal to the superior pole of the patella with an open stripper. This point allows for consistent identification of tendon width and depth with minimal dissection. We then proceed to harvest distally with a cylindrical tendon corer. This approach enables controlled graft harvesting with predictable thickness and length for a broad range of reconstructions, including ACL reconstruction with various lateral stabilization techniques and PCL reconstruction. The bidirectional tendon strip technique represents a refined, reproducible approach for RF tendon harvest in ACL reconstruction. It integrates the anatomic consistency and strength of the RF with a minimally invasive strategy that minimizes morbidity and optimizes graft characteristics.