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.
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).
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.
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.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to The Knee
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- The extensor mechanism of the knee joint: An anatomical study.Knee Surgery, Sport Traumatol Arthrosc. 2006; 14: 214-220
- Quadriceps tendon vs. patellar tendon autograft for ACL reconstruction using a hardware-free press-fit fixation technique: comparable stability, function and return-to-sport level but less donor site morbidity in athletes after 10 years.Arch Orthop Trauma Surg. 2020; 140: 1465-1474
- Rupture of the patellar ligament after use of its central third for anterior cruciate reconstruction. A report of two cases.J Bone Jt Surg - Ser A. 1984; 66: 1294-1297
- Fractures associated with patellar ligament grafts in cruciate ligament surgery.J Bone Jt Surg - Ser B. 1992; 74-B: 617-619
- Current trends in anterior cruciate ligament reconstruction.J Knee Surg. 2009; 22: 7-12
- An alternative cruciate reconstruction graft: The central quadriceps tendon.Arthrosc J Arthrosc Relat Surg. 1995; 11: 252-254
- A newly discovered muscle: The tensor of the vastus intermedius.Clin Anat. 2016; 29: 256-263
- New insight in the architecture of the quadriceps tendon.J Exp Orthop. 2016; 3
- Anatomical evaluation of the rectus femoris tendon and its related structures.Arch Orthop Trauma Surg. 2012; 132: 1665-1668
- Anterior knee pain 7 years after an anterior cruciate ligament reconstruction with a bone-patellar tendon-bone autograft.Scand J Med Sci Sport. 2000; 10: 221-227
- Complications following arthroscopic anterior cruciate ligament reconstruction: A 2-5-year follow-up of 604 patients with special emphasis on anterior knee pain.Knee Surgery, Sport Traumatol Arthrosc. 1999; 7: 2-8
- Diagnosis and management of quadriceps strains and contusions.Curr Rev Musculoskelet Med. 2010; 3: 26-31
- Current trends in anterior cruciate ligament reconstruction.Knee Surg Relat Res. 2013; 25: 165-173
- Anatomic Evaluation of the Quadriceps Tendon in Cadaveric Specimens: Application for Anterior Cruciate Ligament Reconstruction Graft Choice.Spartan Med Res J. 2019;
- Quadriceps function relates to muscle size following ACL reconstruction.J Orthop Res. 2016; 34: 1656-1662
- Anatomic guidelines for harvesting a quadriceps free tendon autograft for anterior cruciate ligament reconstruction.Arthrosc - J Arthrosc Relat Surg. 2012; 28: 980-984
- Comparative Efficacy of Graft Options in Anterior Cruciate Ligament Reconstruction: A Systematic Review and Network Meta-Analysis.Arthrosc Sport Med Rehabil. 2020; 2: e645-e654
- Proposal for a new classification of plantaris muscle origin and its potential effect on the knee joint.Ann Anat. 2020; 231: 151506
- A proposal for a new classification of pes anserinus morphology.Knee Surgery, Sport Traumatol Arthrosc. 2019; 27: 2984-2993
- Impact of plantaris ligamentous tendon.Sci Rep. 2021; 11
- The relationship between additional heads of the quadriceps femoris, the vasti muscles, and the patellar ligament.Biomed Res Int. 2022; 2022: 1-11
- Quadriceps or multiceps femoris?—Cadaveric study.Clin Anat. 2021; 34: 71-81
- Quadriceps Tendon Graft Anatomy in the Skeletally Immature Patient.Orthop J Sport Med. 2019; 7: 1-7
- Minimally Invasive Quadriceps Tendon Harvest and Graft Preparation for All-Inside Anterior Cruciate Ligament Reconstruction.Arthrosc Tech Elsevier Masson SAS. 2016; 5: e1049-e1056
- Quadriceps tendon autograft for anterior cruciate ligament reconstruction: A comprehensive review of current literature and systematic review of clinical results.Arthrosc - J Arthrosc Relat Surg. 2015; 31: 541-554
- Arthroscopically Assisted ACL Reconstruction Using Autologous Quadriceps Tendon.Knee Cruciate Ligaments. 1992; : 443-451
- Qualitative and Quantitative Anatomy of the Human Quadriceps Tendon in Young Cadaveric Specimens.Orthop J Sport Med. 2021; 9 (232596712110373)
- Muscle atrophy contributes to quadriceps weakness after anterior cruciate ligament reconstruction.J Sci Med Sport. 2016; 19: 7-11
- Clinical anatomy of the quadriceps femoris and extensor apparatus of the knee.Clin Orthop Relat Res. 2009; 467: 3297-3306
- MR imaging of the quadriceps tendon: Normal layered configuration and its importance in cases of tendon rupture.Am J Roentgenol. 1992; 159: 1031-1034
Published online: December 20, 2022
Accepted: November 3, 2022
Received in revised form: September 27, 2022
Received: June 11, 2022
© 2022 Elsevier B.V. All rights reserved.