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Pośnik M, Zielinska N, Okoń A, Węgiel A, Głowacka M, Olewnik Ł. Morphological Variability of the Thigh Muscle Traps in an Ultrasound That Awaits Clinicians. J Clin Med 2025; 14:464. [PMID: 39860470 PMCID: PMC11765969 DOI: 10.3390/jcm14020464] [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: 09/03/2024] [Revised: 01/02/2025] [Accepted: 01/06/2025] [Indexed: 01/27/2025] Open
Abstract
Objectives: Muscles and their tendons present a considerable diversity of morphological variations. The aim of this study was to explore variants of muscles and tendons from compartments of the thigh and to raise awareness about potential problems during ultrasound examination. Materials and Methods: This comprehensive review of the literature was created on the basis of scientific articles sourced from PubMed. The search included all relevant papers related to the topic, ensuring that the most up-to-date studies were incorporated. In order to achieve these results, we created the exclusion criteria and extracted papers that did not meet the requirements of our review. Relevant papers were incorporated, and tracking of citations was fulfilled. The described method allowed for a broad yet detailed understanding, ensuring that the review of the literature covers all key aspects of the presented research. Results: Various aspects of thigh muscle anomalies were already undertaken; however, as this study has shown, current knowledge, while valuable, is insufficient to draw definitive conclusions regarding the prevalence and clinical implications of these muscle variations. A more robust body of ultrasound-based research is essential to accurately characterize these anomalies, establish their frequency, and assess their impact on clinical decision-making, including diagnostic accuracy, surgical planning, and therapeutic interventions. Conclusions: Numerous anatomical variations of the thigh muscles and tendons that were described in literature over the years might have clinical implications and could lead to mistakes during diagnosis by ultrasound imaging.
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Affiliation(s)
- Marta Pośnik
- Department of Radiology, Diagnostic Imaging and Interventional Radiology, Medical University of Lodz, 90-419 Lodz, Poland;
| | - Nicol Zielinska
- Department of Clinical Anatomy, Masovian Academy in Płock, 09-402 Płock, Poland; (N.Z.); (A.O.)
| | - Adrian Okoń
- Department of Clinical Anatomy, Masovian Academy in Płock, 09-402 Płock, Poland; (N.Z.); (A.O.)
| | - Andrzej Węgiel
- Department of Rheumatology, Medical University of Lodz, 90-549 Lodz, Poland;
| | - Mariola Głowacka
- Nursing Department, Masovian Academy in Płock, 09-402 Płock, Poland;
| | - Łukasz Olewnik
- Department of Clinical Anatomy, Masovian Academy in Płock, 09-402 Płock, Poland; (N.Z.); (A.O.)
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Spuehler D, Kuster L, Ullrich O, Grob K. Femoral nerve palsy following Girdlestone resection arthroplasty: An observational cadaveric study. World J Orthop 2024; 15:1175-1182. [DOI: 10.5312/wjo.v15.i12.1175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Revised: 11/12/2024] [Accepted: 12/05/2024] [Indexed: 12/17/2024] Open
Abstract
BACKGROUND When patients with a failed hip arthroplasty are unsuitable for reimplantation, Girdlestone resection arthroplasty (GRA) is a viable treatment option. We report on a patient who was treated with a GRA due to a periprosthetic infection. We discovered partial paralysis of the quadriceps muscle in this patient. We investigated the femoral nerve anatomy, particularly the nerve entry points, to better understand this phenomenon.
AIM To reveal the femoral nerve anatomy with respect to severe proximal migration after GRA.
METHODS Eight cadaveric hemipelves were investigated. The branches of the femoral nerve were dissected and traced distally. The GRA was performed by the direct anterior approach. Axial stress to the lower extremity was applied, and the relative movement of the femur was recorded. The femoral nerve and its entry points were assessed.
RESULTS GRA led to a 3.8 cm shift of the femur in vertical direction, a 1.8 cm shift in the dorsal direction, and a 2.3 cm shift in the lateral direction. A 36.5° external shift was observed. This caused stress to the lateral division of the femoral nerve. We observed migration of the femoral nerve entry point at the following locations: (1) Vastus medialis (5.3 mm); (2) The medial part of the vastus intermedius (5.4 mm); (3) The lateral part of the vastus intermedius (16.3 mm); (4) Rectus femoris (23.1 mm); (5) Tensor vastus intermedius (30.8 mm); and (6) Vastus lateralis (28.8 mm).
CONCLUSION Migration of the femur after GRA altered the anatomy of the femoral nerve. Stress occurred at the lateral nerve division leading to poor functional results.
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Affiliation(s)
- Dominik Spuehler
- Department of Orthopaedic Surgery and Traumatology, Cantonal Hospital Sankt Gallen, Sankt Gallen 9007, Switzerland
| | - Lukas Kuster
- Department of Orthopaedics Surgery, Sir Charles Gairdner Hospital, Perth 6009, Western Australia, Australia
| | - Oliver Ullrich
- Institute of Anatomy, University of Zurich, Zurich 8057, Switzerland
| | - Karl Grob
- Department of Orthopaedic Surgery and Traumatology, Cantonal Hospital Sankt Gallen, Sankt Gallen 9007, Switzerland
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Olewnik Ł, Zielinska N, Karauda P, Piagkou M, Koptas K, Maślanka K, Ruzik K, Triantafyllou G, Balcerzak A, Klejman E, Paulsen F. The quadratus femoris muscle anatomy: Do we know everything? Ann Anat 2024; 255:152284. [PMID: 38830558 DOI: 10.1016/j.aanat.2024.152284] [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: 10/09/2023] [Revised: 04/01/2024] [Accepted: 05/06/2024] [Indexed: 06/05/2024]
Abstract
INTRODUCTION The purpose of this study was to characterize the morphological variations in the quadratus femoris muscle (QF) and to create an anatomical classification that could be used in the planning of surgical procedures in this area, radiological imaging, and rehabilitation. MATERIALS AND METHODS Ninety-two lower limbs from 46 cadavers, fixed in 10 % formalin solution, were examined. RESULTS The QF muscle was present in all specimens. According to morphology, the QF muscle was classified into three types. The most common type was Type I, characterized by one muscular belly (78.3 %), while the second most common type was Type II, characterized by two bellies, was observed in 17.4 % of cases. The rarest type was Type III. It was characterized by three bellies and was found in 4.3 % of the cases. CONCLUSIONS The current classification system on quadratus femoris morphological variability is novel. Morphological variants may contribute to clinical issues, such as the ischiofemoral impingement syndrome, that could arise from type I quadratus femoris. Hence, the current study may be applicated to planning surgical procedures, imaging, and rehabilitation.
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Affiliation(s)
- Łukasz Olewnik
- Department of Clinical Anatomy, Masovian Academy in Płock, Poland.
| | - Nicol Zielinska
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Piotr Karauda
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Maria Piagkou
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Krzysztof Koptas
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Krystian Maślanka
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Kacper Ruzik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - George Triantafyllou
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Adrian Balcerzak
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Ewa Klejman
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland
| | - Friedrich Paulsen
- Institute of Functional and Clinical Anatomy, Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany
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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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Sariyildiz A, Coskun Benlidayi I, Piskin FC, Kundakci B, Ornek C, Andirin M. Not an arthritis, but a fibrotic band of the quadriceps muscle: A case report of unilateral restricted knee flexion in an adolescent. Int J Rheum Dis 2024; 27:e15113. [PMID: 38459630 DOI: 10.1111/1756-185x.15113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/05/2024] [Accepted: 02/22/2024] [Indexed: 03/10/2024]
Affiliation(s)
- Aylin Sariyildiz
- Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Cukurova University, Adana, Turkey
| | - Ilke Coskun Benlidayi
- Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Cukurova University, Adana, Turkey
| | - Ferhat Can Piskin
- Faculty of Medicine, Department of Radiology, Cukurova University, Adana, Turkey
| | - Bugra Kundakci
- Faculty of Medicine, Department of Orthopaedics and Traumatology, Cukurova University, Adana, Turkey
| | - Ceren Ornek
- Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Cukurova University, Adana, Turkey
| | - Meryem Andirin
- Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Cukurova University, Adana, Turkey
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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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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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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: 0.3] [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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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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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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14
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Sam F, Kandagaddala M, Prithishkumar IJ, Mahata KM, Gowri M, Rabi S. Prevalence of the additional head of quadriceps femoris in the South Indian population: a cadaveric and radiological study. Sci Rep 2021; 11:16132. [PMID: 34373504 PMCID: PMC8352952 DOI: 10.1038/s41598-021-95374-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 07/21/2021] [Indexed: 11/30/2022] Open
Abstract
Quadriceps femoris is an extensor muscle in the anterior compartment of thigh and is traditionally taught to be composed of four heads. Recently, there is an increased interest in the occurrence of an additional muscle head of quadriceps femoris. But scientific knowledge regarding its incidence is lacking in the South Indian population. This study was done to confirm the presence of the additional head by routine anatomic dissection and radiological imaging techniques. Forty-one formalin fixed human cadaveric lower limbs were dissected and the morphology of the additional head was noted. Retrospective analysis of 88 MRI images of patients was done. The additional muscle head was present in 43.9% of the cadaveric lower limbs and was consistently located between the vastus lateralis and vastus intermedius. It originated from variable portions of the greater trochanter, intertrochanteric line, lateral lip of linea aspera and lateral surface of the shaft of femur and inserted either as a muscle belly or as an aponeurosis into the vastus intermedius (55.6%), vastus lateralis (22.2%) or directly into the base of the patella. It received its vascular supply from branches of the lateral circumflex femoral artery and was innervated by branches from the posterior division of the femoral nerve. In addition, the additional muscle head was identified by MRI and its incidence was reported to be 30.68% for the first time in living subjects. The result of this study provides additional information in understanding the morphology of the quadriceps femoris muscle.
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Affiliation(s)
- Femina Sam
- Department of Anatomy, Christian Medical College Vellore, The Tamil Nadu Dr. MGR Medical University, Chennai, India.
| | | | | | | | - Mahasampath Gowri
- Department of Biostatistics, Christian Medical College, Vellore, India
| | - Suganthy Rabi
- Department of Anatomy, Christian Medical College Vellore, The Tamil Nadu Dr. MGR Medical University, Chennai, India
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15
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Mendes Da Costa T, Leveille LA, Rosenbaum DG. Quads or quins? Atraumatic restricted knee flexion due to accessory quadriceps bands in children. Pediatr Radiol 2021; 51:435-440. [PMID: 33211185 DOI: 10.1007/s00247-020-04866-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/28/2020] [Accepted: 09/30/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Recent anatomical investigations have emphasized the variability in the knee extensor apparatus, with particular attention to a fifth component of the quadriceps femoris termed the tensor vastus intermedius or accessory "quinticeps femoris." Disorders of this structure have not been described in the pediatric imaging literature. OBJECTIVE To review the clinical features, pathoanatomy and imaging findings of children presenting with derangement of the accessory quadriceps femoris, with a particular emphasis on the utility of early magnetic resonance imaging (MRI) of the thigh. MATERIALS AND METHODS This is a retrospective analysis of 3 children, ages 3-10 years at presentation, who underwent imaging evaluation with subsequent surgically proven accessory quadriceps femoris muscles. Their clinical histories, including duration of symptoms, MRI findings, intervention and surgical outcomes, are reported. RESULTS All patients presented with progressive unilateral restricted knee flexion and had multiple imaging studies targeting the knee before diagnosis. Diagnosis in all patients was made on MRI of the thighs, which demonstrated a fusiform low signal intensity structure with muscle-like architecture arising from the anterior or anterolateral proximal femur and blending with the common quadriceps tendon distally. All patients underwent surgical release of the anomalous band with significant functional improvement. CONCLUSION In cases of progressive limited knee flexion without intrinsic pathology, an accessory quadriceps muscle should be considered as an extrinsic cause. Our experience demonstrated this to be readily identifiable on MRI, with symptomatic improvement following surgical release. Early recognition of this condition should prevent unnecessary intervention such as knee arthroscopy and the debilitating loss of flexion due to delayed diagnosis.
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Affiliation(s)
- Thomas Mendes Da Costa
- Department of Radiology, British Columbia Children's Hospital, University of British Columbia, 4500 Oak St., Vancouver, BC, V6H 3N1, Canada
| | - Lise A Leveille
- Department of Orthopaedic Surgery, British Columbia Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Daniel G Rosenbaum
- Department of Radiology, British Columbia Children's Hospital, University of British Columbia, 4500 Oak St., Vancouver, BC, V6H 3N1, Canada.
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16
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Olewnik Ł, Karauda P, Gonera B, Kurtys K, Tubbs RS, Paulsen F, Szymański R, Polguj M. Impact of plantaris ligamentous tendon. Sci Rep 2021; 11:4550. [PMID: 33633305 PMCID: PMC7907062 DOI: 10.1038/s41598-021-84186-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 02/11/2021] [Indexed: 01/11/2023] Open
Abstract
There are countless morphological variations among the muscles, tendons, ligaments, arteries, veins and nerves of the human body, many of which remain undescribed. Anatomical structures are also subject to evolution, many disappearing and others continually emerging. The main goal of this pilot study was to describe a previously undetected anatomical structure, the plantaris ligamentous tendon, and to determine its frequency and histology. Twenty-two lower limbs from 11 adult cadavers (11 left, and 11 right) fixed in 10% formalin were examined. The mean age of the cadavers at death was 60.1 years (range 38–85). The group comprised six women and five men from a Central European population. All anatomical dissections of the leg and foot area accorded with the pre-established protocol. Among the 22 lower limbs, the PLT was present in 16 (72.7%) and absent in six (27.3%). It originated as a strong fan-shaped ligamentous tendon from the superior part of the plantaris muscle, the posterior surface of the femur and the lateral aspect of the knee joint capsule. It inserted to the ilio-tibial band. Histologically, a tendon and ligament were observed extending parallel to each other. A new anatomical structure has been found, for which the name plantaris ligamentous tendon is proposed. It occurs around the popliteal region between the plantaris muscle, the posterior surface of the femur, and the ilio-tibial band.
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Affiliation(s)
- Łukasz Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland.
| | - Piotr Karauda
- Department of Normal and Clinical Anatomy, Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
| | - Bartosz Gonera
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Konrad Kurtys
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA.,Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA, USA.,Department of Anatomical Sciences, St. George's University, West Indies, Grenada
| | - Friedrich Paulsen
- Institute of Functional and Clinical Anatomy, Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany.,Department of Topographic Anatomy and Operative Surgery, Sechenov University, Moscow, Russia
| | - Rafał Szymański
- Department of Histology, Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
| | - Michał Polguj
- Department of Normal and Clinical Anatomy, Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
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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: 0.2] [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: 1.6] [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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19
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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: 0.2] [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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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: 1.2] [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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21
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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: 0.4] [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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22
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Magnetic resonance imaging of the quadriceps tendon autograft in anterior cruciate ligament reconstruction. Skeletal Radiol 2019; 48:1685-1696. [PMID: 31093713 DOI: 10.1007/s00256-019-03235-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 04/03/2019] [Accepted: 05/01/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Quadriceps tendon (QT) autograft is emerging as a popular technique for primary anterior cruciate ligament (ACL) reconstruction. Studies have shown that it has comparable outcomes to bone-patellar tendon-bone (BPTB) and hamstring tendon (HT) autografts while mitigating post-operative complications associated with these grafts. PURPOSE To provide a literature summary of the important pre- and post-operative magnetic resonance imaging (MRI) findings of the quadriceps tendon and pertinent postoperative complications associated with the QT harvest. Radiologists should be familiar with MR findings after autologous graft harvest of the quadriceps tendon for reconstruction of the ACL. LEVEL OF EVIDENCE Level IV.
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23
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ALDI (Anterior Lateral Decubitus Intermuscular) approach to the hip: Comprehensive description of the surgical technique with operative video. Orthop Traumatol Surg Res 2019; 105:923-930. [PMID: 31178409 DOI: 10.1016/j.otsr.2019.02.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/19/2019] [Accepted: 02/26/2019] [Indexed: 02/06/2023]
Abstract
The direct anterior approach to the hip is judged to be difficult and even after many solutions, such as special operating tables, have been proposed to perform it, in some reports the complication rate remains high. The complications reported are nerve lesions, dislocation, muscles damages, intraoperative fractures. We describe a modification of the anterior approach, undertaken keeping the patient in lateral decubitus, in order to gain a better range of leg movement and a significant reduction of the force applied to the retractors, the technique was named ALDI (anterior lateral decubitus intermuscular) approach. The surgeon starts behind the patient as in all the other traditional approaches, to maintain unchanged the acetabular view and the dexterity in cup implantation. For the femoral preparation, he moves in front of the patient to have a better visualization. In a series of 150 patients, with a mean operative time of 51.38minutes (range, 40-112), we had no intraoperative fractures, one (0.6%) lateral femoral cutaneous nerve temporary neurapraxia, one (0.8%) posttraumatic dislocation four years after the operation and, no revisions for aseptic loosening or infection. At the 5 years follow-up, the mean Oxford Hip score was 45.2 (range, 38-48; SD 2.6), the mean Harris Hip Score was 96,7 (range, 76-100; SD 2.8), and the mean UCLA score was 7 (range, 5-10; SD 1.4). The possibility to always obtain the optimal position of the surgical window with reduced tension on the muscles, and the unchanged initial surgeon position, could make the ALDI approach the ideal technique for the surgeons that decide to perform an anterior approach.
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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: 2.4] [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: 0.6] [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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Veeramani R, Gnanasekaran D. Morphometric study of tensor of vastus intermedius in South Indian population. Anat Cell Biol 2017; 50:7-11. [PMID: 28417049 PMCID: PMC5386929 DOI: 10.5115/acb.2017.50.1.7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 02/21/2017] [Accepted: 02/22/2017] [Indexed: 11/27/2022] Open
Abstract
Tensor of vastus intermedius is a newly discovered muscle located between vastus lateralis and vastus intermedius. The purpose of this study was to investigate the detailed morphology of tensor of vastus intermedius, specifically to provide data pertaining to the attachments, innervations, variation in the types and its morphometry in South Indian population. The tensor of vastus intermedius was studied in thirty six cadaveric lower limbs using macrodissection techniques. The origin of the muscle was from upper part of intertrochanteric line and anterior part of greater trochanter of femur inserted to medial aspect of upper border of patella. The muscle was classified into four types based on the origin and also the aponeurosis course with independent type (type 1) being common. The mean and standard deviation of the length of tensor of vastus intermedius and aponeurosis were 145.40±37.55 mm and 193.55±42.32 mm, respectively. The results of the study suggest that tensor of vastus intermedius is variable and the information provided regarding the attachments, types and quantitative data will contribute to the existing knowledge of the muscle.
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Affiliation(s)
- Raveendranath Veeramani
- Department of Anatomy, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Dhivyalakshmi Gnanasekaran
- Department of Anatomy, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
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Grob K, Manestar M, Filgueira L, Ackland T, Gilbey H, Kuster MS. New insight in the architecture of the quadriceps tendon. J Exp Orthop 2016; 3:32. [PMID: 27813020 PMCID: PMC5095096 DOI: 10.1186/s40634-016-0068-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 10/24/2016] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Published data regarding the structure of the quadriceps tendon are diverse. Dissection of the quadriceps muscle group revealed that beside the rectus femoris, vastus lateralis, vastus intermedius and vastus medialis a fifth muscle component- named the tensor vastus intermedius consistently fused into quadriceps tendon. It can be hypothesized that all these elements of the extensor apparatus of the knee joint must also be represented in the quadriceps tendon. This study investigated the multi-layered quadriceps tendon with special emphasis on all components of the quadriceps muscle group including the newly discovered tensor vastus intermedius. METHODS Ten cadaveric lower limbs were dissected. All muscle bellies of the extensor apparatus of the knee joint were identified and traced distally until they merged into the quadriceps tendon. Connections between the different aponeurotic layers of each muscle were studied from origin to insertion. The fusing points of each layer were marked. Their distance to the patella and the distances between the fusing points were measured. RESULTS Six elements of the quadriceps muscle group form a tri-laminar structure of the quadriceps tendon. The intermediate layer could be further sub-divided. The elements of the quadriceps tendon are 1. lateral aponeurosis of the vastus intermedius, 2. deep and 3. superficial medial aponeurosis of the vastus intermedius, 4. vastus lateralis, 5. tensor vastus intermedius and 6. rectus femoris. Even with differences in fiber direction - these elements join each other a certain distance proximal to the patella. All elements were fused over a region measuring 13 to 90 mm proximal to the patella. Lateral parts of the vastus intermedius formed the deepest layer of the quadriceps tendon. The superficial and deep layer of the medial vastus intermedius aponeurosis fused 56 mm (range, 30 to 90 mm) and 33 mm (range, 13 to 53 mm) above the patella with the aponeurosis of the tensor vastus intermedius and vastus lateralis respectively. Together they built the two-layered intermediate layer of the quadriceps tendon. The tendon of the rectus femoris forms the superficial layer. The vastus medialis inserts medially in all layers of the quadriceps tendon. Fibers of the lateral muscle components were oriented towards the medial, and fibers of the medial muscle components were oriented towards the lateral femoral condyle. CONCLUSIONS The three-layered quadriceps tendon is formed by six elements. These are 1. lateral aponeurosis of the vastus intermedius, 2. deep and 3. superficial medial aponeurosis of the vastus intermedius, 4. vastus lateralis, 5. tensor vastus intermedius and 6. rectus femoris. These elements of the extensor apparatus join each other proximal to the patella in a complex onion-like architecture. Its two-layered intermediate layer shows variable fusions points. The vastus medialis contributes to the quadriceps tendon with its medial insertion into all layers of the quadriceps tendon.
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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, CH-8057, Zürich, Switzerland
| | - Luis Filgueira
- Department of Anatomy, University of Fribourg, Rue Albert Gockel 1, CH-1700, Fribourg, Switzerland
| | - Timothy Ackland
- The University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia
| | - Helen Gilbey
- Hollywood Functional Rehabilitation Clinic, Perth, WA, Australia
| | - Markus S Kuster
- The University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia
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Rajasekaran S, Hall MM. Sonographic Appearance of the Tensor of the Vastus Intermedius. PM R 2016; 8:1020-1023. [DOI: 10.1016/j.pmrj.2016.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 04/14/2016] [Indexed: 10/21/2022]
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