Matic Kolar, Goran Vrgoč, David Martinčič
Background/Objectives: Graft selection remains one of the main hot topics in anterior cruciate ligament (ACL) reconstruction. Despite significant advances in surgical techniques, graft-related factors continue to influence postoperative stability, graft survival, donor-site morbidity, and return-to-sport outcomes. Hamstring tendon (HT), bone-patellar tendon-bone (BPTB), and quadriceps tendon (QT) autografts currently represent the most widely utilized graft choices. Recently, isolated rectus femoris tendon (RFT) harvesting has emerged as a potential alternative, based on the concept of selective utilization of the superficial component of the QT, while preserving deeper structures of the extensor mechanism. Methods: A narrative review of the available literature in accordance with the principles of the Scale for the Assessment of Narrative Review Articles (SANRA) on RFT autografts for ACL reconstruction was performed, focusing on anatomical, biomechanical, technical, and clinical studies. Relevant evidence regarding graft morphology, harvesting techniques, biomechanical properties, and clinical outcomes in both primary and revision procedures was synthesized. Results: Initial evidence consists of anatomical and biomechanical investigations, as well as three clinical series (one primary, two revision reconstructions). Available data suggest favorable biomechanical characteristics, including adequate graft length, strength, and versatility, together with promising short-term clinical outcomes. Conclusions: Isolated RFT autografting represents a promising emerging option for ACL reconstruction. Preclinical and anatomical studies support the rationale for selective harvesting, and the currently available, albeit very limited, clinical data are encouraging. Higher-level prospective evidence is required to define its role in contemporary ACL surgery.