ESSR 2019 / P-0130
Layered Anatomic Approach: The Quadriceps Muscle Complex Injuries
Congress: ESSR 2019
Poster No.: P-0130
Type: Educational Poster
Keywords: Trauma, Motility, Cancer, Normal variants, Experimental investigations, Education, Ultrasound, MR, CT, Musculoskeletal system, Anatomy
Authors: R. Britel1, L. Muntaner Gimbernat1, A. Rodriguez Baeza2, A. Kassarjian3; 1Palma de Mallorca/ES, 2Barcelona /ES, 3Pozuelo de Alarcón/ES



•MRI  can  identify  direct  and  indirect  tendon  origins.


•Most  intramuscular  injuries  of  RF  involve deep myotendinous junction.   


•Eccentric  contraction,  hip  extension  &  knee flexion.



A 18-year-old manhad a complete grade III proximal direct and indirect proximal rectusfemoriswithanintact ASIS membrane.The ASIS membrane  constraintstheRectusFemorismuscle at itstheoreticalanatomic position tetheringthedirect and indirect  tendonstumps

A similar concept to the ASIS –RF membrane , has been evolving at the elbow where nowadays it  is accepted that the insertion of the distal biceps has evolved to “the distal biceps brachii tendinous complex “ formed by  the internal bicipital aponeurosis, the distal biceps brachii tendon and the external bicipital aponeurosis (also known as lacertus fibrosus).Our research supports a novel anatomic approach


There is an additional  membranous fan-shaped  origin ,a frequent anatomic    variant , from  ASIS


The ASIS origin  implies to evolve from classic RF direct and indirect tendon origin to the 



Additional  membranous fan-shaped  origin running from the proximal membranous origin continuation from anterosuperior iliac spine ASIS is a frequent anatomic    variant.



èThe tensor vastus intermedius muscle (TVI) fulfils all criteria for an independent muscle. It is innervated by independent branches of the femoral nerve and is vascularized through separate muscle branches èInterpreting the TVI as an independent muscle and understanding its role within the extensor mechanism would change our understanding of the complex architecture and function of the extensor apparatus of the knee joint as a whole



QMC  myomyouspointoffailureresearch  : intramuscular deglovingrectusfemoris  injuryphenomenonpathogenesis

•Role of unipennate outer muscle  versus  bipennate inner muscle with central tendon is under research   •Role of central aponeurosis  /COMPLEX aponeurotic system is under research



•Genus Articularis muscle ( GA  ) is a vestigial  muscle deep to quadriceps on the anterior aspect of the thigh that consists of several bundles which arise from the distal third surfaces of the femur   . •A similar concept to genus articularis-vastus intermedius   complex  has been evolving at the elbow where it has resemblance to “ elbow´s subanconeus-medial head of the triceps concept”  (Subanconeus is a  muscle also controversial  about if it is an  independent muscle  and also has de capsular insertions) . •Articularis genus is a deep bundle of quadriceps femoris related to vastus intermedius or an and its distal capsular insertions Subaconeus area considered to represent the deep fibres of the medial head of triceps brachii and genus articularisis considered by some authors  to represent the deep fibres of vastus  intermedius as both  share a common  innervation from branches of the femoral nerve •From the clinical point of view it has been observed that participates in the elevation of the suprapatellar bursa on stimulating a branch of the femoral nerve and contribute to  retract the suprapatellar bursa proximally  has a protective role preventing interposition of  these structures between the patella and femur during  maximal extension of the knee joint •Further research is required to evaluate  if the genus articularis-vastus intermedius   complex dysfunction is related undifferentiated anterior knee pain  manifested by fat pad edema on MRI 



The “prepatellar quadriceps continuation” is the appropriate designation

for the deepest soft-tissue layer that lies anterior to the patella, related to the deep rectus femoris tendinous fibers

The prepatellar quadriceps continuation is formed by fibers of the rectus femoris tendon and connects the quadriceps and patellar tendons.

The attachment site of the prepatellar quadriceps continuation is formed by the distal extension of the deep longitudinal fibers of the rectus femoris tendon. At the border zone between the tendons and the patella, the tendinous fibers gradually transform into fibrocartilage.

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