Anat Cell Biol.  2021 Mar;54(1):1-9. 10.5115/acb.20.258.

Morphometric analysis of vastus medialis oblique muscle and its influence on anterior knee pain

• Sawy MME
• Mikkawy DMEE
• El-Sayed SM
• Desouky AM

• KMID: 2514576
• DOI: http://doi.org/10.5115/acb.20.258

Abstract

Healthy knees require full range squatting movements. Vastus medialis (VM) muscle regulates and adjusts the extensor apparatus that inf luences the patellofemoral function. This work was designed to investigate the anatomy and morphometry of vastus medialis oblique (VMO) muscle by widely used imaging techniques and investigate how VMO muscle participates in anterior knee pain. Ten dissected cadaveric specimens were examined, focusing on fiber orientations, origin, insertions and nerve supply of VMO muscle. Magnetic resonance imaging and ultrasound of VMO muscle were recorded. Anatomical cross-sectional areas of VMO muscle were determined in painless and painful knees and statistically analyzed. In cadaveric specimens, there was distinct separation between VM longus and VMO (change in fiber angle or fibrofascial plane). VMO inserted directly into the medial proximal margin of the patella, capsule of the knee joint and continuous with the patellar tendon. Separate branch of femoral nerve run along the anteromedial border of the muscle. Anatomical cross-sectional area was significantly decreased in painful knee by –17.2%±11.0% at lower end of shaft of femur, –21.1%±6.0% at upper border of patella, –36.7%±11.0% at mid-patellar level. VMO is distinct muscle within quadriceps femoris group. VMO muscle would track the patella medially and participate in last phase of knee extension. Assessment of the VMO muscle anatomical cross-sectional area by ultrasonography may constitute promising and reliable tool to evaluate patellofemoral pain syndrome staging.

Keyword

Vastus medialis; Measures; Anterior knee pain

Figure

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  Fig. 1 VM muscle dissection showing (A) VML has vertical fibers and VMO with increased obliquity of muscle fibers. VMO inserted into the medial proximal margin of the patella with fleshy fibers (dotted red line). Lowermost fibers of VMO covered the medial aspect of medial condyle of femur. Nerve to VM runs in a separate fibrotic tunnel (red asterisks). (B) The dotted white line demonstrates the origin of VMO. VMO muscle fibers merge with fibrous capsule of the knee joint. (C) A fascial plane (arrow) separates the VM into two independent parts. Also, the VMO overlaps and merges with the joint capsule. cap, capsule of the knee joint; MC, medial condyle of femur; P, patella; VM, vastus medialis; VML, vastus medialis longus; VMO, vastus medialis oblique.

• 

  Fig. 2 MRI cross sections of the knee joint through the lower third of the right thigh showing: (A) at lower end of shaft of femur, VMO (marked by dotted white line) originates from medial supracondylar line (red arrow). (B) at medial epicondyle, VMO totally covered the medial aspect of medial condyle. VMO inserted in patella by fleshy fibers (white arrow) (C) at level of the popliteal groove, VMO was well defined that compressed the knee joint space (blue arrow) medially. F, lower end of shaft of femur; g, popliteal groove; MC, medial condyle of femur; MRI, magnetic resonance imaging; VMO, vastus medialis oblique.

• 

  Fig. 3 MRI sagittal sections through the extensor apparatus of the knee showing: (A) a fascial plane (red arrows) separates VM into two parts. (B) Lowermost fibers of VMO (blue arrow) overlap the anterior aspect of medial condyle of femur. (C) VMO inserted into the medial proximal margin of the patella by fleshy fibers (white arrow). MC, medial condyle of femur; MRI, magnetic resonance imaging; P, patella; VM, vastus medialis; VML, vastus medialis longus; VMO, vastus medialis oblique.

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  Fig. 4 MRI coronal sections through the extensor apparatus of the knee showing: (A) VMO inserted into the medial proximal margin of the patella and has a small region of direct continuity with the patellar tendon (red arrows) (B) Lowermost fibers of VMO overlapped the anterior aspect of the medial condyle of femur. In fully extended knee, the medial condyle was pushed posteriorly than the lateral condyle. MC, medial condyle of femur; MRI, magnetic resonance imaging; P, patella; VMO, vastus medialis oblique.

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  Fig. 5 U/S images of the VMO from a representative participant made by linear probe. (A) Crosssection showing anatomical structures immediately above the patella (B) Crosssection at midpatellar level. arrow, the VMO overlaps and merges with the joint capsule; F, femur; Fc, femoral condyle; P, patella; T, quadriceps tendon; U/S, ultrasound; VMO, vastus medialis oblique.

Reference

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