Anatomy

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The quadriceps muscle group is composed of the rectus femoris and vastus muscles (intermedius, lateralis and medialis) (Fig. 8). The primary mechanism of action is knee flexion. Only the rectus femoris is biarticular. Proximally the rectus femoris has a direct head insertion on the anterior inferior iliac spine and an indirect head extending slightly laterally blending with the lateral aspect of acetabulum and hip capsule [26]. The direct head forms the anterior fascia of the proximal third of the muscle whereas the indirect head continues centrally located within the muscle and terminating at the distal aspect of the muscle

Proximal attachments of the vastus lateralis are multiple and include the in-tertrochanteric line, anterior and inferior border of greater trochanter, lateral gluteal tuberosity, upper linea aspera, and lateral intermuscular septum. Distally it inserts on the lateral border of the patella and patellar tendon.

Linea Aspera
Fig. 8. Axial T1-weighted imaging of the mid thigh showing muscle of the quadriceps group: l, vastus lateralis; m, vastus medialis; i, vastus intermedius; q, rectus femoris.
Stress Fracture Greater Trochanter

Fig. 9. Axial T2 fat-saturated images from unilateral right hip MR arthrogram (higher resolution technique) shows direct and indirect tendons of the rectus femoris at the myotendinous junction (A), tendon (B), and tendon insertion (C) levels. The white arrow represents the indirect head, which forms the central tendon. The direct head (black arrow) inserts on the anterior inferior iliac spine.

Fig. 9. Axial T2 fat-saturated images from unilateral right hip MR arthrogram (higher resolution technique) shows direct and indirect tendons of the rectus femoris at the myotendinous junction (A), tendon (B), and tendon insertion (C) levels. The white arrow represents the indirect head, which forms the central tendon. The direct head (black arrow) inserts on the anterior inferior iliac spine.

The proximal attachment of the vastus intermedius is the upper two thirds of anterolateral surface of femur and distally attaches to the upper border of patella and patellar tendon.

Vastus medialis proximal attachments include the entire length of linea aspera and medial condyloid ridge with the distal attachment primarily involving the medial half upper border of patella and the patellar tendon. The most distal fibers referred as the vastus medialis oblique (VMO) due to its oblique orientation of muscle fibers that are important of patellar stability in last 10 to 20 degrees of knee extension [26].

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