Magnetic Resonance Imaging of the Extensor Mechanism

Yablon, Corrie M.; Pai, Deepa; Dong, Qian; Jacobson, Jon A.

doi:10.1016/j.mric.2014.07.004

Cited by 33 publications

(38 citation statements)

References 73 publications

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“…MR imaging has been shown to be the most accurate method of detecting muscle and tendon injuries (Perfitt et al, ). However, the fact that the intervening TVI has not been mentioned in previous MR image studies (Zeiss et al, ; Sonin et al, ; Yablon et al, ; Grob et al, ) reflects the limitations of virtual MR imaging dissections. MR imaging alone cannot easily recognize fascial or aponeurotic planes.…”

Section: Discussionmentioning

confidence: 99%

Magnetic resonance imaging of the tensor vastus intermedius: A topographic study based on anatomical dissections

et al. 2017

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The tensor of the vastus intermedius (TVI) is a newly described component of the extensor apparatus of the knee joint. The objective of this study was to evaluate the appearance of the TVI on magnetic resonance (MR) imaging and its association with the adjacent vastus lateralis (VL) and vastus intermedius (VI) muscles and to compare these findings with the corresponding anatomy. MR images were analyzed from a cadaveric thigh where the TVI, as part of the extensor apparatus of the knee joint, had been dissected. The course of the TVI in relation to the adjacent VL and VI was studied. The anatomic dissection and MR imaging revealed a multilayered organization of the lateral extensor apparatus of the knee joint. The TVI is an intervening muscle between the VL and VI that combined into a broad flat aponeurosis in the midthigh and merged into the quadriceps tendon. Dorsally, the muscle fibers of the TVI joined those of the VL and VI and blended into the attachment at the lateral lip of the linea aspera. In this area, distinguishing between these three muscles was not possible macroscopically or virtually by MR imaging. In the dorsal aspect, the onion-like muscle layers of the VL, TVI, and VI fuse to a hardly separable muscle mass indicating that these muscles work in conjunction to produce knee extension torque when knee joint action is performed. Clin. Anat. 30:1096-1102, 2017. © 2017 Wiley Periodicals, Inc.

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Section: Discussionmentioning

confidence: 99%

Magnetic resonance imaging of the tensor vastus intermedius: A topographic study based on anatomical dissections

et al. 2017

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“…Patellar problems are also common after total knee arthroplasty (Russell et al 2014). A better understanding of the quadriceps tendon anatomy is therefore fundamental for an improvement in surgical techniques and for the radiological interpretation of a traumatized extensor apparatus of the knee joint (Yablon et al 2014; Zeiss et al 1992). …”

Section: Introductionmentioning

confidence: 99%

New insight in the architecture of the quadriceps tendon

et al. 2016

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BackgroundPublished data regarding the structure of the quadriceps tendon are diverse. Dissection of the quadriceps muscle group revealed that beside the rectus femoris, vastus lateralis, vastus intermedius and vastus medialis a fifth muscle component– named the tensor vastus intermedius consistently fused into quadriceps tendon. It can be hypothesized that all these elements of the extensor apparatus of the knee joint must also be represented in the quadriceps tendon. This study investigated the multi-layered quadriceps tendon with special emphasis on all components of the quadriceps muscle group including the newly discovered tensor vastus intermedius.MethodsTen cadaveric lower limbs were dissected. All muscle bellies of the extensor apparatus of the knee joint were identified and traced distally until they merged into the quadriceps tendon. Connections between the different aponeurotic layers of each muscle were studied from origin to insertion. The fusing points of each layer were marked. Their distance to the patella and the distances between the fusing points were measured.ResultsSix elements of the quadriceps muscle group form a tri-laminar structure of the quadriceps tendon. The intermediate layer could be further sub-divided. The elements of the quadriceps tendon are 1. lateral aponeurosis of the vastus intermedius, 2. deep and 3. superficial medial aponeurosis of the vastus intermedius, 4. vastus lateralis, 5. tensor vastus intermedius and 6. rectus femoris. Even with differences in fiber direction – these elements join each other a certain distance proximal to the patella.All elements were fused over a region measuring 13 to 90 mm proximal to the patella. Lateral parts of the vastus intermedius formed the deepest layer of the quadriceps tendon. The superficial and deep layer of the medial vastus intermedius aponeurosis fused 56 mm (range, 30 to 90 mm) and 33 mm (range, 13 to 53 mm) above the patella with the aponeurosis of the tensor vastus intermedius and vastus lateralis respectively. Together they built the two-layered intermediate layer of the quadriceps tendon. The tendon of the rectus femoris forms the superficial layer. The vastus medialis inserts medially in all layers of the quadriceps tendon.Fibers of the lateral muscle components were oriented towards the medial, and fibers of the medial muscle components were oriented towards the lateral femoral condyle.ConclusionsThe three-layered quadriceps tendon is formed by six elements. These are 1. lateral aponeurosis of the vastus intermedius, 2. deep and 3. superficial medial aponeurosis of the vastus intermedius, 4. vastus lateralis, 5. tensor vastus intermedius and 6. rectus femoris. These elements of the extensor apparatus join each other proximal to the patella in a complex onion-like architecture. Its two-layered intermediate layer shows variable fusions points. The vastus medialis contributes to the quadriceps tendon with its medial insertion into all layers of the quadriceps tendon.

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“…The genu articularis muscle is the deepest myotendinous component of the extensor mechanism. It consists of one to seven separate muscle slips that arise from the distal anterior femur and extend obliquely to insert on the suprapatellar pouch (30,32). During active extension, it retracts the suprapatellar pouch upward, preventing it from being entrapped at the patellofemoral joint (32).…”

Section: Quadriceps Tendonmentioning

confidence: 99%

“…Quadriceps Tendon Disease.-Disease affecting the quadriceps tendon parallels that affecting tendons throughout the body, ranging from tendinosis to varying degrees of partial tears to complete rupture, characterized by transection of all of its layers (28). Quadriceps tendinosis is less common than patellar tendinosis and is typically related to overuse in athletes involved in jumping sports, resulting in a thickened heterogeneous tendon with altered echotexture and increased signal intensity at MRI (30). Quadriceps tears typically occur in the setting of underlying tendinosis, with partial tears being more common than complete tears (33).…”

Section: Quadriceps Tendonmentioning

confidence: 99%

“…The muscle between the anterior femur and quadriceps tendon corresponds to the genu articularis muscle (white * ), which inserts on the suprapatellar pouch rather than on the patella. Complete quadriceps tendon tears are far more common in males than in females and typically occur after the age of 50 years from decelerating trauma superimposed on a tendon weakened by underlying tendinosis (30,33,34). The injury may be limited to the tendon or, less commonly, associated with an avulsion fracture of the superior patella (8).…”

Section: Quadriceps Tendonmentioning

confidence: 99%

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Layered Approach to the Anterior Knee: Normal Anatomy and Disorders Associated with Anterior Knee Pain

2018

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Anterior knee pain is a common complaint that can be caused by a wide spectrum of disorders affecting the many varied tissues at the anterior knee. The anatomy and pathologic conditions of the anterior knee can be approached systematically by organizing the region into four layers: (a) superficial layer of fat, fascia, and bursae; (b) functional layer composed of the extensor mechanism and patellar stabilizers; (c) intracapsular extrasynovial layer containing the fat pads; and (d) intra-articular layer. The superficial layer is composed of delicate tissues that are predisposed to blunt and penetrating trauma, irritation, and infection. The extensor mechanism forms the functional layer, is responsible for knee extension and patellar stabilization, and is engaged in repetitive movements; overuse disorders dominate in this layer. The fat pads of the anterior knee are discussed collectively as an extracapsular extrasynovial layer, functioning to improve congruence and protect the articular surfaces during motion. Diseases involving the fat pads can be primary or secondary to pathologic conditions in the rest of the joint. The synovial lining and cartilage surface are in the fourth and final intra-articular layer; pathologic conditions are centered around arthritides and internal derangement. Symptoms in the anterior knee may be due to conditions affecting one or more of these interrelated layers. © RSNA, 2018 • radiographics.rsna.org Dyan V. Flores, MD Catalina Mejía Gómez, MD Mini N. Pathria, MD Abbreviations: ACL = anterior cruciate ligament, FNS = focal nodular synovitis, MPFL = medial patellofemoral ligament, PD = proton density RadioGraphics 2018; 38:2069-2101 ). © RSNA, 2018After completing this journal-based SA-CME activity, participants will be able to:This journal-based SA-CME activity has been approved for AMA PRA Category 1 Credit TM . See rsna.org/learning-center-rg.

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Magnetic Resonance Imaging of the Extensor Mechanism

Cited by 33 publications

References 73 publications

Magnetic resonance imaging of the tensor vastus intermedius: A topographic study based on anatomical dissections

Magnetic resonance imaging of the tensor vastus intermedius: A topographic study based on anatomical dissections

New insight in the architecture of the quadriceps tendon

Layered Approach to the Anterior Knee: Normal Anatomy and Disorders Associated with Anterior Knee Pain

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