Early Neuromuscular Recovery After Rectus Femoris Tendon Harvest for Revision Anterior Cruciate Ligament Reconstruction: A Retrospective Comparative Study

Objectives: Revision anterior cruciate ligament reconstruction remains technically challenging, and graft selection may influence early postoperative recovery. The rectus femoris tendon has recently been proposed as an autologous graft option, particularly in patients with previous hamstring harvest. However, its impact on early neuromuscular recovery remains poorly documented. Hypothesis: Rectus femoris tendon harvest for revision anterior cruciate ligament reconstruction is not associated with increased early postoperative morbidity and may allow satisfactory early neuromuscular recovery. Material and Methods: This retrospective single-center comparative study included 50 consecutive patients who underwent anterior cruciate ligament reconstruction between August 2025 and February 2026. Twenty-five patients underwent revision anterior cruciate ligament reconstruction using a rectus femoris tendon autograft, and 25 underwent primary anterior cruciate ligament reconstruction using hamstring tendon autografts. The primary outcome was the arthrogenic muscle inhibition grade at postoperative day 21. Surface electromyography of the vastus medialis on day 21 was also assessed. Secondary outcomes included tourniquet time, postoperative pain, hematoma, knee range of motion, and complications. Results: At day 21, absence of arthrogenic muscle inhibition (grade 0) was more frequent in the rectus femuris group than in the hamstring group (28% versus 0%; p = 0.0096), whereas grade 2A inhibition was more frequent in the hamstring group (48% versus 20%; p = 0.04). The quadriceps activation ratio on surface electromyography tended to be higher in the RF group (0.65 ± 0.15 versus 0.52 ± 0.18), without reaching statistical significance ( p = 0.07). Tourniquet time was longer in the rectus femoris group (49.1 ± 10.6 min versus 29.4 ± 5.4 min; p < 0.001), with no significant between-group differences in postoperative pain, hematoma, extension deficit, or complications. Associated meniscal lesions were similarly frequent overall in both groups (60% vs 52%), although ramp lesions were significantly more frequent in the RF group (44% vs 8%; p = 0.008). Conclusion: In this exploratory comparison, rectus femoris tendon harvest in revision anterior cruciate ligament reconstruction was not associated with increased early postoperative morbidity and was associated with less arthrogenic muscle inhibition at 3 weeks, despite longer operative time. However, interpretation of these findings should remain cautious because the comparison involved non-equivalent groups, with revision procedures in the reduction femoris group and primary procedures in the hamstring group. Rectus femoris tendon harvest appears to be a safe autograft option in revision anterior cruciate ligament reconstruction, with no increase in early postoperative morbidity in this series. Level of evidence: Level III, retrospective comparative study