A cadaver study of the function of the oblique part of vastus medialis

Goh, James Cho‐Hong; Lee, Peter Y. C.; Bose, K.

doi:10.1302/0301-620x.77b2.7706335

Cited by 150 publications

(140 citation statements)

References 8 publications

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“…This in vitro experiment confirmed the general pattern of patellar kinematics found in some previous studies, 13,14,20,22,39 with the patella translating medially as the knee starts to flex, then translating progressively laterally from 208 to 908 knee flexion. The kinematic pattern was repeatable between knees and the medial-lateral translation pattern matched data from dynamic measurements obtained previously in vivo.…”

Section: Discussionsupporting

confidence: 89%

“…37,38 This clinical knowledge suggests the importance of having experimental tracking data that are based on the physiological/anatomical tensions and orientations of all the quadriceps muscle components, 25 especially the VMO. 39 One important factor in achieving realism was that we measured patellar tracking during knee flexion-extension motion cycles. Some studies have reported ''kinematics'' based on a sequence of measurements in static postures, so may have failed to record transient effects.…”

Section: Discussionmentioning

confidence: 99%

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Patellofemoral kinematics during knee flexion-extension: An in vitro study

2006

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The purpose of this work was to obtain kinematics data for the normal human patellofemoral joint in vitro. Eight fresh-frozen cadaver knees were used. The heads of the quadriceps were separated, and the knees mounted in a kinematics rig. The femoral axis was aligned with an electromagnetic transmitter. The six heads of the quadriceps, including vasti medialis and lateralis obliquus, were loaded via cables according to their physiological cross-sectional areas and orientations. Magnetic trackers were mounted on the patella and tibia. The knee was flexedextended against the extending muscle action, and patellar tracking was measured in six degrees of freedom. As the knee flexed, the patella flexed by 0.7 times the tibiofemoral flexion angle. It also translated medially 4 mm to engage the trochlear groove at 208 knee flexion, then translated to 7 mm lateral by 908 knee flexion. The patella tilted progressively to 78 lateral by 908 knee flexion, and patellar medial-lateral rotation was usually less than 38. This is believed to be the first set of patellar tracking data obtained in both flexion and extension motion while the patella was acted on by a full set of quadriceps muscle tensions acting in physiological directions. These data may be used in future studies of the effects of pathologies on patellar tracking. ß

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Patellofemoral kinematics during knee flexion-extension: An in vitro study

2006

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“…Nevertheless, the fiber orientation in the distal part of the muscle is noticeably more horizontal than in the proximal part, and there is considerable evidence the distal part has a role in maintaining patellar alignment [24]. The distal part, which can be considered the functional equivalent of the VMO, has its own motor point, is a relatively weak extensor, inserts into the medial border of the patella [23], is more active at 90°fl exion than the rest of quadriceps [22], and pulls the patella medially [15,17,25]. Although Peeler et al [31] said there was no sign of a separate nerve entering the VMO, numerous authors disagree [16,17,20,41,44].…”

Section: Discussionmentioning

confidence: 99%

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

Waligora

Johanson

Hirsch

2009

Clin Orthop Relat Res

122

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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 threelayered 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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“…Various different techniques for doing this are described in the literature: Sakai et al [24] digitised two points on a medial-lateral axis (not described in full), a third point on the proximal pole, and the centre of the patella. Several authors digitised the medial-lateral axis and proximal-distal axis by the most prominent proximal/medial/distal/lateral points on the patella [7,9,23]. Being points located through the skin, these have an indirect relationship to the articular geometry, which must be further quantified if contact conditions are of interest.…”

Section: Patellar Body-fixed Axesmentioning

confidence: 99%

Standardisation of the description of patellofemoral motion and comparison between different techniques

Bull

Katchburian

Shih

et al. 2002

Knee, Surg, Sports Traumatol, Arthrosc

114

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Patellofemoral motion is significant clinically, yet in the literature many different methods and terminologies are used, thus making comparison between papers difficult. The aim of this study was to review and explain the different methods used for the description of patellofemoral joint motion, compare these methods by experimentation, and propose a standardised method. We found three main methods for describing patellar motion: motion of the patella about femoral body fixed axes, about patellar body fixed axes, or a combination of these. Description about femoral body fixed axes does not make sense clinically. Description about patellar body fixed axes is straightforward, yet the definition of these axes is prone to error due to the lack of anatomical landmarks. The combination method makes most sense clinically and uses more easily found anatomical landmarks. Patellar flexion varied by up to 26% when describing the motion about different axes. Tilt and shift were highly sensitive to the choices of coordinate systems and the axes of motion. The pattern of rotation was consistent between all methods, however, differences between the methods increased with patellar flexion. We propose the description of patello-femoral motion in terms of shift (along a femoral medial-lateral axis), tilt (about the patellar long axis), rotation (about a floating patellar anterior-posterior axis) and flexion (about the femoral medial-lateral axis).

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A cadaver study of the function of the oblique part of vastus medialis

Cited by 150 publications

References 8 publications

Patellofemoral kinematics during knee flexion-extension: An in vitro study

Patellofemoral kinematics during knee flexion-extension: An in vitro study

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

Standardisation of the description of patellofemoral motion and comparison between different techniques

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