Tensor Vastus Intermedius Research Articles

Unveiling the Tensor Vastus Intermedius - A distinct anatomical phenomenon or a standard variation? A comparative analysis of comprehensive literature and original cadaveric studies.

The aim of this study was to enhance the understanding of the tensor vastus intermedius (TVI), a recently recognized addition to the quadriceps femoris muscle group, by conducting a systematic literature review with empirical cadaveric research to provide comprehensive data on its anatomical features, including dimensions, topography, variations, and prevalence. An exhaustive literature review was conducted using medical databases such as PubMed, MEDLINE, and Scopus. This review was complemented by original cadaveric research involving 30 autopsied adult bodies, encompassing 60 lower limbs, to empirically investigate the TVI's anatomical characteristics. The TVI was consistently identified in the medial aspect between the vastus lateralis (VL) and vastus intermedius (VI) in all examined cases. Detailed documentation covered its anatomical specifics, e.g. location, origin, and fascial connections, categorized using the criteria of Grob etal. Measurements of the muscle belly - length, width, and thickness - showed no significant lateral differences, but revealed gender-based disparities in TVI's size. The review not only confirms the consistent presence of the TVI, but also addresses the discrepancies in existing literature about its anatomical distribution and dimensional metrics. The observed methodological variations in previous studies underscore the need for standardized research methodologies in muscle anatomy. This in-depth review analysis significantly contributes to a deeper understanding of TVI, proving particularly beneficial for professionals in rehabilitation and related medical fields.

Tensor vastus intermedius: a review of its discovery, morphology and clinical importance.

This review aims to summarise the relevant literature surrounding the tensor vastus intermedius, a newly discovered muscle, and to discuss its morphology and potential clinical importance. No such review currently exists in the literature. A comprehensive literature search regarding the tensor vastus intermedius was performed using PubMed and Google Scholar in July 2020. Principles of Evidence-Based Anatomy and the Anatomical Quality Assessment Tool were employed to ensure a high-level review. All relevant papers were included and citation tracking was performed to uncover further publications. The tensor vastus intermedius is found in the anterior compartment of the thigh and has a similar morphology to the other vasti muscles. It has four main variations and a consistent neurovascular supply. The muscle has been implicated in a number of case reports and surgical procedures, which are described in detail in this paper. In the 4 years since the tensor vastus intermedius was formally described, a significant amount of work has been done to help us understand its structure and function. Further efforts are needed to gain a full picture as to its clinical importance. As such, it is recommended that this muscle should be acknowledged in anatomical education.

The development of the tensor vastus intermedius during the human embryonic period and its clinical implications.

The tensor vastus intermedius (TVI) is a newly discovered muscle located in the anterolateral thigh area and is considered the fifth component of the quadriceps femoris muscle. There have been several papers describing its anatomical and morphological features in detail; however, many features of this muscle, such as its ontology or kinetic functions, remain unknown. The purpose of this study was to determine the initial appearance of the TVI muscle in human embryonic development and to investigate its growth and development. Histological observations were performed on 30 lower limbs of 15 human embryos from Carnegie stage (CS) 21, 22, and 23 (with crown-rump length ranging from 18.7 to 28.7mm). Myocyte clusters of the TVI were observed between the vastus lateralis and intermedius muscles in 7 out of 10 limbs in CS 22, indicating that the TVI arises during this stage. In CS 23, the TVI was clearly present in all specimens except one. However, neither the aponeurosis nor the tendonous structure of the TVI were observed in these embryonic stages. Formation of the conventional four components of the quadriceps muscle is completed within CS 21; therefore, our results suggest that the TVI is the last element to develop in the quadriceps femoris complex. It is posited that after the embryonic period, the TVI continues to grow, while forming the tendinous structure toward the patella and receiving vascular supply from certain vascular branches. The clinical significance of these findings is that orthopedists and plastic surgeons who perform surgical procedures within the anterolateral thigh (ALT) area should be aware of the anatomy and development of the TVI in order to reduce surgical complications. Our present research aims to contribute to a deeper understanding of the morphogenesis of the TVI and the other femoral extensor muscles.

Quads or quins? Atraumatic restricted knee flexion due to accessory quadriceps bands in children.

Recent anatomical investigations have emphasized the variability in the knee extensor apparatus, with particular attention to a fifth component of the quadriceps femoris termed the tensor vastus intermedius or accessory "quinticeps femoris." Disorders of this structure have not been described in the pediatric imaging literature. To review the clinical features, pathoanatomy and imaging findings of children presenting with derangement of the accessory quadriceps femoris, with a particular emphasis on the utility of early magnetic resonance imaging (MRI) of the thigh. This is a retrospective analysis of 3 children, ages 3-10years at presentation, who underwent imaging evaluation with subsequent surgically proven accessory quadriceps femoris muscles. Their clinical histories, including duration of symptoms, MRI findings, intervention and surgical outcomes, are reported. All patients presented with progressive unilateral restricted knee flexion and had multiple imaging studies targeting the knee before diagnosis. Diagnosis in all patients was made on MRI of the thighs, which demonstrated a fusiform low signal intensity structure with muscle-like architecture arising from the anterior or anterolateral proximal femur and blending with the common quadriceps tendon distally. All patients underwent surgical release of the anomalous band with significant functional improvement. In cases of progressive limited knee flexion without intrinsic pathology, an accessory quadriceps muscle should be considered as an extrinsic cause. Our experience demonstrated this to be readily identifiable on MRI, with symptomatic improvement following surgical release. Early recognition of this condition should prevent unnecessary intervention such as knee arthroscopy and the debilitating loss of flexion due to delayed diagnosis.

Intra- and inter-muscular differences in the cross-sectional area of the quadriceps muscles assessed by extended field-of-view ultrasonography.

Τo examine the inter- and intra-muscular differences in the anatomical cross-sectional area (CSA) of the quadricep muscles, using extended - field of view (EFOV) ultrasonography (US). Panoramic transverse US images of the thigh were acquired from 10 young participants at five different locations across the thigh, in two sessions, spaced a week apart. The CSA of the vastus medialis (VM), rectus femoris (RF), vastus intermedius (VI), vastus lateralis (VL) and tensor vastus intermedius (TVI) was quantified. The intraclass correlation coefficients ranged from 0.75 to 0.97 and the standard error of measurement ranged from 0.78% to 6.61%, indicating high test-retest reliability. Analysis of the variance indicated that among the 5 quadriceps muscles the VL and the RF displayed the greater CSA proximally, the VI medially and the VM distally across the thigh (p <0.05). No differences in the quadriceps CSA measured with and without including the TVI were found (p >0.05). The EFOV US technique provides transverse scans of the quadriceps muscle in vivo and allowed a reliable and non-invasive determination of CSA at a low cost. Evaluation of CSA along the thigh largely depends on the measurement site. Future studies that examine the quadriceps CSA using EFOV after any form of intervention should consider changes of at least 6.5% as meaningful.

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

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.

Anatomical Investigation of the Tensor Vastus Intermedius in the Quadriceps Muscle Group

Study ObjectivesThe aim of this study is to further investigate the presence of the tensor vastus intermedius (TVI) in a larger sample size of 80 thighs and also attempt to bring novel imaging techniques to the discussion.BackgroundUntil this year, the quadriceps muscle group has been described as containing four muscles, with few studies describing its deviation from this definition. Most recently, a study reported finding this additional muscle belly in all 26 cadaver dissections performed, which was then named TVI for its similarities to the tensor fascia lata (TFL) and its anatomical relationship to the vastus intermedius (VI) (Grob et al 2016).MethodsIn the preliminary dissections performed on 49 donor thighs we focused specifically on TVI presence, tendinous properties and nerve innervation. This current study includes 80 donor thighs and will include the previously stated focuses as well as the vascular supply of the TVI. Biostatistical analysis will also be used to find any correlation of TVI bilaterally or with known factors of the donor such as gender.ResultsAlong with the TVI muscle belly presence, there is variation among its tendinous contribution to the quadriceps tendon, which is classified based on the muscle it fuses with, vastus lateralus (VL), VI or both, or whether it is completely independent.ConclusionOur preliminary investigation showed TVI presence in 38% of cadaver thighs, which is also what we expect to find in the additional 80 thighs analyzed of the present study.

The interaction between the vastus medialis and vastus intermedius and its influence on the extensor apparatus of the knee joint.

Although the vastus medialis (VM) is closely associated with the vastus intermedius (VI), there is a lack of data regarding their functional relationship. The purpose of this study was to investigate the anatomical interaction between the VM and VI with regard to their origins, insertions, innervation and function within the extensor apparatus of the knee joint. Eighteen human cadaveric lower limbs were investigated using macro-dissection techniques. Six limbs were cut transversely in the middle third of the thigh. The mode of origin, insertion and nerve supply of the extensor apparatus of the knee joint were studied. The architecture of the VM and VI was examined in detail, as was their anatomical interaction and connective tissue linkage to the adjacent anatomical structures. The VM originated medially from a broad hammock-like structure. The attachment site of the VM always spanned over a long distance between: (1) patella, (2) rectus femoris tendon and (3) aponeurosis of the VI, with the insertion into the VI being the largest. VM units were inserted twice-once on the anterior and once on the posterior side of the VI. The VI consists of a complex multi-layered structure. The layers of the medial VI aponeurosis fused with the aponeuroses of the tensor vastus intermedius and vastus lateralis. Together, they form the two-layered intermediate layer of the quadriceps tendon. The VM and medial parts of the VI were innervated by the same medial division of the femoral nerve. The VM consists of multiple muscle units inserting into the entire VI. Together, they build a potential functional muscular complex. Therefore, the VM acts as an indirect extensor of the knee joint regulating and adjusting the length of the extensor apparatus throughout the entire range of motion. It is of clinical importance that, besides the VM, substantial parts of the VI directly contribute to the medial pull on the patella and help to maintain medial tracking of the patella during knee extension. The interaction between the VM and VI, with responsibility for the extension of the knee joint and influence on the patellofemoral function, leads readily to an understanding of common clinical problems found at the knee joint as it attempts to meet contradictory demands for both mobility and stability. Surgery or trauma in the anteromedial aspect of the quadriceps muscle group might alter a delicate interplay between the VM and VI. This would affect the extensor apparatus as a whole.

New insight in the architecture of the quadriceps tendon.

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.

A newly discovered muscle: The tensor of the vastus intermedius.

The quadriceps femoris is traditionally described as a muscle group composed of the rectus femoris and the three vasti. However, clinical experience and investigations of anatomical specimens are not consistent with the textbook description. We have found a second tensor-like muscle between the vastus lateralis (VL) and the vastus intermedius (VI), hereafter named the tensor VI (TVI). The aim of this study was to clarify whether this intervening muscle was a variation of the VL or the VI, or a separate head of the extensor apparatus. Twenty-six cadaveric lower limbs were investigated. The architecture of the quadriceps femoris was examined with special attention to innervation and vascularization patterns. All muscle components were traced from origin to insertion and their affiliations were determined. A TVI was found in all dissections. It was supplied by independent muscular and vascular branches of the femoral nerve and lateral circumflex femoral artery. Further distally, the TVI combined with an aponeurosis merging separately into the quadriceps tendon and inserting on the medial aspect of the patella. Four morphological types of TVI were distinguished: Independent-type (11/26), VI-type (6/26), VL-type (5/26), and Common-type (4/26). This study demonstrated that the quadriceps femoris is architecturally different from previous descriptions: there is an additional muscle belly between the VI and VL, which cannot be clearly assigned to the former or the latter. Distal exposure shows that this muscle belly becomes its own aponeurosis, which continues distally as part of the quadriceps tendon.

Knee Pain Associated with Rupture of Tensor Vastus Intermedius, a Newly Discovered Muscle: A Case Report

Introduction: Muscle strains within the quadriceps muscle group are common and occur mostly in the rectus femoris. We report a case of an isolated rupture of the tensor vastus intermedius (TVI); a muscle that has recently been described. It belongs to the quadriceps muscle group and is closely related to the vastus lateralis and vastus intermedius. Case presentation: A healthy 62-year old woman presented with a history of a sudden onset of left knee and thigh pain after stumbling and preventing a near fall. Rupture of the aponeurotic tendon of the TVI was diagnosed by magnetic resonance imaging (MRI). Conservative treatment was successful. Four months after injury the patient returned to her pre-injury level of activity. MRI evaluation five months post-injury revealed full resorption of the muscular haematoma and a healed TVI aponeurosis with scar tissue formation. Conclusion: Due to its anatomic appearance, lesions to the TVI may be overlooked. The isolated rupture of the TVI in the present case further supports the recent finding, that the TVI is a distinct anatomical structure independent of the adjacent vasti.