The anatomical properties of the indirect head of the rectus femoris tendon: a cadaveric study with clinical significance for labral reconstruction surgery

  • Ran AtzmonEmail author
  • Zachary T. Sharfman
  • Ehud Atoun
  • Thomas G. Sampson
  • Eyal Amar
  • Ehud Rath
Arthroscopy and Sports Medicine



Acetabular labral tear is a common pathology. In some clinical situations, primary labral repair may not be possible and labral reconstruction is indicated.

Purpose and clinical relevance

Describe the anatomy of the indirect head of the rectus femoris (IHRF) tendon with clinical application in arthroscopic labral reconstruction surgery.


Twenty-six cadaver hips were dissected. Thirteen measurements, each with clinical relevance to arthroscopic labral reconstruction using an IHRF tendon graft were taken on each hip. All measurements were taken in triplicate. Mean values, standard deviations and intra-observer reliability were calculated.


The mean footprint of the direct head of the rectus femoris tendon was 10.6 mm × 19.6 mm. The width and thickness at the confluence of both heads were 10.9 mm and 6.9 mm, respectively. The mean total length of the footprint and “free portion” of the IHRF was 55.3 mm, the mean cranial to caudal footprint measured at the 12 o’clock, 1 o’clock, and 2 o’clock positions were 22.3 mm. The mean length of the Indirect Head footprint alone was 38.1 mm. The mean length of IHRF tendon suitable for grafting was 46.1 mm and the mean number of clock face sectors covered by this graft was 3.3 clock face sectors. Intra-observer reliability was ≥ 0.90 for all recorded measurements. The origin of the IHRF on the acetabulum fans out posteriorly, becoming thinner and wider as the origin travels posteriorly. The tendon footprint is firmly attached on the lateral wall of the ilium and becomes a free tendon overlying the acetabular bone as it travels anteriorly and distally towards its muscular attachment.


The IHRF tendon is in an ideal location for harvesting and contains the appropriate thickness, length and triangular architecture to serve as a safe and local graft source for acetabular labral reconstruction surgery.


Autograft Rectus femoris Reconstruction Labrum Femoroacetabular impingement 



Indirect head of rectus femoris


Femoroacetabular impingement


Tensor fascia lata


Anterior inferior iliac spine


Direct head of rectus femoris



We would like to acknowledge Mrs. Rachel Oz, Dr. Alex Hari, Mrs. Ada Feldman and Dr. Tatiana Melnikoy of the Tel Aviv University Anatomy Department for sharing their expertise and experience in the delicate field of anatomical dissection and research.

Author contributions

RA and ZS participated in the dissection of the cadavers and in drafting the manuscript, EA and TS participated in the study design and helped to draft the manuscript. EA participated in the design of the study and performed the statistical analysis. ER conceived of the study, participated in the dissection and the study design, and helped to draft the manuscript. All authors read and approved the final manuscript.


There is no funding source of any kind.

Compliance with ethical standards

Conflict of interest

All the authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study—all the participants in the study signed a Form to Bequeath a Body for the Purposes of Scientific and Medical Research.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Assuta Medical Center, Department of Orthopaedic SurgeryAffiliated with the Faculty of Health and Science and Ben Gurion UniversityAshdodIsrael
  2. 2.Montefiore Department of Orthopaedic SurgeryAlbert Einstein College of MedicineBronxUSA
  3. 3.Barzilai Medical Center, Department of Orthopaedic SurgeryAffiliated with the Faculty of Health and Science and Ben Gurion UniversityAshkelonIsrael
  4. 4.Post Street SurgicalSan FranciscoUSA
  5. 5.Tel Aviv Medical Center, Department of Orthopaedic SurgeryAffiliated With the Sackler Faculty of Medicine and Tel Aviv UniversityTel Aviv-YafoIsrael

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