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Peer-reviewedCC BY 4.0Journal of Clinical Medicine

The Indirect Head of the Rectus Femoris as a Variable Surgical Landmark in Hip Arthroscopy: A Review of Surgical Access, Capsulotomy, Iatrogenic Injury and Reconstruction

  • Ingrid C. Landfald1,2,3
  • Michał Podgórski4
  • Andrzej Borowski5
  • Marcin Wiśniewski6,7
  • Daria Domosławska7
  • Łukasz Olewnik1,2
7 affiliations
  1. 1Department of Clinical Anatomy, Mazovian University in Płock, 09-402 Płock, Poland
  2. 2VARIANTIS Research Laboratory, Department of Clinical Anatomy, Mazovian University in Płock, 09-402 Płock, Poland
  3. 3VARIA Research Laboratory, Department of Clinical Anatomy, Mazovian University in Płock, 09-402 Płock, Poland
  4. 4Department of Radiology and Diagnostic Imaging, Faculty of Medicine, Medical University of Lodz, 90-419 Lodz, Poland
  5. 5Department of Orthopaedics and Traumatology, Medical University of Lodz, 90-419 Lodz, Poland
  6. 6Department of Normal Anatomy, Faculty of Medicine, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-821 Bydgoszcz, Poland
  7. 7Faculty of Health Sciences, Collegium Medicum, Mazovian University in Płock, 09-402 Płock, Poland
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Abstract

Background: The indirect head of the rectus femoris (IHRF) occupies a surgically important position within the anterior pericapsular region of the hip and is increasingly used as a landmark during arthroscopic capsular access. Purpose: To synthesize current evidence regarding the role of the IHRF in hip arthroscopy, focusing on surgical access, iatrogenic injury, tendon protection, acetabular exposure, anatomical variability and reconstruction. Methods: This structured narrative review incorporated a literature search of PubMed, Scopus and Web of Science Core Collection using complementary approaches addressing IHRF anatomy, hip arthroscopy, capsulotomy, pericapsular relationships, iatrogenic injury, imaging and reconstruction. The searches yielded 22,200 records, of which 13,058 were unique after removal of 9142 duplicates. The evidence was synthesised qualitatively because of substantial methodological and clinical heterogeneity. Results: The IHRF has been described as an intraoperative landmark during longitudinal and outside-in capsulotomy. Cadaveric evidence documents tendon violation during capsular access, and an intraoperative IHRF injury has also been reported in a clinical cohort; however, comparative clinical evidence concerning IHRF-specific safety remains insufficient. Technical studies also indicate that the tendon may interfere with anterosuperior acetabular exposure. Anatomical studies demonstrate frequent superior and inferior aponeurotic expansions and substantial variation in proximal tendon morphology. However, the identified surgical literature has not evaluated capsulotomy safety or operative outcomes according to these configurations. The IHRF has also been used as a local graft for acetabular labral reconstruction and incorporated into capsular reconstructive techniques. Conclusions: The IHRF is both a useful surgical landmark and an anatomically variable structure at risk during hip arthroscopy. Whether morphological variability has clinically meaningful consequences for surgical access, tendon protection and reconstructive use remains unresolved.

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Cite

BibTeXRIS
BibTeX
@article{landfald2026indirect,
  title = {{The Indirect Head of the Rectus Femoris as a Variable Surgical Landmark in Hip Arthroscopy: A Review of Surgical Access, Capsulotomy, Iatrogenic Injury and Reconstruction}},
  author = {Ingrid C. Landfald and Michał Podgórski and Andrzej Borowski and Marcin Wiśniewski and Daria Domosławska and Łukasz Olewnik},
  journal = {Journal of Clinical Medicine},
  year = {2026},
  month = nov,
  doi = {10.3390/jcm15228780},
  url = {https://www.mdpi.com/2077-0383/15/22/8780},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - The Indirect Head of the Rectus Femoris as a Variable Surgical Landmark in Hip Arthroscopy: A Review of Surgical Access, Capsulotomy, Iatrogenic Injury and Reconstruction
AU  - Ingrid C. Landfald
AU  - Michał Podgórski
AU  - Andrzej Borowski
AU  - Marcin Wiśniewski
AU  - Daria Domosławska
AU  - Łukasz Olewnik
PY  - 2026
DA  - 2026/11/10
JO  - Journal of Clinical Medicine
DO  - 10.3390/jcm15228780
UR  - https://www.mdpi.com/2077-0383/15/22/8780
AB  - Background: The indirect head of the rectus femoris (IHRF) occupies a surgically important position within the anterior pericapsular region of the hip and is increasingly used as a landmark during arthroscopic capsular access. Purpose: To synthesize current evidence regarding the role of the IHRF in hip arthroscopy, focusing on surgical access, iatrogenic injury, tendon protection, acetabular exposure, anatomical variability and reconstruction. Methods: This structured narrative review incorporated a literature search of PubMed, Scopus and Web of Science Core Collection using complementary approaches addressing IHRF anatomy, hip arthroscopy, capsulotomy, pericapsular relationships, iatrogenic injury, imaging and reconstruction. The searches yielded 22,200 records, of which 13,058 were unique after removal of 9142 duplicates. The evidence was synthesised qualitatively because of substantial methodological and clinical heterogeneity. Results: The IHRF has been described as an intraoperative landmark during longitudinal and outside-in capsulotomy. Cadaveric evidence documents tendon violation during capsular access, and an intraoperative IHRF injury has also been reported in a clinical cohort; however, comparative clinical evidence concerning IHRF-specific safety remains insufficient. Technical studies also indicate that the tendon may interfere with anterosuperior acetabular exposure. Anatomical studies demonstrate frequent superior and inferior aponeurotic expansions and substantial variation in proximal tendon morphology. However, the identified surgical literature has not evaluated capsulotomy safety or operative outcomes according to these configurations. The IHRF has also been used as a local graft for acetabular labral reconstruction and incorporated into capsular reconstructive techniques. Conclusions: The IHRF is both a useful surgical landmark and an anatomically variable structure at risk during hip arthroscopy. Whether morphological variability has clinically meaningful consequences for surgical access, tendon protection and reconstructive use remains unresolved.
SN  - 2077-0383
ER  -