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Ashton DM, Blaker CL, Hartnell N, Haubruck P, Liu Y, Hefferan SA, Little CB, Clarke EC. The Biomechanical, Biochemical, and Morphological Properties of 19 Human Cadaveric Lower Limb Tendons and Ligaments: An Open-Access Data Set. Am J Sports Med 2024; 52:2391-2401. [PMID: 38910352 DOI: 10.1177/03635465241260054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
BACKGROUND Methodological heterogeneity hinders data comparisons across isolated studies of tendon and ligament properties, limiting clinical understanding and affecting the development and evaluation of replacement materials. PURPOSE To create an open-access data set on the morphological, biomechanical, and biochemical properties of clinically important tendons and ligaments of the lower limb, using consistent methodologies, to enable direct tendon/ligament comparisons. STUDY DESIGN Descriptive laboratory study. METHODS Nineteen distinct lower limb tendons and ligaments were retrieved from 8 fresh-frozen human cadavers (5 male, 3 female; aged 49-65 years) including Achilles, tibialis posterior, tibialis anterior, fibularis (peroneus) longus, fibularis (peroneus) brevis, flexor hallucis longus, extensor hallucis longus, plantaris, flexor digitorum longus, quadriceps, patellar, semitendinosus, and gracilis tendons; anterior cruciate, posterior cruciate, medial collateral, and lateral collateral ligaments; and 10 mm-wide grafts from the contralateral quadriceps and patellar tendons. Outcomes included morphology (tissue length, ultrasound-quantified cross-sectional area [CSAUS], and major and minor axes), biomechanics (failure load, ultimate tensile strength [UTS], failure strain, and elastic modulus), and biochemistry (sulfated glycosaminoglycan [sGAG] and hydroxyproline contents). Tissue differences were analyzed using mixed-model regression. RESULTS There was a range of similarities and differences between tendons and ligaments across outcomes. A key finding relating to potential graft tissue suitability was the comparable failure loads, UTS, CSAUS, sGAG, and hydroxyproline present between hamstring tendons (a standard graft source) and 5 tendons not typically used for grafting: fibularis (peroneus) longus and brevis, flexor and extensor hallucis longus, and flexor digitorum longus tendons. CONCLUSION This study of lower limb tendons and ligaments has enabled direct comparison of morphological, biomechanical, and biochemical human tissue properties-key factors in the selection of suitable graft tissues. This analysis has identified 6 potential new donor tissues with properties comparable to currently used grafts. CLINICAL RELEVANCE This extensive data set reduces the need to utilize data from incompatible sources, which may aid surgical decisions (eg, evidence to expand the range of tendons considered suitable for use as grafts) and may provide congruent design inputs for new biomaterials and computational models. The complete data set has been provided to facilitate further investigations, with the capacity to expand the resource to include additional outcomes and tissues.
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Affiliation(s)
- Dylan M Ashton
- Murray Maxwell Biomechanics Laboratory, Institute of Bone and Joint Research, Kolling Institute, Northern Sydney Local Health District, Sydney Musculoskeletal Health, Faculty of Medicine and Health, University of Sydney, St. Leonards, New South Wales, Australia
| | - Carina L Blaker
- Murray Maxwell Biomechanics Laboratory, Institute of Bone and Joint Research, Kolling Institute, Northern Sydney Local Health District, Sydney Musculoskeletal Health, Faculty of Medicine and Health, University of Sydney, St. Leonards, New South Wales, Australia
| | - Nicholas Hartnell
- Bone Ligament and Tendon Pty Ltd, Bowral, New South Wales, Australia
| | - Patrick Haubruck
- Heidelberg Trauma Research Group, Centre for Orthopaedics, Trauma Surgery and Spinal Cord Injury, Trauma and Reconstructive Surgery, Heidelberg University Hospital, Heidelberg, Germany
- Raymond Purves Bone and Joint Research Laboratories, Institute of Bone and Joint Research, Kolling Institute, Northern Sydney Local Health District, Sydney Musculoskeletal Health, Faculty of Medicine and Health, University of Sydney, St. Leonards, New South Wales, Australia
| | - Ying Liu
- Raymond Purves Bone and Joint Research Laboratories, Institute of Bone and Joint Research, Kolling Institute, Northern Sydney Local Health District, Sydney Musculoskeletal Health, Faculty of Medicine and Health, University of Sydney, St. Leonards, New South Wales, Australia
| | - Samantha A Hefferan
- Murray Maxwell Biomechanics Laboratory, Institute of Bone and Joint Research, Kolling Institute, Northern Sydney Local Health District, Sydney Musculoskeletal Health, Faculty of Medicine and Health, University of Sydney, St. Leonards, New South Wales, Australia
| | - Christopher B Little
- Raymond Purves Bone and Joint Research Laboratories, Institute of Bone and Joint Research, Kolling Institute, Northern Sydney Local Health District, Sydney Musculoskeletal Health, Faculty of Medicine and Health, University of Sydney, St. Leonards, New South Wales, Australia
| | - Elizabeth C Clarke
- Murray Maxwell Biomechanics Laboratory, Institute of Bone and Joint Research, Kolling Institute, Northern Sydney Local Health District, Sydney Musculoskeletal Health, Faculty of Medicine and Health, University of Sydney, St. Leonards, New South Wales, Australia
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Martonovich N, Reisfeld S, Yonai Y, Behrbalk E. Arthritis or an Adjacent Fascial Response? A Case Report of Combined Pyomyositis and Aseptic Arthritis. Case Rep Rheumatol 2024; 2024:2608144. [PMID: 38957409 PMCID: PMC11219200 DOI: 10.1155/2024/2608144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 06/10/2024] [Accepted: 06/13/2024] [Indexed: 07/04/2024] Open
Abstract
Pyomyositis, accompanied by aseptic arthritis, has been previously documented in several publications. However, none of the authors in the mentioned case reports offered a pathophysiological explanation for this unusual phenomenon or proposed a treatment protocol. We present a case of a healthy, 70-year-old male who was presented to the emergency department 4 days after tripping over a pile of wooden planks and getting stabbed by a nail to his thigh. The right thigh was swollen. Unproportional pain was produced by a light touch to the thigh. A laboratory test and a CT scan were obtained. The working diagnosis was pyomyositis of the thigh and septic arthritis of the ipsilateral knee. The patient underwent urgent debridement and irrigation of his right thigh. An arthroscopic knee lavage was performed as well. Intraoperative cultures from the thigh revealed the growth of Streptococcus pyogenes and Staphylococcus aureus. Cultures from synovial fluid were sterile; thus, septic arthritis was very unlikely. The source of the knee effusion might have been an aseptic inflammatory response due to the proximity of the thigh infection. Anatomically, the quadriceps muscle inserts on the patella, and its tendon fuses with the knee capsule, creating a direct fascial track from the thigh to the knee. The inflammatory response surrounding the infection may have followed this track, creating a domino effect, affecting adjacent capillaries within the joint capsule, and causing plasma leakage into the synovial space, leading to joint effusion. Our suggested treatment is addressing the primary infection with antibiotics and considering adding anti-inflammatory therapy, given our suspicion that this process has an inflammatory component.
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Affiliation(s)
- Noa Martonovich
- Orthopedic Surgery DepartmentHillel Yaffe Medical Centre, Hadera, Israel
- Rappaport Faculty of MedicineTechnion, Haifa, Israel
| | - Sharon Reisfeld
- Rappaport Faculty of MedicineTechnion, Haifa, Israel
- Infectious Diseases UnitHillel Yaffe Medical Centre, Hadera, Israel
| | - Yaniv Yonai
- Orthopedic Surgery DepartmentHillel Yaffe Medical Centre, Hadera, Israel
- Rappaport Faculty of MedicineTechnion, Haifa, Israel
| | - Eyal Behrbalk
- Orthopedic Surgery DepartmentHillel Yaffe Medical Centre, Hadera, Israel
- Rappaport Faculty of MedicineTechnion, Haifa, Israel
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S Oliveira S, G L Bandeira W, M Lopes L, R M Lima R, C Cavalcante J. Incidence of the tensor of the vastus intermedius: A cadaveric study. Morphologie 2024; 108:100609. [PMID: 37897940 DOI: 10.1016/j.morpho.2023.100609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 10/30/2023]
Abstract
INTRODUCTION The quadriceps femoris muscle is present in the anterior region of the thigh and is classically described as a muscle with four heads: rectus femoris, vastus lateralis, vastus medialis, and vastus intermedius. A few years ago, a "fifth head" was described and named the tensor of the vastus intermedius (TVI). The TVI belly is in line with the belly of the vastus lateralis, and its aponeurosis imposes considerable tension on the vastus intermedius, medializing its action, to play a significant role in knee extension. OBJECTIVE To perform a study of the TVI incidence in a Brazilian population and describe its variations. MATERIAL AND METHODS We dissected lower limbs from cadavers previously fixed in 10% formaldehyde, belonging to the Laboratory of Anatomy of the Department of Morphology of the Biosciences Center of the Federal University of Rio Grande do Norte. RESULTS Eighty-one lower limbs were analyzed with only 33 (40.74%) of them presenting TVI. All four types of TVI described by the literature were present in our sample with the following distribution: type 1 with 15.15%; type 2 with 9.1%; type 3 with 33.33%; type 4 with 42.42%. DISCUSSION Although the literature points to the TVI as a normal belly of the quadriceps, making it a "quinticeps", our analysis points to the TVI as a variation and probably a matter of regionality. However, the presence of TVI is not a rare case and cannot be disregarded, which makes this study important for anatomists, physiotherapists, physicians, and surgeons.
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Affiliation(s)
- S S Oliveira
- Department of Morphology, Biosciences Center, Laboratory of Anatomy, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - W G L Bandeira
- Department of Morphology, Biosciences Center, Laboratory of Anatomy, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - L M Lopes
- Department of Morphology, Biosciences Center, Laboratory of Anatomy, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - R R M Lima
- Department of Morphology, Biosciences Center, Laboratory of Anatomy, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - J C Cavalcante
- Department of Morphology, Biosciences Center, Laboratory of Anatomy, Federal University of Rio Grande do Norte, Natal, RN, Brazil.
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Olewnik Ł, Zielinska N, Aragones P, Ruzik K, Paulsen F, Borowski A, LaPrade RF. The accessory heads of the quadriceps femoris muscle may affect the layering of the quadriceps tendon and potential graft harvest lengths. Knee Surg Sports Traumatol Arthrosc 2023; 31:5755-5764. [PMID: 37932536 PMCID: PMC10719154 DOI: 10.1007/s00167-023-07647-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 10/24/2023] [Indexed: 11/08/2023]
Abstract
PURPOSE The aim of the study was to assess the quadriceps femoris system for the presence of additional layers. METHODS One hundred and twenty-eight lower limbs fixed in 10% formalin were examined. RESULTS Five types of quadriceps tendon layering were found based on the accessory heads of the quadriceps muscle. Type I (55%)-represented by four heads and four layers, and it was something new because standard orthopaedic textbooks described quadriceps tendon as a structure composed of only three layers. Type II (27.4%)-the first four layers were the same as in Type 1, but the accessory tendon of the fifth head of the quadriceps femoris muscle had the deepest attachments. Type III (10.9%)-this type included 6 heads of quadriceps femoris. It consisted of five layers. Type IV (3.1%)-this type included 7 quadriceps femoris heads. This type consisted of only four layers. Type V (3.1%)-this type included 8 heads of the quadriceps femoris heads. This type consist of 5 layers. CONCLUSION The findings of this study provide a detailed anatomy of the quadriceps tendon including the accessory tendons of the accessory heads of the quadriceps tendon. The accessory heads of the quadriceps femoris muscle contribute to the layering of the quadriceps tendon. The second conclusion of this study is the development of safe distances depending on the types. Not all types are perfect for harvesting-Type IV seems to be the safest type, in turn Type V the most dangerous.
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Affiliation(s)
- Łukasz Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland.
| | - Nicol Zielinska
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Paloma Aragones
- Department of Anatomy and Embryology, School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Kacper Ruzik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Friedrich Paulsen
- Institute of Functional and Clinical Anatomy, Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Andrzej Borowski
- Orthopaedics and Pediatric Orthopaedics Department, Medical University of Lodz, 90-419, Lodz, Poland
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Fernandes A, Pinto J, Cunha P, Duarte C, Estaca A, Pereira T, Bettencourt M, Candelária I, E Silva MR. Complete Distal Rupture of the Rectus Femoris in an Elite Football Player: A Non-operative Treatment. Cureus 2023; 15:e45494. [PMID: 37859921 PMCID: PMC10584386 DOI: 10.7759/cureus.45494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/21/2023] Open
Abstract
Although muscle injuries represent the most frequent injury in professional football, isolated complete distal ruptures of the rectus femoris (RF) muscle are rare, and there is no consensus on their treatment and return to play (RTP). In this article, we report a clinical case of successful non-surgical management of an RF grade 4c muscle injury in a professional football player, in which the athlete was able to RTP 21 weeks after the injury, had no re-injury >1 year after RTP, and is playing at an elite level in the Portuguese Football First League.
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Affiliation(s)
- Alexandre Fernandes
- Health and Performance Unit, Casa Pia Atlético Clube - Futebol Sduq, Lisbon, PRT
- Physical Medicine and Rehabilitation, Hospital de Cascais, Lisbon, PRT
| | - Julio Pinto
- Health and Performance Unit, Casa Pia Atlético Clube - Futebol Sduq, Lisbon, PRT
| | - Pedro Cunha
- Health and Performance Unit, Casa Pia Atlético Clube - Futebol Sduq, Lisbon, PRT
| | - Carlos Duarte
- Health and Performance Unit, Casa Pia Atlético Clube - Futebol Sduq, Lisbon, PRT
| | - Alexandre Estaca
- Health and Performance Unit, Casa Pia Atlético Clube - Futebol Sduq, Lisbon, PRT
| | - Tiago Pereira
- Health and Performance Unit, Casa Pia Atlético Clube - Futebol Sduq, Lisbon, PRT
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Solie B, Monson J, Larson C. Graft-Specific Surgical and Rehabilitation Considerations for Anterior Cruciate Ligament Reconstruction with the Quadriceps Tendon Autograft. Int J Sports Phys Ther 2023; 18:493-512. [PMID: 37020435 PMCID: PMC10069402 DOI: 10.26603/001c.73797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 01/28/2023] [Indexed: 04/03/2023] Open
Abstract
Anterior cruciate ligament reconstruction (ACLR) with a bone-patellar tendon-bone (BPTB) or hamstring tendon (HT) autograft has traditionally been the preferred surgical treatment for patients returning to Level 1 sports. More recently, international utilization of the quadriceps tendon (QT) autograft for primary and revision ACLR has increased in popularity. Recent literature suggests that ACLR with the QT may yield less donor site morbidity than the BPTB and better patient-reported outcomes than the HT. Additionally, anatomic and biomechanical studies have highlighted the robust properties of the QT itself, with superior levels of collagen density, length, size, and load-to-failure strength compared to the BPTB. Although previous literature has described rehabilitation considerations for the BPTB and HT autografts, there is less published with respect to the QT. Given the known impact of the various ACLR surgical techniques on postoperative rehabilitation, the purpose of this clinical commentary is to present the procedure-specific surgical and rehabilitation considerations for ACLR with the QT, as well as further highlight the need for procedure-specific rehabilitation strategies after ACLR by comparing the QT to the BPTB and HT autografts. Level of Evidence Level 5.
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Park HK, Han JY, Cho YS, Nam KI. Distribution of the tensor of the vastus intermedius. Clin Anat 2023; 36:607-611. [PMID: 36597837 DOI: 10.1002/ca.24000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/28/2022] [Accepted: 12/24/2022] [Indexed: 01/05/2023]
Abstract
The tensor of the vastus intermedius (TVI) was first described by Grob et al. in 2016. It originates from the anteroinferior greater trochanter and inserts into the upper patella and receives blood and nerves independently of other muscles. It has been overlooked, but since micro-surgery and detailed rehabilitation treatments are being developed, more research on it is warranted. Here we report on the TVI in a Korean cadaveric study. A total of 58 cadavers (41 males and 17 females) were included. Thighs were examined using a standardized dissection protocol. The quadriceps femoris muscle was identified and its components were defined by blunt dissection. A total of 116 lower limbs were dissected. In 40 of them, there was a separately innervated TVI muscle belly between the fasciae of the vastus lateralis (VL) and the vastus intermedius (VI) muscles. TVIs were classed as independent (ID), VI, and VL types according to the relative relationship between the TVI, VL, and VI, and subdivided into two parts: Part 1 was the proximal muscular portion of the TVI attached to the VL or VI, and part 2 was the distal aponeurotic area. TVIs were analyzed in detail via 58 Korean cadavers. We subdivided them on the basis of their location and association with related muscles. A larger study is needed to clarify the function and prevalence of the TVI.
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Affiliation(s)
- Hyeng-Kyu Park
- Department of Physical and Rehabilitation Medicine, Research Institute of Medical Sciences, Heart Research Center, Chonnam National University, Chonnam National University Medical School & Hospital, Gwangju, Republic of Korea
| | - Jae-Young Han
- Department of Physical and Rehabilitation Medicine, Research Institute of Medical Sciences, Heart Research Center, Chonnam National University, Chonnam National University Medical School & Hospital, Gwangju, Republic of Korea
| | - Young-Suk Cho
- Department of Anatomy, Chonnam National University Medical School, Jeonnam, Republic of Korea
| | - Kwang-Il Nam
- Department of Anatomy, Chonnam National University Medical School, Jeonnam, Republic of Korea
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Liu Q, Deng X, Hou Z, Xu L, Zhang Y. Selective Repair of Motor Branches in the Femoral Nerve by Transferring the Motor Branches of Obturator Nerve: An Anatomical Feasibility Study. Ann Plast Surg 2023; 90:67-70. [PMID: 36534103 DOI: 10.1097/sap.0000000000003327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Anterior branch of the obturator nerve transfer has been proven as an effective method for femoral nerve injuries, but the patient still has difficulty in rising and squatting, up and downstairs. Here, we presented a novel neurotization procedure of selectively repairing 3 motor branches of the femoral nerve by transferring motor branches of the obturator nerve in the thigh level and assessing its anatomical feasibility. METHODS Eight adult cadavers (16 thighs) were dissected. The nerve overlap distance between the gracilis branch and the rectus femoris (RF) branch, the adductor longus (AL) branch and the vastus medialis (VM) branch, as well as the adductor magnus (AM) branch and the vastus intermedius (VI) branch were measured. Also, the axon counts of the donor and recipient nerve were evaluated by histological evaluation. RESULTS In all specimens, nerve overlap of at least 2.1 cm was observed in all 16 dissected thighs between the donor and recipient nerve branches, and the repair appeared to be without tension. There is no significant difference in the axon counts between gracilis branch (598 ± 83) and the RF branch (709 ± 151). The axon counts of the AL branch (601 ± 93) was about half of axon counts of the VM branch (1423 ± 189), and the axon counts of AM branch (761 ± 110) was also about half of the VI branch (1649 ± 281). CONCLUSIONS This novel technique of the combined nerve transfers below the inguinal ligament, specifically the gracilis branch to the RF branch, the AL branch to the VM branch, and the AM branch to the VI branch, is anatomically feasible. It provides a promising alternative in the repair of femoral nerve injuries and an anatomical basis for the clinical application of motor branches of the obturator nerve transfer to repair the motor portion of the injured femoral nerve.
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Affiliation(s)
- Qing Liu
- From the Department of Plastic and Cosmetic Surgery, the Second Affiliated Hospital, Nanchang University, Nanchang, China
| | - Xiaobing Deng
- Department of Hand Surgery, Jiayou Shuguang Orthopaedic Hospital, Jiangxi Academy of Medical Sciences, Nanchang, China
| | - Zhiping Hou
- From the Department of Plastic and Cosmetic Surgery, the Second Affiliated Hospital, Nanchang University, Nanchang, China
| | - Lei Xu
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
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Olewnik Ł, Zielinska N, Ruzik K, Karauda P, Podgórski M, Borowski A, LaPrade RF. A new look at quadriceps tendon - Is it really composed of three layers? Knee 2023; 40:292-304. [PMID: 36549105 DOI: 10.1016/j.knee.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 09/27/2022] [Accepted: 11/03/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The aim of this study was to qualitatively and quantitatively describe the anatomy of the QT including its size, its layers and relationship between layers. METHODS Sixty lower limbs (15 females and 15 males fixed in 10% formalin were examined. A retrospective analysis of 20 thigh MRI examinations was performed (10 males, and 10 females). RESULTS In all dissected specimens, the quadriceps femoris was composed of 4 layers: superficial (first layer), middle (second layer), middle-deep (third layer) and deep (fourth layer). The first layer (superficial) was formed by the rectus femoris tendon and fascia. The second layer was composed of tendons of the vastus medialis and superficial part of the vastus lateralis. The third layer was formed by the intermediate part of the vastus lateralis. The fourth layer was composed of the tendon of the vastus intermedius. This type of anatomy was visualized in 4 males and 2 female on MRI scans. CONCLUSION The findings of this study provide a detailed anatomy of the quadriceps tendon. There were 4 different layers of the QT consistently found in all specimens. The first layer was independent and composed by the rectus femoris tendon, the second was formed by the superficial part of the vastus lateralis and vastus medialis. The third layer was formed by the intermediate part of the vastus lateralis, and the deepest fourth layer was composed of the vastus intermedius. This detailed structural anatomy was also able to be visualized on MRI scans.
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Affiliation(s)
- Łukasz Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland.
| | - Nicol Zielinska
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland.
| | - Kacper Ruzik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland.
| | - Piotr Karauda
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland.
| | - Michał Podgórski
- Department of Radiology, Diagnostic Imaging and Interventional Radiology, Medical University of Lodz, Poland
| | - Andrzej Borowski
- Orthopaedics and Pediatric Orthopaedics Department, Medical University of Lodz, 90-419 Lodz, Poland.
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Yamaguchi Y, Kodama R, Yamada S. Morphogenetic progression of thigh and lower leg muscles during human embryonic development. Anat Rec (Hoboken) 2022. [PMID: 36571467 DOI: 10.1002/ar.25140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 11/12/2022] [Accepted: 12/05/2022] [Indexed: 12/27/2022]
Abstract
Fetal musculoskeletal movements are first observed at approximately seven to 8 weeks of gestation. However, the separation and formation of skeletal muscles, especially the limbs, have not yet been described in detail. In this study, we elucidate the sequence of events leading to the formation of each thigh and lower leg muscle using serial sections. To observe muscle formation, 26 serial sections (50 legs) of human embryonic specimens ranging from Carnegie stages (CS) 19 to 23 were selected from the Kyoto collection stored at the Congenital Anomaly Research Center, Kyoto University Graduate School of Medicine. As a result, we show the detailed formation and separation processes of the thigh and lower leg muscles. In the thigh, sartorius and tensor fasciae latae are separated at CS19, and the individual muscles observed in adults are identified after CS21. In the lower leg, the tibialis anterior exhibits early separation at CS20, and all muscles are identified at CS22. This study enables future research into the relationship between embryonic development and the evolution of muscle action from quadrupedal to erect bipedal walking.
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Affiliation(s)
- Yutaka Yamaguchi
- Congenital Anomaly Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ryota Kodama
- Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shigehito Yamada
- Congenital Anomaly Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Zielinska N, Balcerzak A, Tubbs RS, Olewnik Ł. Additional head of the rectus femoris muscle: a case report. Surg Radiol Anat 2022; 44:829-834. [PMID: 35438333 DOI: 10.1007/s00276-022-02937-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 03/29/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The aim of the present case is to describe an interesting variation of the additional head of the rectus femoris. METHODS A male body donor, 81 years old at death, was subjected to routine anatomical dissection for research and teaching purposes at the Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland. RESULTS We have found an example of an accessory head of the quadriceps femoris, a double-headed rectus femoris in which the proximal attachment is connected to the rectus femoris muscle originating from the anterior inferior iliac spine. The muscle belly of this additional structure is separate but fused distally with the vastus lateralis muscle. It then passes into the patellar ligament inserted into the tibial tuberosity. CONCLUSIONS Knowledge of the possible occurrence of an additional head is nevertheless important for clinicians, especially for orthopedists performing reconstructive surgeries. It could also be significant for physiotherapists arranging rehabilitation plans after such surgeries because it could potentially help to achieve faster recovery.
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Affiliation(s)
- Nicol Zielinska
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Adrian Balcerzak
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - R Shane Tubbs
- Department of Anatomical Sciences, St. George's University, True Blue, Grenada.,Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA.,Department of Neurology, Tulane University School of Medicine, New Orleans, LA, USA.,Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA.,Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA.,Department of Neurosurgery, Ochsner Medical Center, New Orleans, LA, USA
| | - Łukasz Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland.
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Olewnik Ł, Ruzik K, Szewczyk B, Podgórski M, Aragonés P, Karauda P, Tubbs RS, Sanudo JR, Pires MB, Polguj M. The relationship between additional heads of the quadriceps femoris, the vasti muscles, and the patellar ligament. BIOMED RESEARCH INTERNATIONAL 2022; 2022:9569101. [PMID: 35224103 PMCID: PMC8866009 DOI: 10.1155/2022/9569101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 01/26/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The quadriceps femoris consists of four muscles: the rectus femoris, vastus medialis, vastus intermedius, and vastus lateralis. However, the effect of additional quadriceps femoris heads on the vasti muscles and patellar ligaments is unknown. The aims of the present study are to determine the relationship between additional quadriceps femoris heads and the vasti muscles and patellar ligaments and to review the morphology of the vastus lateralis, vastus medialis, and vastus intermedius. MATERIALS AND METHODS One hundred and six lower limbs (34 male and 19 female cadavers) fixed in 10% formalin were examined. RESULTS On all lower extremities, the vastus lateralis consisted of superficial, intermediate, and deep layers. The vastus medialis, on the other hand, consisted of only the longus and obliquus layers. The quadriceps head had one or more supplementary heads in 106 dissected limbs from 68 cadavers (64.1%). The distal portion of the patella was wider in lower limbs without supplementary heads than in type IA but narrower than in type IIIA. In general, the distal portion of the patella was narrower in specimens with a supplementary head than in those without (19.03 SD 3.18 mm vs. 20.58 SD 2.95 mm, p = 0.03817). Other patellar ligament dimensions did not differ significantly. CONCLUSION The quadriceps femoris muscle is characterized by high morphological variability. Occurrence of extra heads is at the level of 64.1%. The vastus lateralis consists of three parts (superficial, intermediate, and deep), and vastus medialis consists of two (longus and oblique).
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Affiliation(s)
- Łukasz Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
| | - Kacper Ruzik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
| | - Bartłomiej Szewczyk
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
| | - Michał Podgórski
- Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Paloma Aragonés
- Department of Orthopedics Surgery, Hospital Santa Cristina, Madrid, Spain
| | - Piotr Karauda
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
| | - R. Shane Tubbs
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Jose Ramon Sanudo
- Department of Human Anatomy and Embryology, Facultad de Medicina, Universidad Complutense de Madrid, Spain
| | | | - Michał Polguj
- Department of Normal and Clinical Anatomy, Chair of Anatomy and Histology, Medical University of Lodz, Poland
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Biomechanical comparison of two medial patellofemoral ligament reconstruction techniques: Quadriceps tendon fixation versus single-tunnel patella fixation with gracilis autograft did not differ in load to failure and stiffness. Knee 2021; 33:169-175. [PMID: 34626887 DOI: 10.1016/j.knee.2021.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 08/08/2021] [Accepted: 09/20/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the ultimate failure load and stiffness of two patellar fixation techniques for medial patellofemoral ligament (MPFL) reconstruction: (1) quadriceps tendon fixation (QT), (2) single tunnel (STG) patella fixation with gracilis autograft. METHODS A total of 16 fresh-frozen cadaveric knees (eight matched pairs) were randomized into two groups (QT vs. STG). The MPFL reconstructions were subjected to cyclic loading for 10 cycles to 30 N and then tested to failure at a constant displacement rate of 15 mm/min using a materials-testing machine (MTS 810 Universal Testing System). Failure mode, ultimate failure load and stiffness were recorded for each cadaveric specimen. RESULTS There was no significant difference in mean ultimate failure load among groups (P = 0.35). The STG group failed at a mean ultimate load of 190.04 N [standard deviation (SD) 23.18] and the QT group failed at 206.24 N (SD 37.99). The STG group had a mean stiffness of 21.38 N/mm (SD 1.44). This was not significantly higher than the mean stiffness value achieved for the QT group at 20.36 N/mm (SD 1.3) (P = 0.19). In the QT group all reconstructions failed due to tendon rupture at the patella attachment. The reason for failure in the STG group was the graft-suture connection. CONCLUSIONS This cadaver study showed no statistically significant difference in biomechanical performance of the evaluated patella fixation techniques, in terms of maximum load to failure and stiffness. Both techniques are reliable in terms of biomechanical properties and could offer additional surgical solutions.
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Anatomy, Morphology and Function of the Tensor of Vastus Intermedius: A Systematic Review. J Funct Morphol Kinesiol 2021; 6:jfmk6030077. [PMID: 34564196 PMCID: PMC8482252 DOI: 10.3390/jfmk6030077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/04/2021] [Accepted: 09/08/2021] [Indexed: 11/16/2022] Open
Abstract
The tensor of vastus intermedius is a newly discovered muscle that is located at the anterior compartment of the thigh. The aim of the present study is to report, assess and synthetize the existing evidence on the anatomy, variation and morphological characteristics of the TVI as well as to examine its clinical importance. A systematic review was performed evaluating both anatomical and medical imaging studies which provided information about TVI anatomy, prevalence, variations and morphological characteristics. The search strategy was conducted in major electronic databases. Two reviewers worked independently to screen all possible references via a title/abstract examination. Methodological quality was examined with the Anatomical Quality Assurance checklist. A total of 295 cadaveric knees were included in the nine studies where in 244 (82.7%) cases the TVI was identified. Based on this evidence, it appears that the TVI is located between the vastus lateralis and vastus intermedius. The muscle belly is located proximally, and it is combined with a broad and flat aponeurosis before forming a tendinous structure that is attached at the medial aspect of the patella. The TVI presented some morphological variations and complex muscle architecture that varied along its length. There is insufficient good quality evidence as more than half of the included studies were ranked as having a "High" risk of bias with various methodological issues. Higher quality studies are recommended to evaluate the TVI morphology to better understand its functional and clinical importance.
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15
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Applied Anatomy of the Quadriceps Tendon Related to the Technique of Harvesting the Quadriceps Tendon Graft. Tech Orthop 2021. [DOI: 10.1097/bto.0000000000000572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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Utsunomiya N, Kodama R, Yamaguchi Y, Tsuge I, Yamada S. The development of the tensor vastus intermedius during the human embryonic period and its clinical implications. J Anat 2021; 239:583-588. [PMID: 34028017 PMCID: PMC8349409 DOI: 10.1111/joa.13453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/04/2021] [Accepted: 04/27/2021] [Indexed: 11/26/2022] Open
Abstract
The tensor vastus intermedius (TVI) is a newly discovered muscle located in the anterolateral thigh area and is considered the fifth component of the quadriceps femoris muscle. There have been several papers describing its anatomical and morphological features in detail; however, many features of this muscle, such as its ontology or kinetic functions, remain unknown. The purpose of this study was to determine the initial appearance of the TVI muscle in human embryonic development and to investigate its growth and development. Histological observations were performed on 30 lower limbs of 15 human embryos from Carnegie stage (CS) 21, 22, and 23 (with crown-rump length ranging from 18.7 to 28.7 mm). Myocyte clusters of the TVI were observed between the vastus lateralis and intermedius muscles in 7 out of 10 limbs in CS 22, indicating that the TVI arises during this stage. In CS 23, the TVI was clearly present in all specimens except one. However, neither the aponeurosis nor the tendonous structure of the TVI were observed in these embryonic stages. Formation of the conventional four components of the quadriceps muscle is completed within CS 21; therefore, our results suggest that the TVI is the last element to develop in the quadriceps femoris complex. It is posited that after the embryonic period, the TVI continues to grow, while forming the tendinous structure toward the patella and receiving vascular supply from certain vascular branches. The clinical significance of these findings is that orthopedists and plastic surgeons who perform surgical procedures within the anterolateral thigh (ALT) area should be aware of the anatomy and development of the TVI in order to reduce surgical complications. Our present research aims to contribute to a deeper understanding of the morphogenesis of the TVI and the other femoral extensor muscles.
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Affiliation(s)
- Natsuko Utsunomiya
- Department of Plastic and Reconstructive SurgeryGraduate School of MedicineKyoto UniversityKyotoJapan
- Congenital Anomaly Research CenterGraduate School of MedicineKyoto UniversityKyotoJapan
| | - Ryota Kodama
- Human Health SciencesGraduate School of MedicineKyoto UniversityKyotoJapan
| | - Yutaka Yamaguchi
- Congenital Anomaly Research CenterGraduate School of MedicineKyoto UniversityKyotoJapan
| | - Itaru Tsuge
- Department of Plastic and Reconstructive SurgeryGraduate School of MedicineKyoto UniversityKyotoJapan
| | - Shigehito Yamada
- Congenital Anomaly Research CenterGraduate School of MedicineKyoto UniversityKyotoJapan
- Human Health SciencesGraduate School of MedicineKyoto UniversityKyotoJapan
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Sawy MME, Mikkawy DMEE, El-Sayed SM, Desouky AM. Morphometric analysis of vastus medialis oblique muscle and its influence on anterior knee pain. Anat Cell Biol 2021; 54:1-9. [PMID: 33262319 PMCID: PMC8017455 DOI: 10.5115/acb.20.258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/01/2020] [Accepted: 11/02/2020] [Indexed: 11/27/2022] Open
Abstract
Healthy knees require full range squatting movements. Vastus medialis (VM) muscle regulates and adjusts the extensor apparatus that influences the patellofemoral function. This work was designed to investigate the anatomy and morphometry of vastus medialis oblique (VMO) muscle by widely used imaging techniques and investigate how VMO muscle participates in anterior knee pain. Ten dissected cadaveric specimens were examined, focusing on fiber orientations, origin, insertions and nerve supply of VMO muscle. Magnetic resonance imaging and ultrasound of VMO muscle were recorded. Anatomical cross-sectional areas of VMO muscle were determined in painless and painful knees and statistically analyzed. In cadaveric specimens, there was distinct separation between VM longus and VMO (change in fiber angle or fibro-fascial plane). VMO inserted directly into the medial proximal margin of the patella, capsule of the knee joint and continuous with the patellar tendon. Separate branch of femoral nerve run along the anteromedial border of the muscle. Anatomical cross-sectional area was significantly decreased in painful knee by -17.2%±11.0% at lower end of shaft of femur, -21.1%±6.0% at upper border of patella, -36.7%±11.0% at mid-patellar level. VMO is distinct muscle within quadriceps femoris group. VMO muscle would track the patella medially and participate in last phase of knee extension. Assessment of the VMO muscle anatomical cross-sectional area by ultrasonography may constitute promising and reliable tool to evaluate patellofemoral pain syndrome staging.
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Affiliation(s)
- Marwa M El Sawy
- Department of Anatomy, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Dalia M E El Mikkawy
- Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Sayed M El-Sayed
- Department of Anatomy, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmed M Desouky
- Department of Anatomy, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Ogami-Takamura K, Saiki K, Endo D, Murai K, Nishi K, Okamoto K, Murata H, Hara T, Tsurumoto T. Gross anatomical investigation of the muscular head between the vastus lateralis and intermedius in the Japanese population: a cadaver study. Anat Sci Int 2020; 96:231-238. [PMID: 33219435 DOI: 10.1007/s12565-020-00579-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 09/24/2020] [Indexed: 10/22/2022]
Abstract
Unlike the general understanding of the quadriceps femoris, the existence of a new muscular head between the vastus lateralis and the vastus intermedius was reported, and named the tensor of the vastus intermedius in the Swedish population. The purpose of this study was to investigate the presence and form of the muscular head in the Japanese population and to clarify its structure by gross anatomical approaches. A total of 35 thighs of 20 Japanese cadavers were investigated. We searched for the muscular head and classified it into four types. In addition, nerve fiber analysis was performed for each classification type. Regarding classification, 11% were the independent type, 29% were the common type, 37% were the vastus lateralis type, and 23% were the vastus intermedius type. Based on nerve fiber analysis, in the common type, the muscular head was under dual nerve supply from the vastus lateralis and intermedius. The other three types were innervated only by nerves from the vastus lateralis. The target muscular head may always be present in Japanese. The nerves from the vastus lateralis were always distributed in the target muscular head based on nerve fiber analysis; therefore, this muscular head may be most closely related to the vastus lateralis. The name of this muscular head should be "the accessory head of the vastus lateralis" rather than "the tensor of the vastus intermedius."
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Affiliation(s)
- Keiko Ogami-Takamura
- Department of Macroscopic Anatomy, Graduate School of Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, Nagasaki, 852-8523, Japan. .,Center of Cadaver Surgical Training, School of Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, Nagasaki, 852-8523, Japan. .,Department of Anesthesiology and Intensive Care Medicine, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan.
| | - Kazunobu Saiki
- Department of Macroscopic Anatomy, Graduate School of Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, Nagasaki, 852-8523, Japan
| | - Daisuke Endo
- Department of Macroscopic Anatomy, Graduate School of Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, Nagasaki, 852-8523, Japan
| | - Kiyohito Murai
- Department of Macroscopic Anatomy, Graduate School of Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, Nagasaki, 852-8523, Japan
| | - Keita Nishi
- Department of Oral Anatomy and Dental Anthropology, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8588, Japan
| | - Keishi Okamoto
- Department of Macroscopic Anatomy, Graduate School of Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, Nagasaki, 852-8523, Japan
| | - Hiroaki Murata
- Department of Anesthesiology and Intensive Care Medicine, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan
| | - Tetsuya Hara
- Department of Anesthesiology and Intensive Care Medicine, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan
| | - Toshiyuki Tsurumoto
- Department of Macroscopic Anatomy, Graduate School of Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, Nagasaki, 852-8523, Japan.,Center of Cadaver Surgical Training, School of Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, Nagasaki, 852-8523, Japan
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Olewnik Ł, Tubbs RS, Ruzik K, Podgórski M, Aragonés P, Waśniewska A, Karauda P, Szewczyk B, Sanudo JR, Polguj M. Quadriceps or multiceps femoris?-Cadaveric study. Clin Anat 2020; 34:71-81. [PMID: 32644202 DOI: 10.1002/ca.23646] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/07/2020] [Accepted: 07/07/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE The quadriceps femoris (QF) consists of four muscles: the rectus femoris; vastus medialis; vastus lateralis, and vastus intermediate. The tendons of all of these parts join together into a single tendon that attaches to the patella. The QF is a powerful extensor of the knee joint that is needed for walking. A growing number of publications have examined the fifth head of the QF muscle. There is no information about the possibility of other heads, and there is no correct classification of their proximal attachments. Further, the frequency of occurrence of additional heads/components of the QF remains unclear. METHODS One hundred and six lower limbs (34 male and 18 female) fixed in 10% formalin solution were examined. RESULTS Additional heads of the QF were present in 64.1% of the limbs. Three main types were identified and included subtypes. The most common was Type I (44.1%), which had an independent fifth head. This type was divided into two subtypes (A-B) depending on its location relative to the vastus intermediate. The second most common type was Type II (30.8%), which originated from other muscles: IIA from the vastus lateralis; IIB from the vastus intermediate, and IIC from the gluteus minimus. In addition, Type III (25%) was characterized by multiple heads: IIIA-two heads with a single common tendon; IIIB-two heads with two separate tendons; IIIC-three heads (lateral, intermediate, medial), and IIID-four heads (bifurcated lateral and bifurcated medial). CONCLUSION The introduction of a new classification based on a proximal attachment is necessary. The presence of the fifth, sixth, seventh, or eighth head varies.
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Affiliation(s)
- Łukasz Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Richard Shane Tubbs
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA.,Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA.,Department of Anatomical Sciences, St. George's University, True Blue, Grenada
| | - Kacper Ruzik
- Department of Normal and Clinical Anatomy, Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
| | - Michał Podgórski
- Department of Imaging Diagnostic, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Paloma Aragonés
- Department of Orthopedics Surgery, Hospital Santa Cristina, Madrid, Spain
| | - Anna Waśniewska
- Department of Normal and Clinical Anatomy, Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
| | - Piotr Karauda
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Bartłomiej Szewczyk
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Jose Ramón Sanudo
- Department of Human Anatomy and Embryology, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Michał Polguj
- Department of Normal and Clinical Anatomy, Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
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Aragonés P, Olewnik Ł, Polguj M, Quinones S, Sanudo J. The fifth head of quadriceps femoris: for sure? Surg Radiol Anat 2020; 43:33-36. [PMID: 32902694 DOI: 10.1007/s00276-020-02564-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 08/29/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE The quadriceps femoris has been described as a muscle composed by four heads: rectus femoris, vastus lateralis, vastus medialis and vastus intermedius. Each head fuse with the other ones making up the quadriceps tendon, which inserts into the patella. Nevertheless, there has been described a fifth component of the quadriceps muscle in recent anatomical publications. Understanding this fifth head may be important for orthopedics and radiologist. METHODS Cadaveric dissection of left thigh of a female 83 years old was performed to demonstrate a fifth head of the quadriceps femoris muscle. RESULTS In this study, a fifth head of the quadriceps femoris muscle was found in the left thigh of a female cadaver 83 years old. This fifth head was made up by four independent muscular fascicles attaching in a common flat tendon that joins distally with the lateral border of the quadriceps tendon. The fifth head found was supplied by branches of the ascending branch of the lateral femoral circumflex artery and by branches of the deep lateral division of the femoral nerve. CONCLUSIONS The incidence of this fifth belly in cadaveric studies has been reported as a range from 29 to 100%. However, no published articles refer an anatomical finding such as this multi-bellied fifth head. The knowledge of the existence and location of the fifth belly is necessary to make accurate diagnosis of QF muscle strains. Its anatomical course may be involved in patellar tracking.
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Affiliation(s)
- P Aragonés
- Department of Orthopedics Surgery, Hospital Santa Cristina, C/Amadeo Vives s/n, 28009, Madrid, Spain.
- Department of Human Anatomy, Universidad Alfonso X El Sabio, Avda de la Universidad 1, 28691, Madrid, Spain.
| | - Ł Olewnik
- Department of Normal and Clinical Anatomy, Chair of Anatomy and Histology, Medical University of Lodz, Lodz, 90-151, Poland
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, 90-151, Poland
| | - M Polguj
- Department of Normal and Clinical Anatomy, Chair of Anatomy and Histology, Medical University of Lodz, Lodz, 90-151, Poland
| | - S Quinones
- Department of Human Anatomy and Embryology, Medical Faculty, Universidad Complutense de Madrid, Madrid, 28040, Spain
| | - J Sanudo
- Department of Human Anatomy and Embryology, Medical Faculty, Universidad Complutense de Madrid, Madrid, 28040, Spain
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Chivot M, Pioger C, Cognault J, Sharma A, Pailhé R, Cavaignac E, Ollivier M, Jacquet C. Every layer of quadriceps tendon's central and medial portion offers similar tensile properties than Hamstrings or Ilio-Tibial Band Grafts. J Exp Orthop 2020; 7:50. [PMID: 32651731 PMCID: PMC7351916 DOI: 10.1186/s40634-020-00261-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 06/11/2020] [Indexed: 01/10/2023] Open
Abstract
PURPOSE The aim of our cadaveric study was to compare the mechanical properties of different parts of the quadriceps' tendon in a load to failure analysis as compared to three other, and most common types of grafts that are used to perform ligament's reconstruction. METHODS Ten fresh-frozen cadavers (5 women, 5 men) were selected from our anatomical department. Mean age at death was 64 years (48-87 years). Tendons were harvested to prepare (1) different quadriceps tendon's specimens: lateral portion (QTlat), medial portion superficial layer (QTMsup) and deep layer (QTMdeep) and central portion superficial (QTCsup) and deep layers (QTCdeep) (2) Patellar Tendon (PT), (3) Gracilis+Semi-Tendinosus specimens (GST). Specimens were stored at - 40 °C in a freezing solution. Specimens were securely attached to a dedicated loading platform, measurements were done using a validated software. Load to failure testing was then carried out. Young's Elastic moduli, ultimate Stress (MPa) and Deformation (%) were analysed. RESULTS The elastic moduli of the PT was significantly higher than all other grafts, all medial and central QT layers (superficial and deep) were significantly higher than its lateral part (QTlat). In terms of Ultimate Stress, all grafts were significantly greater than QTlat, PT and GST were significantly superior to QT central portions and to ITB but there did not differ with the medial portion of QT. ITB ultimate stress values were significantly higher than QTlat. The ultimate deformations of all grafts were similar. CONCLUSIONS This study provides reference values in in order to characterize different parts of the QT that presents anatomically and Mechanically with complex characteristics. Every Layer of Quadriceps Tendon's Central and Medial Portion Offered Similar Mechanical Properties than Two Strand Hamstrings or Ilio-Tibial Band.
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Affiliation(s)
- Matthieu Chivot
- Aix-Marseille University, CNRS, ISM UMR 7287, 13288, Cedex 09, Marseille, France
| | - Charles Pioger
- Aix-Marseille University, CNRS, ISM UMR 7287, 13288, Cedex 09, Marseille, France.,Clinique du Parc, 69006, Lyon, France
| | | | - Akash Sharma
- Aix-Marseille University, CNRS, ISM UMR 7287, 13288, Cedex 09, Marseille, France.,Clinique du Parc, 69006, Lyon, France
| | - Regis Pailhé
- Department of Orthopaedic Surgery and Sport Traumatology, Grenoble South Teaching Hospital, 38130, Echirolles, France
| | - Etienne Cavaignac
- Department of Orthopedic Surgery and Trauma, Hôpital Pierre Paul Riquet, Toulouse, France
| | - Matthieu Ollivier
- Aix-Marseille University, CNRS, ISM UMR 7287, 13288, Cedex 09, Marseille, France. .,Department of Orthopedic surgery and Traumatology, University institute of movement and locomotion, St. Marguerite Hospital, 270 Boulevard Sainte Marguerite, 29 13274, Marseille, BP, France.
| | - Christophe Jacquet
- Aix-Marseille University, CNRS, ISM UMR 7287, 13288, Cedex 09, Marseille, France.,Clinique du Parc, 69006, Lyon, France
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Medial patellofemoral ligament reconstruction using a central strip of the quadriceps tendon in patients with recurrent patellar instability: a prospective case series. CURRENT ORTHOPAEDIC PRACTICE 2020. [DOI: 10.1097/bco.0000000000000882] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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23
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Bonnechère B, Louryan S, Feipel V. Triceps, quadriceps or pentaceps femoris? Need for proper muscle definition. Morphologie 2020; 104:77-84. [PMID: 31296371 DOI: 10.1016/j.morpho.2019.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 05/29/2019] [Accepted: 06/13/2019] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Over the last years, the definition of quadriceps femoris (QF) has evolved somewhat and some authors now define a fifth head: the tensor of vastus intermedius (TVI). Descriptions of the different components of QF in textbooks and recent findings remain confusing. Therefore, the aim of this study is to obtain more information on this possible fifth head. MATERIALS AND METHODS Twenty lower limbs of 10 embalmed cadavers, six females and four males, were investigated by macro-dissection. The dissection and separation of the different heads were performed with the fingers and a distinction between the different parts of the quadriceps was noted only if it was possible to separate the heads without scalpel to avoid artificial separation of muscle parts. RESULTS In 9 lower limbs we found a QF as classically described in textbook. TVI was found in only 7 limbs and in 4 cases we were not able to differentiate VI and VM or VI and VL (triceps femoris as described by Testut). These results, and the diversity of descriptions found in the literature have led us to review the definition of an isolated muscle. CONCLUSION In this study, the presence of TVI was not demonstrated in all limbs unlike previously published studies on the subject. Harmonisation of dissection techniques, but also a clear definition of a muscle is required in order to be able to compare studies and draw clear conclusions.
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Affiliation(s)
- B Bonnechère
- Laboratory of Anatomy, Biomechanics and Organogenesis (LABO), Université Libre de Bruxelles, Lennik street, 808, 1070 Brussels, Belgium; Department of Electronics and Informatics - ETRO, Vrije Universiteit Brussel, Pleinlaan 2, 1050 Brussels, Belgium; Imec, Leuven, Belgium.
| | - S Louryan
- Laboratory of Anatomy, Biomechanics and Organogenesis (LABO), Université Libre de Bruxelles, Lennik street, 808, 1070 Brussels, Belgium
| | - V Feipel
- Laboratory of Functional Anatomy, Université Libre de Bruxelles, Lennik street, 808, 1070 Brussels, Belgium
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Unusual case report of seven-headed quadriceps femoris muscle. Surg Radiol Anat 2020; 42:1225-1229. [DOI: 10.1007/s00276-020-02472-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 04/11/2020] [Indexed: 11/30/2022]
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Quadriceps tendon autograft ACL reconstructed subjects overshoot target knee extension angle during active proprioception testing. Knee Surg Sports Traumatol Arthrosc 2020; 28:645-652. [PMID: 31776624 DOI: 10.1007/s00167-019-05795-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 11/07/2019] [Indexed: 01/18/2023]
Abstract
PURPOSE To compare the active joint position sense (JPS), muscle strength, and knee functions in individuals who had anterior cruciate ligament (ACL) reconstruction with quadriceps tendon autograft, hamstring tendon autograft, tibialis anterior allograft and healthy individuals. It was hypothesized that when compared to an age and gender-matched healthy control group, subjects who were post-ACL reconstruction would display impaired active joint position sense, knee extensor and flexor strength symmetry and knee function at 1 year post-surgery. A secondary hypothesis was that differences would exist between the quadriceps tendon autograft, hamstring tendon autograft and tibialis anterior allograft groups. METHODS Sixty-seven patients with ACL reconstruction and 20 healthy individuals were included. Active JPS reproduction was measured at 15°, 45° and 75° of knee flexion. International Knee Documentation Committee (IKDC) subjective score and one-leg hop test were used to assess the functional status of the patients. RESULTS The JPS detection was different at the 15° target angle between groups (F3.86 = 24.56, p < 0.001). A significantly higher proportion of quadriceps tendon autograft group patients failed to identify the 15° active JPS assessment position compared to the other groups (p < 0.0001). The quadriceps index was lower in patients compared to healthy individuals (p < 0.001), while the hamstring index was similar (n.s.). The knee functional outcomes were similar between ACL reconstructed groups and healthy controls (n.s.). CONCLUSION Knee proprioception deficits and impaired muscle strength were evident among patients at a mean 13.5 months post-ACL reconstruction compared with healthy controls. Patients who underwent ACL reconstruction using a quadriceps tendon autograft may be more likely to actively over-estimate knee position near terminal extension. Physiotherapists may need to focus greater attention on terminal knee extension proprioceptive awareness among this patient group. LEVEL OF EVIDENCE III.
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Shea KG, Burlile JF, Richmond CG, Ellis HB, Wilson PL, Fabricant PD, Mayer S, Stavinoha T, Troyer S, Dingel AB, Ganley TJ. Quadriceps Tendon Graft Anatomy in the Skeletally Immature Patient. Orthop J Sports Med 2019; 7:2325967119856578. [PMID: 31321249 PMCID: PMC6624918 DOI: 10.1177/2325967119856578] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background: The quadriceps tendon (QT) is increasingly considered for primary and
revision anterior cruciate ligament reconstruction in skeletally immature
patients, as it may be harvested as a purely soft tissue graft with
considerable tissue volume. Because of distinct rectus tendon (RT)
separation from the QT complex, the potential for RT retraction exists and
could lead to QT weakness after QT graft harvest. Purpose: To describe the anatomy of the pediatric QT and clarify decussation of the RT
and QT to avoid the risk of delayed RT retraction and QT weakness after QT
graft harvest. Study Design: Descriptive epidemiology study. Methods: Nine cadaveric knee specimens (aged 4-11 years) underwent gross dissection.
Coronal-plane width and depth of the QT were measured at intervals proximal
to the superior pole of the patella at distances of 0.0, 0.5, 1.0, and 1.5
times the length of the patella. The distance was measured from the superior
patellar pole to the point of RT separation from the remainder of the
deeper/posterior QT. Results: The median patellar length was 28 mm (interquartile range, 26-37 mm). The
coronal-plane width of the QT was larger superficially/anteriorly when
closest to the patella but wider when measured deeper/posteriorly as the
tendon extended proximally. The median distance between the superior pole of
the patella and RT separation from the QT was 0.95 times the patellar
length. The distance to widening of the deeper/posterior aspect of the QT
was 1.14 times the patellar length proximal to the patella. Conclusion: The RT begins a distinct separation from the QT above the superior pole of
the patella at a median of 0.95 times the patellar length in skeletally
immature specimens. The deeper/posterior aspect of the QT begins to increase
in coronal-plane width proximally after a distance of 1.14 times the
patellar length above the knee, while the superficial/anterior aspect of the
tendon continues to narrow. Awareness of the separation of the RT from the
QT, and the coronal-plane width variation aspects of the QT proximally, is
important for surgeons utilizing the QT as a graft to avoid inadvertent
release of the RT from the rest of the QT complex.
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Affiliation(s)
- Kevin G Shea
- Department of Orthopaedic Surgery, School of Medicine, Stanford University, Stanford, California, USA
| | | | - Connor G Richmond
- College of Osteopathic Medicine, University of New England, Biddeford, Maine, USA
| | - Henry B Ellis
- Department of Orthopaedic Surgery, Texas Scottish Rite Hospital for Children, Dallas, Texas, USA
| | - Philip L Wilson
- Department of Orthopaedic Surgery, Texas Scottish Rite Hospital for Children, Dallas, Texas, USA
| | - Peter D Fabricant
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Stephanie Mayer
- Department of Orthopedic Surgery, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Tyler Stavinoha
- Department of Orthopaedic Surgery, School of Medicine, Stanford University, Stanford, California, USA
| | | | - Aleksei B Dingel
- Department of Orthopaedic Surgery, School of Medicine, Stanford University, Stanford, California, USA
| | - Theodore J Ganley
- Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Shubert DJ, McDonough EB. Bilateral Medial and Lateral Patellofemoral Ligament Reconstruction in a Patient with Hypermobility Type Ehlers-Danlos Syndrome: A Case Report. JBJS Case Connect 2019; 9:e0359. [PMID: 31390333 DOI: 10.2106/jbjs.cc.18.00359] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
CASE Medial patellar instability (MPI) is a known sequela of previous lateral retinacular release. Literature on surgical intervention is scarce. We present a case of a 35-year-old woman with hypermobility type Ehlers-Danlos syndrome, with bilateral iatrogenic MPI (IMPI) and lateral patellar instability. This condition led to a marked decrease in quality of life, 10/10 persistent pain, and frequent dislocation events. She was successfully treated surgically, and at 2 years had 0/10 pain and no further dislocations. CONCLUSIONS Our technique for medial and lateral patellofemoral ligament reconstruction is a viable intervention for patients with IMPI, even in the setting of underlying collagen disorder.
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Affiliation(s)
- Daniel J Shubert
- Department of Orthopaedics, West Virginia University, Morgantown, West Virginia
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Does epimuscular myofascial force transmission occur between the human quadriceps muscles in vivo during passive stretching? J Biomech 2019; 83:91-96. [DOI: 10.1016/j.jbiomech.2018.11.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 11/14/2018] [Accepted: 11/15/2018] [Indexed: 12/31/2022]
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Fink C, Lawton R, Förschner F, Gföller P, Herbort M, Hoser C. Minimally Invasive Quadriceps Tendon Single-Bundle, Arthroscopic, Anatomic Anterior Cruciate Ligament Reconstruction With Rectangular Bone Tunnels. Arthrosc Tech 2018; 7:e1045-e1056. [PMID: 30377585 PMCID: PMC6203691 DOI: 10.1016/j.eats.2018.06.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 06/26/2018] [Indexed: 02/03/2023] Open
Abstract
Many surgeons use quadriceps tendon (QT) graft for anterior cruciate ligament (ACL) revision surgery; however, despite excellent clinical results, the QT has not achieved universal acceptance for primary ACL reconstruction. One of the reasons for this may be that the QT is technically demanding to harvest and the scar from open harvesting techniques is less cosmetically favorable than that from hamstring tendon techniques. Recent evidence has suggested that broad flat QT grafts may more closely mimic native ACL "ribbon-like" morphology than hamstring tendon grafts. Furthermore, rectangular bone tunnels may more accurately re-create native ACL attachments, allowing grafts to simulate native ACL rotation during knee flexion and potentially improving biomechanics. Rectangular tunnels have further advantages in revision cases, in which-in comparison with round tunnels-they have reduced overlap with pre-existing transtibial tunnels, increasing the chance of bypassing primary tunnels during revision surgery. Finally, instrumentation for minimally invasive QT harvesting has reduced technical difficulty and improved cosmetic results. Hence, technical and cosmetic concerns are no longer barriers to QT use. These anatomic and biomechanical advantages and technical developments make the QT an increasingly attractive option for both primary and revision ACL reconstruction.
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Affiliation(s)
- Christian Fink
- Gelenkpunkt–Sports and Joint Surgery, Innsbruck, Austria,Research Unit for Orthopaedic Sports Medicine and Injury Prevention, Institute for Sports Medicine, Alpine Medicine and Health Tourism, Private University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria,Address correspondence to Christian Fink, M.D., Gelenkpunkt–Sports and Joint Surgery, Olympiastrasse 39, 6020 Innsbruck, Austria.
| | - Robert Lawton
- Gelenkpunkt–Sports and Joint Surgery, Innsbruck, Austria,Research Unit for Orthopaedic Sports Medicine and Injury Prevention, Institute for Sports Medicine, Alpine Medicine and Health Tourism, Private University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | | | - Peter Gföller
- Gelenkpunkt–Sports and Joint Surgery, Innsbruck, Austria
| | - Mirco Herbort
- Department of Trauma, Hand and Reconstructive Surgery, Westfälian-Wilhelms University of Münster, Münster, Germany
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Abstract
PURPOSE Critically evaluate the published literature related to quadriceps tendon (QT) medial patellofemoral ligament (MPFL) reconstruction. RECENT FINDINGS Hamstring tendon (HT) MPFL reconstruction techniques have been shown to successfully restore patella stability, but complications including patella fracture are reported. Quadriceps tendon (QT) reconstruction techniques with an intact graft pedicle on the patella side have the advantage that patella bone tunnel drilling and fixation are no longer needed, reducing risk of patella fracture. Several QT MPFL reconstruction techniques, including minimally invasive surgical (MIS) approaches, have been published with promising clinical results and fewer complications than with HT techniques. Parallel laboratory studies have shown macroscopic anatomy and biomechanical properties of QT are more similar to native MPFL than hamstring (HS) HT, suggesting QT may more accurately restore native joint kinematics. Quadriceps tendon MPFL reconstruction, via both open and MIS techniques, have promising clinical results and offer valuable alternatives to HS grafts for primary and revision MPFL reconstruction in both children and adults.
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The interaction between the vastus medialis and vastus intermedius and its influence on the extensor apparatus of the knee joint. Knee Surg Sports Traumatol Arthrosc 2018; 26:727-738. [PMID: 28124107 DOI: 10.1007/s00167-016-4396-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 12/01/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Although the vastus medialis (VM) is closely associated with the vastus intermedius (VI), there is a lack of data regarding their functional relationship. The purpose of this study was to investigate the anatomical interaction between the VM and VI with regard to their origins, insertions, innervation and function within the extensor apparatus of the knee joint. METHODS Eighteen human cadaveric lower limbs were investigated using macro-dissection techniques. Six limbs were cut transversely in the middle third of the thigh. The mode of origin, insertion and nerve supply of the extensor apparatus of the knee joint were studied. The architecture of the VM and VI was examined in detail, as was their anatomical interaction and connective tissue linkage to the adjacent anatomical structures. RESULTS The VM originated medially from a broad hammock-like structure. The attachment site of the VM always spanned over a long distance between: (1) patella, (2) rectus femoris tendon and (3) aponeurosis of the VI, with the insertion into the VI being the largest. VM units were inserted twice-once on the anterior and once on the posterior side of the VI. The VI consists of a complex multi-layered structure. The layers of the medial VI aponeurosis fused with the aponeuroses of the tensor vastus intermedius and vastus lateralis. Together, they form the two-layered intermediate layer of the quadriceps tendon. The VM and medial parts of the VI were innervated by the same medial division of the femoral nerve. CONCLUSION The VM consists of multiple muscle units inserting into the entire VI. Together, they build a potential functional muscular complex. Therefore, the VM acts as an indirect extensor of the knee joint regulating and adjusting the length of the extensor apparatus throughout the entire range of motion. It is of clinical importance that, besides the VM, substantial parts of the VI directly contribute to the medial pull on the patella and help to maintain medial tracking of the patella during knee extension. The interaction between the VM and VI, with responsibility for the extension of the knee joint and influence on the patellofemoral function, leads readily to an understanding of common clinical problems found at the knee joint as it attempts to meet contradictory demands for both mobility and stability. Surgery or trauma in the anteromedial aspect of the quadriceps muscle group might alter a delicate interplay between the VM and VI. This would affect the extensor apparatus as a whole.
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Grob K, Manestar M, Gascho D, Ackland T, Gilbey H, Fretz C, Kuster MS. Magnetic resonance imaging of the tensor vastus intermedius: A topographic study based on anatomical dissections. Clin Anat 2017; 30:1096-1102. [DOI: 10.1002/ca.22981] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 08/10/2017] [Accepted: 08/11/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Karl Grob
- Department of Orthopaedic Surgery, Rorschacher Strasse 95; CH-9007 St. Gallen Switzerland
| | - Mirjana Manestar
- Department of Anatomy, University of Zürich-Irchel, Winterthurerstrasse 190; Zürich CH-8057 Switzerland
| | - Dominic Gascho
- Department of Forensic Medicine and Imaging, University of Zurich, Winterthurerstrasse 190/52; Zürich CH-8057 Switzerland
| | - Timothy Ackland
- The University of Western Australia, 35 Stirling Highway, Crawley; Perth Western Australia 6009 Australia
| | - Helen Gilbey
- Hollywood Functional Rehabilitation Clinic; Perth Western Australia Australia
| | - Christian Fretz
- Department of Radiology, Rorschacher Strasse 95; CH-9007 St. Gallen Switzerland
| | - Markus S. Kuster
- The University of Western Australia, 35 Stirling Highway, Crawley; Perth Western Australia 6009 Australia
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de Carvalho KL, Silva PE, Castro J, Babault N, Durigan JLQ, de Cássia Marqueti R. Height, Weight, and Age Predict Quadriceps Tendon Length and Thickness in Skeletally Immature Patients: Letter to the Editor. Am J Sports Med 2017; 45:NP26. [PMID: 28714794 DOI: 10.1177/0363546517717699] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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