Anatomy, Bony Pelvis and Lower Limb, Vastus Lateralis Muscle


Article Author:
Nicholas Biondi


Article Editor:
Matthew Varacallo


Editors In Chief:
Shivajee Nallamothu
Matthew Varacallo
Joshua Tuck


Managing Editors:
Avais Raja
Orawan Chaigasame
Carrie Smith
Abdul Waheed
Khalid Alsayouri
Trevor Nezwek
Radia Jamil
Patrick Le
Anoosh Zafar Gondal
Saad Nazir
William Gossman
Hassam Zulfiqar
Hussain Sajjad
Steve Bhimji
Muhammad Hashmi
John Shell
Matthew Varacallo
Heba Mahdy
Ahmad Malik
Sarosh Vaqar
Mark Pellegrini
James Hughes
Beata Beatty
Beenish Sohail
Nazia Sadiq
Hajira Basit
Phillip Hynes


Updated:
12/8/2018 4:23:17 PM

Introduction

The vastus lateralis (VL) is a unipennate muscle, and a member of the anterior compartment of the thigh along with the sartorius, quadriceps femoris, rectus femoris (RF), vastus medialis (VM), and vastus intermedius (VI) muscles. The VL is 1 of the 4 component muscles of the quadriceps muscle group: rector femoris, vastus lateralis, vastus medialis, and vastus intermedius. The vastus lateralis is the largest component of the quadriceps muscle groups and is positioned laterally about the femur.

Structure and Function

The VL has a broad, continuous origination about the proximal femur. Origin points include the intertrochanteric line, greater trochanter, lateral aspect of the linea aspera, gluteal tuberosity, and the lateral intermuscular septum. The fibers of this muscle converge and contribute to the quadriceps tendon, insert on the lateral aspect of the patella, and terminally insert on the tibial tuberosity via the patellar tendon. 

The VL is enclosed by a strong fascial layer known as the fascia lata. The fascia lata thickens laterally as it blends into the iliotibial tract. The intermuscular septae that divide the thigh into anterior, medial and lateral compartments receive their fibrous division from the deep aspect of the fascia lata. The lateral intermuscular septum is much stronger than the other two and separates the VL and VI of the anterior compartment from the short and long heads of the biceps femoris and the posterior compartment. The lateral intermuscular septum between the anterior and posterior compartments forms an inter-nervous plane which may be used as an important intraoperative landmark. 

Anatomically, the VL is bordered laterally by subcutaneous tissue, and medially, it is bordered by the femur and the VI, at the level of the greater trochanter. The RF forms the anteromedial border while the posteromedial aspect of the VL is bordered by the intermuscular septum, sciatic nerve, and biceps femoris muscle at the level of the greater trochanter.

Functionally, the vastus lateralis functions as a primary extender of the knee. In conjunction with the VM, the VL stabilizes the knee joint. The VL is part of the intermediate layer of the quadriceps tendon. The other part of the intermediate layer is the VM. These 2 muscles fuse to form a continuous aponeurosis that inserts on the base of the patella. Reflections of the aponeurosis extend laterally and medially to insert on the sides of the patella. Laterally, the VL ends in an aponeurosis that blends with the lateral patella or RF tendon, and distally, the fibers of the vastus lateralis combine with the vastus medialis fibers to form the retinacular ligament of the knee which inserts on the tibial condyles and ultimately forms the anterior capsule of the knee. This patellar retinaculum helps keep the patella aligned over the femur.

Blood Supply and Lymphatics

The lateral circumflex femoral artery primarily supplies the vastus lateralis. The lateral circumflex femoral artery has three main branches: ascending, transverse, and descending. The muscle also receives some blood supply from perforating arteries of the deep artery of the thigh, also known as the profunda femoris. The perforating arteries pierce the lateral intermuscular septum to gain access to the anterior compartment of the thigh. The parent artery, artery arises from the lateral or posterior side of the femoral artery in the femoral triangle. 

Venous drainage of the VL is achieved through the perforating veins of the deep femoral vein, the lateral femoral circumflex vein, and other unnamed veins from the superficial venous circulation. Larger named veins in the area that assist with drainage are named akin to the corresponding artery.

Nerves

The VL is innervated by penetrating muscular branches of the femoral nerve. The nerve roots involved include L2, L3, and L4. The predominant nerve root responsible for VL action is L3.

Physiologic Variants

The VL may have 2 insertional heads in approximately 60% of specimens. These 2 heads are referred to as the vastus lateralis long head (VLL) and the vastus lateralis obliquus (VLO). A layer of fat or fascia achieves this separation from the longitudinal head in most specimens. Variations in origin and insertion sites were uncommon.[1] If the VLO is present, the angulation of fiber insertion on the patella shows distinct variation from specimen to specimen. The VLL typically inserts at an angle between 10 degrees and 17 degrees +/- 8 degrees. The VLO, however, has an insertional variation between 26 degrees and 41 degrees.[2]

Surgical Considerations

The blood supply for the VL is primarily the lateral circumflex femoral artery as stated above. This main arterial supply enters the muscle anteriorly. The 3 branches of this vessel are anatomic landmarks in many orthopedic approaches to the hip. The ascending branch requires ligation during the anterior approach. The descending branch is in the plane between the VI and the VL and is often encountered during the anterolateral approach to the thigh.

Due to its extensive origin about the femur, the VL plays a key role as a landmark in many operative procedures involving both the femur and the hip joint. For any repair of the femoral shaft or proximal femoral replacement, the VL must be reflected to provide visualization of the femur.

In the lateral approach (Hardinge) to the hip, an internervous interval is created between the gluteus medius innervated by the superior gluteal nerve and the VL innervated by the femoral nerve. This interval is achieved by splitting the VL during the dissection. The VL is identified once the dissection has been carried through the fascia lata. In this approach, the lateral circumflex artery is at risk for damage.[3] During the posterolateral and direct posterior approaches to the thigh, similar internervous planes are created. The intervals are between the femoral nerve and the sciatic nerves. In the posterolateral approach, the interval divides the VL (femoral nerve) and the hamstring muscle group (sciatic nerve). In the direct posterior approach, the interval is between the VL and the biceps femoris (sciatic nerve).

The VLO is also a landmark used in the placement of portals during knee arthroscopy. If a superolateral inflow portal is to be used during an arthroscopic knee procedure, the portal is placed lateral to the body of the VLO.

Clinical Significance

As part of the quadriceps muscle group, the VL contracts during the termination of the swing phase of gait to prepare the knee for weight bearing. The muscle group as a whole is responsible for absorbing the vast majority of the force generated by the heel strike. The muscle group continues to contract through the early portion of the stance phase as part of the loading response. Lastly, as part of the quadriceps muscle group, the VL eccentrically contracts during downhill walking and descending steps.

The VL is the strongest member of the quadriceps muscle group, and thus it is one of the main contributors to anterior knee pain syndromes. The VL is estimated to contribute approximately 40% of the overall strength of the quadriceps muscle group with RF and VI accounting for 35% and the VM totaling the last 25%.[4] Overdevelopment of the vastus lateralis has been attributed as a major cause of patellofemoral dysfunction in addition to a more proximal attachment of the vastus medialis obliquus (VMO). An imbalance between the VL and VM can result in abnormal patellar movement, pain, and joint instability. The patellar movement could be further abnormal depending on the Q-angle of the limb. In a genu valgum (increased Q-angle) lower extremity, the effect of the lateral pull of the patella by the VL will be exacerbated creating an abnormal wear pattern and furthering arthritic processes.


  • Image 7209 Not availableImage 7209 Not available
    Image courtesy S Bhimji MD
Attributed To: Image courtesy S Bhimji MD

Interested in Participating?

We are looking for contributors to author, edit, and peer review our vast library of review articles and multiple choice questions. In as little as 2-3 hours you can make a significant contribution to your specialty. In return for a small amount of your time, you will receive free access to all content and you will be published as an author or editor in eBooks, apps, online CME/CE activities, and an online Learning Management System for students, teachers, and program directors that allows access to review materials in over 500 specialties.

Improve Content - Become an Author or Editor

This is an academic project designed to provide inexpensive peer-reviewed Apps, eBooks, and very soon an online CME/CE system to help students identify weaknesses and improve knowledge. We would like you to consider being an author or editor. Please click here to learn more. Thank you for you for your interest, the StatPearls Publishing Editorial Team.

Anatomy, Bony Pelvis and Lower Limb, Vastus Lateralis Muscle - Questions

Take a quiz of the questions on this article.

Take Quiz
Which muscle arises from the femur and contributes directly to the stability of the knee joint?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
The muscle shown in the image is useful for what type of activity?

(Move Mouse on Image to Enlarge)
  • Image 6437 Not availableImage 6437 Not available
    Image courtesy S Bhimji MD
Attributed To: Image courtesy S Bhimji MD



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
What type of malignancy usually affects the muscle shown in the image?

(Move Mouse on Image to Enlarge)
  • Image 6438 Not availableImage 6438 Not available
    Image courtesy Dr S Bhimji MD
Attributed To: Image courtesy Dr S Bhimji MD



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Neurologic exam of a patient shows the patellar reflex of his left knee shows a 2+/4 response. What muscle is innervated by the same nerve levels?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
As a student, you are assisting on an operation on a 34-year-old female’s left thigh. The patient is suspected to have an abscess in the pectineus muscle due to septic embolization from infective endocarditis. Preoperative planning shows the area suspicious for an abscess to be 2 cm distal to the lesser trochanter in the pectineus muscle prior to its insertion on the femur. During your dissection, you incise the fascia lata enclosing the anterior compartment musculature. To provide better visualization of the deeper structures, the attending surgeon asks you to reflect a bulky muscle originating on the intertrochanteric line, greater trochanter, and lateral linea aspera. On the posterior side of the reflected musculature, you notice an extensive arterial blood supply. Based on your knowledge of anatomy, what is the likely origin of the blood vessels you have identified?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 31-year-old male gunshot wound victim presents to the emergency department following sustaining a gunshot wound to his right lateral thigh. The patient was taken emergently to the operating room. The bullet struck the proximal femur 3 cm distal to the greater trochanter. Open reduction and internal fixation are performed, and the patient is transferred to the post-anesthesia care unit following successful surgery. The patient tolerated the procedure well. The patient completed two months of physical therapy and rehabilitation. Six months following the operation, the patient presents to his primary care physician’s office noting focal leg weakness with full weight bearing especially when descending steps. The patient also notes decreased muscle bulk about his right lateral thigh. There is no pain associated with the weakness. Aside from the above-mentioned surgery, the patient has no notable past medical history. He reports occasional marijuana and alcohol use. He takes naproxen 250 mg by mouth twice daily as needed for pain and a multivitamin daily. On examination, the patient is in no acute distress. His vital signs are stable: temperature 36.7 C, blood pressure 120/76 mmHg, pulse rate 70 bpm, and respiration rate of 12 per minute. Cardiopulmonary examination is unremarkable. Strength testing is notable for 3+/5 strength on right knee extension with 5/5 strength in all other joints. The sensation is intact distally throughout all extremities. Pulse a 2+/4 and symmetric bilaterally. Thigh circumference of the left thigh is 27 cm. The right thigh has a circumference of 21 cm with a notable loss of muscle bulk about the lateral thigh. What structure has likely been compromised?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 58-year-old female motor vehicle accident victim is seen in the emergency department. The patient was an unrestrained passenger in a head-on collision involving two vehicles on a local road. The patient sustained multiple injuries during the collision. She was ejected from the car as a result of the force of impact. She sustained multiple facial and extremity lacerations as well as an anteriorly dislocated shoulder. The patient was placed in a C-spine collar by the emergency medical service personnel on scene. The patient is well known to the hospital. She has a past medical history notable for benign essential hypertension and tobacco abuse disorder. The patient’s blood pressure is controlled with oral amlodipine 10 mg taken every morning. The patient has smoked 1 pack of cigarets daily for the last 23 years. The patient denies alcohol and illicit drug use. The patient has not pertinent surgical history and has no medical allergies. On examination, the patient’s temperature is 36.8 C, the pulse rate is 108 bpm, blood pressure is 106/84, and her respiration rate is 14 per minute. A 3 cm deep laceration is seen about the patient's scalp. The patient's sensation is intact in all 4 extremities. On extremity examination, a rock and other road debris are seen lodged in the skin immediately lateral to the patellar tendon of the right knee. Upon removal of the debris, arterial bleeding is seen. The wound is immediately packed with a pressure dressing. Radiographic examination reveals no occult fracture of the knee. The patient is prepped and taken to the operating room for further examination of the knee wound. Intraoperative examination reveals communication with the knee joint and the external environment. Repair of the fibers of which structure is needed to reseal the joint capsule?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up

Anatomy, Bony Pelvis and Lower Limb, Vastus Lateralis Muscle - References

References

Waligora AC,Johanson NA,Hirsch BE, Clinical anatomy of the quadriceps femoris and extensor apparatus of the knee. Clinical orthopaedics and related research. 2009 Dec     [PubMed]
Weinstabl R,Scharf W,Firbas W, The extensor apparatus of the knee joint and its peripheral vasti: anatomic investigation and clinical relevance. Surgical and radiologic anatomy : SRA. 1989     [PubMed]
Hardinge K, The direct lateral approach to the hip. The Journal of bone and joint surgery. British volume. 1982     [PubMed]
Farahmand F,Senavongse W,Amis AA, Quantitative study of the quadriceps muscles and trochlear groove geometry related to instability of the patellofemoral joint. Journal of orthopaedic research : official publication of the Orthopaedic Research Society. 1998 Jan     [PubMed]

Disclaimer

The intent of StatPearls is to provide practice questions and explanations to assist you in identifying and resolving knowledge deficits. These questions and explanations are not intended to be a source of the knowledge base of all of medicine, nor is it intended to be a board or certification review of Surgery-Orthopaedic. The authors or editors do not warrant the information is complete or accurate. The reader is encouraged to verify each answer and explanation in several references. All drug indications and dosages should be verified before administration.

StatPearls offers the most comprehensive database of free multiple-choice questions with explanations and short review chapters ever developed. This system helps physicians, medical students, dentists, nurses, pharmacists, and allied health professionals identify education deficits and learn new concepts. StatPearls is not a board or certification review system for Surgery-Orthopaedic, it is a learning system that you can use to help improve your knowledge base of medicine for life-long learning. StatPearls will help you identify your weaknesses so that when you are ready to study for a board or certification exam in Surgery-Orthopaedic, you will already be prepared.

Our content is updated continuously through a multi-step peer review process that will help you be prepared and review for a thorough knowledge of Surgery-Orthopaedic. When it is time for the Surgery-Orthopaedic board and certification exam, you will already be ready. Besides online study quizzes, we also publish our peer-reviewed content in eBooks and mobile Apps. We also offer inexpensive CME/CE, so our content can be used to attain education credits while you study Surgery-Orthopaedic.