Isabel Miguel MD PhD. Human anatomy Lecture at Unit of Human Anatomy and Embryology, Spain PRP for Quadriceps Muscles Injuries 8th MuscleTech Network Workshop 3rd October, Barcelona

1. Quadriceps muscle anatomy
Cadaver study
Maribel Miguel
Carlo Martinoli, I Möller, M Blasi, A Pérez
Human anatomy
Faculty of Medicine.
HSC of Bellvitge. Spain
Radiologia – DISC,
Università di Genova, Italy
8th Muscle Tech NetWork Workshop in Muscle and Tendon
Barcelona 3-4 octuber 2016

2. Quadriceps muscle anatomy
Cadaver study
Maribel Miguel
Carlo Martinoli, I Möller, M Blasi, A Pérez
8th Muscle Tech NetWork Workshop in Muscle and Tendon
Barcelona 3-4 octuber 2016
R Balius, G Rodes, J de la Fuente, X Alomar, C Pedret…

3. Quadriceps femoris muscle
It is formed for several parts:
 Rectus femoris
 Vastus lateralis
 Vastus medialis
 Vastus intermedius

4. All these muscles
are located at the
anterior
compartment of the
thigh, and involved by
the deep fascia,
called the fascia lata
Quadriceps femoris muscle

5. All these muscles
are located at the
anterior
compartment of the
thigh, and involved by
the deep fascia,
called the fascia lata
Quadriceps femoris muscle

6. All these muscles
are located at the
anterior
compartment of the
thigh, and involved by
the deep fascia,
called the fascia lata
Quadriceps femoris muscle
Bottoni et cols, 2009

7. Quadriceps femoris muscle
Vastus lateralis
Vastus medialis
Vastus intermedius
Classicaly we know that they
have their origen in the aspera
line in the posterior part of the
femur and other points as the
major trochantis and they go to
the anterior part of the thigh to
find the rectus femoris muscle

8. Quadriceps femoris muscle
A fifth muscle of the anterior thigh, the tensor
of the vastus intermedius (TVI), has been
described recently. This muscle belly has a
separate aponeurotic tendon, closely
associated with the aponeurosis of the VI,
which joins the quadriceps tendon distally
Grob et cols 2016

9. Quadriceps femoris muscle
A fifth muscle of the anterior thigh, the tensor
of the vastus intermedius (TVI), has been
described recently. This muscle belly has a
separate aponeurotic tendon, closely
associated with the aponeurosis of the VI,
which joins the quadriceps tendon distally
Grob et cols 2016

10. Quadriceps femoris muscle
Rectus femoris
Vastus lateralis
Vastus medialis
Vastus intermedius
All of them converge in a comun tendon,
patellar tendon, in the more distal part of
the thigh that goes to insert in the patella
and finally in the tibial tuberosity as the
patellar ligament

11. Quadriceps femoris muscle
Rectus femoris
Vastus lateralis
Vastus medialis
Vastus intermedius
All of them converge in a comun tendon in
the more distal part of the thigh that goes
to insert in the patella and finally in the
tibial tuberosity
Remember that the muscular fibers from
vastus medialis extends longer than the
vastus lateralis and makes more force in
the medial side and the presence of the
iliotibialis tract in the lateral side to
compensate it.

12. Quadriceps femoris muscle
Rectus femoris
Vastus lateralis
Vastus medialis
Vastus intermedius

13. Quadriceps femoris muscle

14. Rectus femoris The most commonly injured muscle of
the anterior thigh
Quadriceps femoris muscle

15. Rectus femoris The most commonly injured muscle of
the anterior thigh
Three distinctive patterns have been described according to the location
of the injury:
• At the entesis
• Within the tendon
• Musculotendinous junction
Pesquert et cols 2016
Quadriceps femoris muscle

16. Rectus femoris muscle
Its origin is tendinous and consists of :
Direct or straight head arises from the anteroinferior iliac spine
(Bony footprint of 13 mm short axis and 26 mm long axis)
Continues down as the aponeurosis fascia of the muscle
Martinolli et al 2007 ; Ryan et al 2014

17. Rectus femoris muscle
Its origin is tendinous and consists of :
Direct or straight head arises from the anteroinferior iliac spine
(Bony footprint of 13 mm short axis and 26 mm long axis)
Indirect or reflected head arises from the superior acetabular ridge in a more lateral
position
(Bony footprint of 17 mm short axis and 48 mm long axis
Continues down as the anterior aponeurosis of the muscle
And form a sagitally and central aponeurosis, located
inside the proximal muscle belly and courses until
two-thirds of the muscle belly and forms most of the
posterior component of the conjoined tendon
Martinolli et al 2007 ; Ryan et al 2014

18. Rectus femoris muscle
Direct head Indirect head

19. Rectus femoris muscle
Indirect head

20. Rectus femoris muscle
Indirect head

21. Rectus femoris muscle
Direct head
Indirect head

22. Rectus femoris muscle

23. Rectus femoris muscle
Direct head Indirect head

24. Rectus femoris muscle
Direct head Indirect head

25. Rectus femoris muscle
Direct head
Indirect head
Both differents origins give differents musculars fibbers in these special
position that so clear explains Dr Martinoli:
Direct musculars fibbers arises until the more posterior position in
the posterior aponeurosis
Indirect muculars fibbers arises also to the posterior aponeurosis
but since the intramuscular tendon

26. Rectus femoris muscle

27. Rectus femoris muscle

28. Rectus femoris muscle

29. Rectus femoris muscle
But we want to add some different origin, sometimes no so
clear and that they can be confused by aponeurosis of the
others anteriors muscles
Reflected portion
is a small tendon.
It is directed more
laterally to merge
with the anterior
capsule of the hip
joint.

30. Rectus femoris muscle
Reflected portion
As Tubb et al (2006) confirm this tendon
attach to the anterior aspect of the
greater trochanter in an inferolateral
direction, superficially with the tendon
of the gluteus minimus

31. Rectus femoris muscle
But we want to add some different origin, sometimes no so clear.
They can be confused by aponeurosis of the others anteriors muscles
Inguinal tendon

32. Rectus femoris muscle
But we want to add some different origin, sometimes no so clear.
They can be confused by aponeurosis of the others anteriors muscles

33. Thank you for your attention