Clinical anatomy of the quadriceps femoris and extensor apparatus of the knee.
Most descriptions of the extensor mechanism of the knee do not take into account its complexity and variability. The quadriceps femoris insertion into the patella is said to be through a common tendon with a three-layered arrangement: rectus femoris (RF) most superficially, vastus medialis (VM) and lateralis (VL) in the intermediate layer, and vastus intermedius (VI) most deeply. We dissected 20 limbs from 17 cadavers to provide a more detailed description of the anterior components of the knee: the tendon, the patellar retinacula, and the patellofemoral ligaments. Only three of the 20 specimens exhibited the typically described quadriceps pattern. The remainder had bilaminar and even more complex trilaminar and tetralaminar fiber arrangements. We found an oblique head of the vastus lateralis (VLO), separated from the longitudinal head by a layer of fat or fascia, in 60% of the specimens. However, we found no distinct oblique head of the vastus medialis (VMO) in any specimen. The medial patellofemoral ligament (MPFL) was more common than the lateral (LPFL), supporting its suggested role as the principal passive medial stabilizer of the patella. Because the quadriceps muscle group plays a direct role in patellofemoral joint function, investigation into the clinical applications of its highly variable anatomy may be worthwhile with respect to joint dysfunction and failures of TKAs.
Waligora
Andrew C
AC
Drexel University College of Medicine, Philadelphia, PA 19129-1096, USA.
Johanson
Norman A
NA
Hirsch
Bruce Elliot
BE
D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects; D002102:Cadaver; D004210:Dissection; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000209:etiology; D007719:Knee Joint / Q000033:anatomy & histology* / Q000601:surgery; D008297:Male; D017888:Medial Collateral Ligament, Knee / Q000033:anatomy & histology; D010329:Patella / Q000033:anatomy & histology; D017847:Patellar Ligament / Q000033:anatomy & histology; D052097:Quadriceps Muscle / Q000033:anatomy & histology* / Q000601:surgery; D017211:Treatment Failure
Radiographics. 1995 Mar;15(2):367-82
7761641
J Bone Joint Surg Am. 1981 Mar;63(3):351-6
7204430
Eur J Radiol. 2005 May;54(2):199-205
15837399
J Athl Train. 1997 Apr;32(2):115-8
16558439
Radiographics. 2000 Oct;20 Spec No:S103-20
11046166
Med Sci Sports Exerc. 2004 Jan;36(1):93-101
14707774
J Bone Joint Surg Am. 1968 Dec;50(8):1535-48
5722849
J Manipulative Physiol Ther. 2006 Feb;29(2):139-44
16461173
Sports Med Arthrosc Rev. 2007 Jun;15(2):48-56
17505317
J Bone Joint Surg Br. 2008 Apr;90(4):527-34
18378934
Radiographics. 1994 May;14(3):541-51
8066269
Clin Orthop Relat Res. 1980 Nov-Dec;(153):183-8
7449213
Clin Anat. 2007 Jul;20(5):556-9
17149742
Anat Rec. 1997 Sep;249(1):135-42
9294658
AJR Am J Roentgenol. 1999 Sep;173(3):691-8
10470905
Knee. 2003 Sep;10(3):215-20
12893142
Clin Anat. 2005 May;18(4):281-9
15832351
J Bone Joint Surg Br. 1992 Jul;74(4):624
1624528
J Anat. 1990 Jun;170:193-8
2254163
Knee Surg Sports Traumatol Arthrosc. 2006 Mar;14(3):214-20
16283173
Clin Anat. 2002 Mar;15(2):116-28
11877790
J Bone Joint Surg Br. 1995 Mar;77(2):225-31
7706335
AJR Am J Roentgenol. 1992 Nov;159(5):1031-4
1414770
J Orthop Res. 1998 Jan;16(1):136-43
9565086
Arthroscopy. 2007 Mar;23(3):269-74
17349469
Surg Radiol Anat. 1989;11(1):17-22
2497528