The accessory heads of the quadriceps femoris muscle may affect the layering of the quadriceps tendon and potential graft harvest length

Abstract

Purpose The aim of the study was to assess the quadriceps femoris system for the presence of additional layers.

Methods One hundred and twenty-eight lower limbs fixed in 10% formalin were examined.

Results Five types of quadriceps tendon layering were found based on the accessory heads of the quadriceps muscle. Type I (55%)—represented by four heads and four layers, and it was something new because standard orthopaedic textbooks described quadriceps tendon as a structure composed of only three layers. Type II (27.4%)—the first four layers were the same as in Type 1, but the accessory tendon of the fifth head of the quadriceps femoris muscle had the deepest attachments. Type III (10.9%)—this type included 6 heads of quadriceps femoris. It consisted of five layers. Type IV (3.1%)—this type included 7 quadriceps femoris heads. This type consisted of only four layers. Type V (3.1%)—this type included 8 heads of the quadriceps femoris heads. This type consist of 5 layers.

Conclusion The findings of this study provide a detailed anatomy of the quadriceps tendon including the accessory tendons of the accessory heads of the quadriceps tendon. The accessory heads of the quadriceps femoris muscle contribute to the layering of the quadriceps tendon. The second conclusion of this study is the development of safe distances depending on the types. Not all types are perfect for harvesting—Type IV seems to be the safest type, in turn Type V the most dangerous.