Illustration of the connection between the vastus medialis obliquus muscle and the superficial medial collateral ligament of the knee: A human knee cadaveric study

Background: While the anatomy of the medial part of the knee has been extensively described, the muscular connections to the superficial medial collateral ligament (sMCL) have not been sufficiently studied. The purpose of this study is to describe the anatomy of the musculo-ligamentous connection between the sMCL and the Vastus Medialis Obliquus muscle (VMO), and to describe its anatomy. Methods: Six Human Cadaveric knees were used in this study. Donors were 4 males and 2 females with a mean age of 49 years old. Dissection was performed in fixed knee extension and directed to show the area of the proximal attachment of the sMCL. Results: A musculo ligamentous connection between the distal portion of the Vastus medialis Obliquus muscle and the sMCL has been identified in our entire specimens. The mean mid substance width of this connection was 9.75 (8.7 -10.8) mm, the mean length was 29.3 (22.2-36.4) mm and the mean thickness was 1.3 (0.9-1.7) mm. Conclusion: The proximal femoral attachment of the sMCL is directly connected to the distal end of VMO. This connection may show that the sMCL can possibly assist in the dynamic stabilization of the knee during extension against valgus stress, through its tension by the contracted VMO muscle.

Dose atrophy of vastus medialis obliquus and vastus lateralis exist in patients with patellofemoral pain syndrome

Background Whether vastus medialis obliquus atrophy exists in patients with patellofemoral pain syndrome and whether the amount of atrophy differs between the vastus medialis obliquus and vastus lateralis muscles remain unknown. Materials From June 2016 to March 2019, 61 patients with patellofemoral pain syndrome were retrospectively included in the study group, and an age-, sex-, and body mass index-matched cohort of 61 patients with normal knees was randomly selected as the control group. All enrolled subjects had undergone CT scans in the supine position. The cross-sectional areas of the vastus medialis obliquus and the vastus lateralis muscle in the sections 0, 5, 10, 15, and 20 mm above the upper pole of the patella were measured, and the vastus medialis obliquus/vastus lateralis muscle area ratio was evaluated. Results In the study group, the vastus medialis obliquus areas and the vastus lateralis muscle areas in the sections that were 0, 5, 10, 15, and 20 mm above the upper pole of the patella were significantly smaller than the respective areas in the control group (P < 0.05). The vastus medialis obliquus/vastus lateralis muscle area ratio was significantly smaller at the upper pole of the patella (the section 0 mm above the upper pole of the patella) than the corresponding ratio in the control group (P < 0.05). No significant difference was noted between the two groups in the sections 5, 10, 15, and 20 mm above the upper pole of the patella (P > 0.05). Conclusion In patients with patellofemoral pain syndrome, vastus medialis obliquus and vastus lateralis muscle atrophy existed in sections 0–20 mm above the upper pole of the patella, compared with normal controls, and atrophy of the vastus medialis obliquus was more evident than that of the vastus lateralis muscle at the upper pole of the patella. These findings support the rationale for the use of general quadriceps exercise combined with vastus medialis obliquus strengthening exercise as part of the rehabilitation programme for the patients with patellofemoral pain syndrome.

The Vastus Medialis obliquus and The Vastus Lateralis Muscle Atrophy is Existed in Patients with Patellofemoral Pain Syndrome

Background: whether the vastus medialis obliquus (VMO) atrophy exists in patients with PFPS and whether the amount of atrophy differs between the VMO and vastus lateralis muscle (VLM) is still obscure. Materials and methods: From June 2016 to March 2019, 61 patients with PFPS were collected into the study group, and an age, sex, and body mass index (BMI) matched cohort of 61 patients with normal knees were randomly selected into the control group. All enrolled subjects had undergone computed Tomography (CT) scans in the supine position. The cross-sectional area of the VMO and VLM in the sections of 0, 5, 10, 15, 20 mm above the upper pole of the patella were measured, and VMO/VLM area ratio were evaluated as well. Results: In the study group and the control group, the VMO area in the section that 0, 5, 10, 15, 20 mm above the upper pole of the patella were 732.64±306.43 mm2 and 941.66±366.83 mm2 (P<0.001), 876.32±341.47 mm2 and 1119.6±405.01 mm2 (P<0.001), 1039.31±410.21 mm2 and 1302.75±425.14 mm2 (P<0.001), 1178.26±449.10 mm2 and 1496.67±474.70 mm2 (P<0.001), 1289.78±487.78 mm2 and 1643.33±507.08 mm2 (P<0.001); the VLM area in the section that 0, 5, 10, 15, 20 mm above the upper pole of the patella were 127.61±66.74 mm2 and 192.2±152.40 mm2 (P=0.003), 183.47±85.41 mm2 and 262.55±187.98 mm2 (P=0.004), 250.66±133.70 mm2 and 352.35±291.96 mm2 (P=0.015), 326.06±139.94 mm2 and 466.27±343.11 mm2 (P=0.013), 574.19±390.00 mm2 (P=0.005); the VMO/ VLM area ratio in the section that 0, 5, 10, 15, 20 mm above the upper pole of the patella were 0.83±0.11 and 7.44±5.13 (P<0.001), 5.37±2.49 and 6.32±4.69 (P=0.168), 4.64±2.43 and 4.15±1.94 (P=0.554), 3.90±1.55 and 3.96±1.66 (P=0.434), 3.42±1.36 and 3.48±1.62 (P=0.826).Conclusion: In patients with PFPS, the VMO and VLM atrophy was existed in the section of 0-20 mm above the upper pole of the patella in comparison with normal people; and the atrophy of the VMO was more evident than that of the VLM in the section that 0-5 mm above the upper pole of the patella. These findings support the rationale for use of general quadriceps exercise combined with VMO strengthening exercise as part of rehabilitation program for patients with PFPS.