The relationship between additional heads of the quadriceps femoris, the vasti muscles, and the patellar ligament

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).

The accessory heads of the quadriceps femoris muscle may affect the layering of the quadriceps tendon and potential graft harvest lengths

“…Olewnik et al [ 18 ] indicate in the earliest studies that the QT consists of four layers, and not three as previously thought. The difference in research was that vasci muscles have a more complex structure than previously expected [ 16 ]. The vastus lateralis consists of three parts: superficial, intermediate, and deep [ 16 ].…”

“…Lower limbs with evidence of surgical intervention in the dissected area were excluded. The thigh area was dissected as described previously [14][15][16]18].…”

“…Although, it might seem that such a large muscle as the quadriceps femoris (QF) has already been completely studied, it is not true. In fact, its proximal and distal attachments demonstrate considerable variability, and the relations of its parts to each other are different [ 6 – 8 , 16 , 28 ].…”

“…A study of the architectural structure of the QF found that the vastus lateralis consists of three layers: superficial, intermediate, and deep [ 16 ]. Interestingly, only the superficial and intermediate layers are part of the quadriceps tendon (QT), while the deep layer attaches laterally to the patella.…”

“…Interestingly, only the superficial and intermediate layers are part of the quadriceps tendon (QT), while the deep layer attaches laterally to the patella. The vastus medialis consists of two parts: longus and obliquus [ 16 ].…”