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Clinical Anatomy of the Quadriceps Femoris and Extensor Apparatus of the Knee

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Clinical Orthopaedics and Related Research®

Abstract

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.

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Authors and Affiliations

  1. Drexel University College of Medicine, Philadelphia, PA, USA

    Andrew C. Waligora BS

  2. Department of Orthopaedic Surgery, Drexel University College of Medicine, Hahnemann University Hospital, Philadelphia, PA, USA

    Norman A. Johanson MD

  3. Department of Neurobiology and Anatomy, Drexel University College of Medicine, 2900 Queen Lane, Philadelphia, PA, 19129-1096, USA

    Bruce Elliot Hirsch PhD

Authors
  1. Andrew C. Waligora BS
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  2. Norman A. Johanson MD
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  3. Bruce Elliot Hirsch PhD
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Correspondence to Bruce Elliot Hirsch PhD.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

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Waligora, A.C., Johanson, N.A. & Hirsch, B.E. Clinical Anatomy of the Quadriceps Femoris and Extensor Apparatus of the Knee. Clin Orthop Relat Res 467, 3297–3306 (2009). https://doi.org/10.1007/s11999-009-1052-y

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  • DOI: https://doi.org/10.1007/s11999-009-1052-y

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