Vastus Medialis Oblique: An Anatomic and Physiologic Study

Bose, K.; Kanagasuntheram, R.; Osman, M B H

doi:10.3928/0147-7447-19800901-12

Cited by 130 publications

(13 citation statements)

References 5 publications

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“…Although hamstrings tension affects the kinematics [18], we felt that it was not practical to add an investigation of their effects to an already long experimental protocol, because of our concern about deterioration of the specimens. Previous works on knee extension have shown the importance of the oblique components of the quadriceps [4] and using multiplanar loading directions on patellar mechanics [25]. Although the individual heads of the quadriceps were tensioned in a physiological ratio, their overall tension was limited by tearing the muscle fibres in these elderly specimens.…”

Section: Discussionmentioning

confidence: 99%

The effect of femoral component rotation on the kinematics of the tibiofemoral and patellofemoral joints after total knee arthroplasty

Merican

Ghosh

Iranpour

et al. 2011

Knee Surg Sports Traumatol Arthrosc

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It was concluded that femoral rotation alone could not restore all aspects of both patellar and tibial kinematics to normal with this specific implant. The clinical relevance of this is that it appears to be inadvisable to reposition the femoral component, in an attempt to improve patellar tracking, if that repositioning may then cause abnormal tibiofemoral kinematics. Further, the pattern of patellar tracking, with the type of TKA used in this study, could not be adjusted to normal by femoral component rotation.

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Section: Discussionmentioning

confidence: 99%

The effect of femoral component rotation on the kinematics of the tibiofemoral and patellofemoral joints after total knee arthroplasty

Merican

Ghosh

Iranpour

et al. 2011

Knee Surg Sports Traumatol Arthrosc

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“…Several authors maintain that the primary role of VMO is to enhance patellar stabilization within the patello‐femoral joint and to prevent lateral patellar subluxation by pulling the patella medially during knee extension and flexion [24, 43, 46, 58]. More than 50 years ago, Brewerton [8], followed by Lieb and Perry [40], Martin and Londeree [44], and Bose et al [7], reported VMO to be active during the full range of knee extension. Mariani et al [43] found the EMG activity of both VM and VL to be of similar degree and mostly pronounced during the last 30° of knee extension in healthy subjects.…”

Section: Clinical Examinationmentioning

confidence: 99%

Anterior knee pain: an update of physical therapy

Werner

2014

Knee Surg Sports Traumatol Arthrosc

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Anterior knee pain is one of the most common knee problems in physically active individuals. The reason for anterior knee pain has been suggested to be multifactorial with patella abnormalities or extensor mechanism disorder leading to patellar malalignment during flexion and extension of the knee joint. Some patients complain mostly of non-specific knee pain, while others report patellar instability problems. The patients present with a variety of symptoms and clinical findings, meaning that a thorough clinical examination is the key for optimal treatment. Weakness of the quadriceps muscle, especially during eccentric contractions, is usually present in the majority of anterior knee pain patients. However, irrespective of whether pain or instability is the major problem, hypotrophy and reduced activity of the vastus medialis are often found, which result in an imbalance between vastus medialis and vastus lateralis. This imbalance needs to be corrected before quadriceps exercises are started. The non-operative rehabilitation protocol should be divided into different phases based on the patient's progress. The goal of the first phase is to reduce pain and swelling, improve the balance between vastus medialis and vastus lateralis, restore normal gait, and decrease loading of the patello-femoral joint. The second phase should include improvement of postural control and coordination of the lower extremity, increase of quadriceps strength and when needed hip muscle strength, and restore good knee function. The patient should be encouraged to return to or to start with a suitable regular physical exercise. Therefore, the third phase should include functional exercises. Towards the end of the treatment, single-leg functional tests and functional knee scores should be used for evaluating clinical outcome. A non-operative treatment of patients with anterior knee pain should be tried for at least 3 months before considering other treatment options.

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“…In the past 20 years, our understanding of the medial patellofemoral complex has evolved significantly. 5,14,15,27 The MPFL was originally described as an aspect of the medial retinaculum connecting the vastus medialis to the adductor tubercle and subsequently named by Warren and Marshall 35 in 1979. Conlan et al 8 described the role of this medial soft tissue restraint in inhibiting lateral patellar displacement.…”

Section: Discussionmentioning

confidence: 99%

A Comprehensive Description of the Lateral Patellofemoral Complex: Anatomy and Anisometry

et al. 2022

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Background: The lateral patellofemoral complex (LPFC) is an important stabilizer of the patella composed of the lateral retinacular structures including the lateral patellofemoral ligament (LPFL), the lateral patellomeniscal ligament (LPML), and the lateral patellotibial ligament (LPTL). While the isolated anatomy of the LPFL has been previously described, no previous study has investigated the entirety of the LPFC structure, length changes, and radiographic landmarks. An understanding of LPFC anatomy is important in the setting of LPFL injury or previous lateral release resulting in iatrogenic medial instability requiring LPFC reconstruction. Purpose: To both qualitatively and quantitatively describe the anatomy and length changes of the LPFC on gross anatomic dissections and standard radiographic views. Study Design: Descriptive laboratory study. Methods: Ten nonpaired cadaveric specimens were utilized in this study. Specimens were dissected to identify distinct attachments of the LPFL, LPML, and LPTL. Ligament lengths, footprints, and centers of each attachment were described with respect to osseous landmarks using a 3-dimensional coordinate measuring device. Ligament length changes were also assessed from 0° to 90° of flexion. Radiopaque markers were subsequently utilized to describe attachments on standard anteroposterior and lateral radiographic views. Results: The individual elements of the LPFC were identified in all specimens. The LPFL patellar attachment had an average total length of 22.5 mm (range, 18.3-27.5 mm), involving a mean of 59% (range, 50%-75%) of the sagittal patella. Based on the average patellar size, a mean of 63% of the LPFL attached to the patella, and the remainder (11.1 ± 1.4 mm) inserted into the patellar tendon. The femoral attachment of the LPFL had a mean maximum length of 24.4 ± 4.3 mm. The center of the LPFL femoral attachment was a mean distance of 13.5 ± 3.2 mm anterior and distal to the lateral epicondyle. The LPFL demonstrated significant shortening, especially in the first 45° of flexion (7.5 ± 5.1 mm). In contrast, the LPTL (5.5 ± 3.0 mm) and LPML (10.0 ± 3.3 mm) demonstrated significant shortening from 45° to 90°. On lateral radiographs, the center of the femoral attachment of the LPFL was a mean total distance of 19.2 ± 7.2 mm from the lateral epicondyle. Conclusion: The most important findings of this study were the correlative anatomy of 3 distinct lateral patellar ligaments (LPFL, LPML, and LPTL) and their anisometry through flexion. All 3 components demonstrated significant shortening during flexion. The quantitative and radiographic measurements detailed the LPFL osseous attachment on the patella; soft tissue attachment on the patellar tendon; and finally, the osseous insertion on the femur distal and anterior to the lateral epicondyle. Similarly, the authors documented the meniscal insertion of the LPML and defined a patellar insertion of the LPTL and LPML as a single attachment. These data allow for reproducible landmarks to aid in the understanding and reconstruction of the lateral patellar restraints. Clinical Relevance: The data produced from this investigation provide a comprehensive description of these 3 lateral patellar stabilizers (LPFL, LPML, LPTL). These data can be used intraoperatively to facilitate anatomic reconstructions of the lateral patellar stabilizers.

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Vastus Medialis Oblique: An Anatomic and Physiologic Study

Cited by 130 publications

References 5 publications

The effect of femoral component rotation on the kinematics of the tibiofemoral and patellofemoral joints after total knee arthroplasty

The effect of femoral component rotation on the kinematics of the tibiofemoral and patellofemoral joints after total knee arthroplasty

Anterior knee pain: an update of physical therapy

A Comprehensive Description of the Lateral Patellofemoral Complex: Anatomy and Anisometry

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