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C OPYRIGHT  2012 BY T HE J OURNAL OF B ONE AND J OINT S URGERY, I NCORPORATED

Articularis Genus: An Anatomic and

MRI Study in Cadavers
Stephanie J. Woodley, BPhty, MSc, PhD, Christopher P. Latimer, BPhty, MSc,
Grant R. Meikle, MBChB, FRANZCR, and Mark D. Stringer, MS, FRCP(UK), FRCS(Engl)

Investigation performed at the University of Otago, Dunedin, New Zealand

Background: The articularis genus muscle is closely associated with the anterior aspect of the knee joint and may act to
elevate or retract the suprapatellar bursa. Its form and function are poorly understood. The purpose of this study was to
define the morphology of the articularis genus and its relationship to the suprapatellar bursa.
Methods: The articularis genus muscle was investigated in twenty-two human lower limbs obtained from eleven donors
(six men and five women; mean age at death, eighty-three years). Eighteen of these limbs underwent magnetic resonance
imaging (MRI) followed by dissection. The number, length, physiological cross-sectional area, attachment sites, and
orientation of individual fascicles, muscle bundles, and whole muscles were recorded. The remaining four limbs under-
went immunohistochemical analysis to determine muscle fiber types.
Results: The articularis genus comprised multiple layered muscle bundles originating from the anterior, anterolateral,
and/or anteromedial surfaces of the distal third of the femur. Distal attachment sites included the proximal and/or
posterior wall of the suprapatellar bursa, the deep surface of the distal tendon of the vastus intermedius, and the medial
and lateral aspects of the knee joint capsule. On dissection, the muscle was observed to consist of a mean of seven
muscle bundles (range, four to ten), but only a mean of four bundles were observed on MRI scans (p < 0.0001). The mean
cross-sectional area of the articularis genus (and standard deviation) was 1.5 ± 0.7 cm2, and its mean fascicular length
and bundle physiological cross-sectional area were 5.9 ± 1.0 cm and 0.2 ± 0.1 cm2, respectively. The articularis genus
displayed a mixed fiber type, with the proportion of type-I fibers varying among specimens (range, 39.9% to 76.4%).
Conclusions: These findings highlight the complex and variable anatomy of the articularis genus, particularly with
respect to the number of bundles and the distal attachment sites. Distinguishing the superficial bundles of the articularis
genus from the vastus intermedius on MRI can be difficult.
Clinical Relevance: Given its relationship to the anterior aspect of the knee joint and its association with the supra-
patellar bursa, the articularis genus may be a neglected cause of undifferentiated anterior knee pain.

A
nterior knee pain is common, especially in athletic ado-
lescents and young adults1,2. Diagnosis and treatment are
challenging. Although the etiology is clear in some cases3,
the majority of cases are idiopathic4. Indeed, some authors define
anterior knee pain as a diagnosis of exclusion after ruling out
recognizable pathology1. In theory, any structure with a sensory
nerve supply in the vicinity of the patellofemoral joint could
potentially be a source of anterior knee pain. Although ‘‘patello-
femoral syndrome’’ is one of the most commonly recognized
causes of anterior knee pain, other abnormalities involving the
osteochondral surfaces, quadriceps femoris tendon, patellar ten-
don, plicae, infrapatellar fat pad, and peripatellar bursae may also
be implicated4.
The articularis genus muscle originates from the anterior
surface of the distal aspect of the femur and inserts into the
proximal and posterior aspects of the suprapatellar bursa. It lies
deep to the vastus intermedius muscle and has been reported to
be present in 80% to 100% of individuals5-9. The unusual in-
sertion of this muscle has prompted speculation that it retracts
or elevates the suprapatellar bursa during extension of the knee,

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any
aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this
work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has
had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this
work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

J Bone Joint Surg Am. 2012;94:59-67 d http://dx.doi.org/10.2106/JBJS.K.00157

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TABLE I Number of Articularis Genus Muscle Bundles Observed
by MRI and Dissection (N = 18 Lower Limbs)
MRI
post-fixed in 10% formalin and dissected; samples were then obtained for
immunohistochemical muscle fiber typing. Details regarding knee function in
the donors prior to death were unavailable, but only knees with no evidence of
previous surgery or major degenerative changes were included.
Dissection

Cadaver No. of No. of No. of Magnetic Resonance Imaging

Specimen Bundles Sub-Bundles* Bundles
MRI scans were acquired on a Signa Infinity 1.5T whole-body imaging system
with Excite software version 11 (GE Medical Systems, Waukesha, Wisconsin)
1 Right 4 4 4
with use of a torso phased-array receive-only coil. Scans extended proximally
Left 4 9 5 for at least 20 cm from the level of the midpoint of the patella. An SPGR
2 Right 4 9 5 (spoiled gradient recalled acquisition in steady state) sequence was used to
Left 4 6 9 obtain both axial and sagittal images (28 ms repetition time, 6 ms echo time,
45 flip angle, 180 1-mm-thick slices with no interslice gap, 20-cm field of view,
3 Right 5 5 7
256 · 256 matrix).
Left 3 5 7 Images were viewed with use of OsiriX version 3.7.1 software (OsiriX
4 Right 3 4 8 Foundation, Geneva, Switzerland) and the number, location, and attachment
Left 3 3 8 sites of the articularis genus muscle bundles were estimated. Axial views proved
superior to sagittal views for differentiating muscle bundles, and the reported
5 Right 5 8 10
MRI findings were therefore based on the axial images. Agreement on archi-
Left 3 4 7 tectural parameters on the MRI scans was reached by consensus reporting
6 Right 4 4 7 among three investigators (G.R.M., M.D.S., and S.J.W.), all of whom were
Left 4 5 7 blinded to the dissection findings. Femoral length was measured from the apex
10,11
of the head of the femur to the base of the medial femoral condyle .
7 Right 5 5 6
Left 4 4 7
Dissection
8 Right 4 5 5
The dissection protocol was first developed with use of two specimens that were
Left 3 5 5 not included in the study. A midline skin incision was made from approxi-
9 Right 2 3 10 mately 20 cm proximal to the proximal pole of the patella to the tibial tuber-
Left 4 4 9 osity. The skin was reflected, the underlying superficial fascia was removed to
expose the quadriceps femoris muscle and the patella, and the rectus femoris
Mean and 3.8 ± 0.8 5.1 ± 1.8 7 ± 1.8
muscle was then resected. A string line was attached between the anterior
stand. dev.
superior iliac spine and the midpoint of the proximal pole of the patella to
enable measurement of bundle orientation. The patella was bisected longitu-
*Distally, some muscle bundles appeared to divide into discrete, dinally with use of a surgical saw, and the quadriceps tendon and the anterior
smaller sub-bundles.
wall of the suprapatellar bursa were then divided longitudinally. The presence
of suprapatellar plicae and their extent (complete or partial separation of the
knee joint cavity from the bursa) were recorded. Marker pins were inserted into
preventing entrapment of the bursa between the patella and the the midpoint of the proximal margin of the bursa and the posterior wall of the
femur5,6. However, the precise function of the articularis genus is joint cavity level with the midpoint of the proximal pole of the patella (Fig. 1).
difficult to establish since its morphology has rarely been de-
scribed. Although this muscle has been examined in various age
groups, including fetuses, there are major discrepancies re-
garding its architecture, distal insertion sites, and relationship to
the vastus intermedius among these reports5,6,8,9. A better
knowledge of the normal anatomy of the articularis genus may
not only contribute toward an improved understanding of knee
joint function but also prove relevant to a subset of the cases of
undifferentiated anterior knee pain. The aim of this study was to
investigate the morphology of the articularis genus and its re-
lationship to the suprapatellar bursa with use of a combination of
cadaveric dissection, magnetic resonance imaging (MRI), and
immunohistochemical techniques.
Fig. 1
Materials and Methods The superoinferior length of the suprapatellar bursa (posterior margin) was
Materials defined as the distance between the midpoint of the superior pole of the

T he anterior aspect of the knee was investigated in twenty-two lower limbs

harvested from eleven embalmed cadavers bequeathed under New Zea-
land’s Human Tissue Acts of 1964 and 2008. Eighteen of these limbs (from four
men and five women; mean age at death, eighty-five years; range, seventy-one
to ninety-seven years) underwent MRI before dissection. The remaining four
lower limbs (from two men; age at death, sixty-eight and eighty years) were
patella (*) and the proximal border of the midpoint of the bursa (M). The
bisected patella (P), the articularis genus muscle (AG), the fat pad (FP) that
extended into the bursa, and remnants of the vastus intermedius tendon
(VI) are also shown. The two green pinheads mark the midpoint of the
patella, where it has been bisected to reveal the bursa.
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TABLE II Frequency, Location, and Attachment Sites of Bundles of the Articularis Genus (N = 18 Lower Limbs)*

No. (%) of
Bundle Dissection Specimens Location Femoral Origin Distal Insertion

A 18 (100) Superficial layer
B 17 (94) Superficial layer
F 15 (83) Superficial layer
G 15 (83) Intermediate layer
J 3 (17) Intermediate layer
E 10 (56) Intermediate layer
I 8 (44) Intermediate layer
H 9 (50) Intermediate layer
C 15 (83) Deep layer
D 12 (67) Deep layer
K 4 (22) Indeterminate
(VI or articularis
genus)
Central, anterior Proximal margin of bursa; distally, tendon of VI
(largest)
Anterolateral Posterolateral wall of bursa; distally, tendon of VI
Anteromedial Posteromedial wall of bursa; distally, medial joint
capsule and also tendon of VI in some cases
Central, anterior Central posterior wall of bursa with or without
(and deep to J blending with fat pad
if present)
Central, anterior Central proximal posterior wall of bursa
Anterolateral Posterolateral proximal wall of bursa
Anterolateral Posterolateral wall of bursa
Anteromedial Medial and posteromedial joint capsule
Anterolateral Posterolateral wall of bursa and joint capsule
Anteromedial Posteromedial wall of bursa and joint capsule
Anterolateral Posterolateral wall of bursa, lateral joint capsule,
and tendon of VI

*VI = vastus intermedius.

Any muscle bundle originating from the femur and inserting distally
into the suprapatellar bursa and/or the knee joint capsule was considered to
12
represent part of the articularis genus . The remaining quadriceps muscles
were systematically removed to completely expose the articularis genus: the
vastus intermedius was bisected longitudinally and reflected laterally and me-
dially; the distal portions of the vastus medialis and vastus lateralis were then
separated from the femur, the lateral intermuscular septum and, where pos-
sible, the vastus intermedius, and removed; and, finally, all remaining fascicles
of the vastus intermedius unrelated to the suprapatellar bursa were excised.
The length of the suprapatellar bursa was recorded as the distance be-
tween its proximal margin and the midpoint of the proximal pole of the patella,
and its width was recorded as the distance between its medial and lateral margins
midway between the limits used to measure its length. A fat pad extended into the
bursa in some specimens, and its dimensions were noted if it was present (Fig. 1).
The number and arrangement of muscle bundles comprising the ar-
ticularis genus were recorded. A muscle bundle was defined as a group of
13,14
fascicles sharing a common origin, insertion, and orientation . The location
where each bundle originated on the femur was recorded as the most proximal

TABLE III Architectural Parameters of the Muscle Bundles Comprising the Articularis Genus (N = 18 Lower Limbs)*

Muscle Bundle No. of Fascicles per Bundle Fascicle Length (cm) Bundle Volume (mL) Bundle PCSA (cm2)

A 5 (1.7) 7.3 (1.4) 3.5 (1.2) 0.4 (0.2)

B 2 (1.0) 6.9 (1.1) 1.1 (0.5) 0.3 (0.4)
C 1 (0.7) 4.5 (1.0) 0.7 (0.5) 0.2 (0.1)
D 1 (0.4) 4.7 (1.3) 0.5 (0.2) 0.1 (0.0)
E 2 (1.0) 5.8 (1.3) 1.1 (0.7) 0.2 (0.1)
F 3 (1.0) 7.0 (1.4) 1.5 (0.9) 0.2 (0.1)
G 2 (0.9) 6.0 (1.4) 1.2 (0.8) 0.2 (0.1)
H 2 (1.5) 6.6 (1.0) 1.2 (1.0) 0.2 (0.1)
I 2 (1.1) 5.3 (0.8) 1.1 (0.8) 0.2 (0.1)
J 1 (0.6) 6.1 (1.6) 0.7 (0.1) 0.1 (0.0)
K 2 (0.0) 4.7 (1.6) 1.4 (0.8) 0.3 (0.1)
Mean 2 (1.1) 5.9 (1.0) 1.2 (0.8) 0.2 (0.1)

*The values are given as the mean, with the standard deviation in parentheses. PCSA = physiological cross-sectional area.
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pennation angle of each muscle bundle was measured in nine specimens with
use of a goniometer (Auckbritt, Henderson, New Zealand).

Comparison of MRI and Dissection Findings

After completion of the dissection, the observed morphology of the articularis
genus was compared with the MRI findings. The number of muscle bundles
was compared with use of the paired Student t test. The relationship of the
mean fascicle length to the femoral length was assessed with use of the Pearson
correlation coefficient. A p value of £0.05 was considered significant.

Immunohistochemistry
Fascicles of the articularis genus were removed, labeled, stored in 10% neutral
buffered formalin, embedded in paraffin, and serially sectioned (slice thickness,
5 mm). Labeled slides were then dewaxed and rehydrated with use of a series of
xylene and ethanol baths. Antigen retrieval was achieved by microwaving in 0.1 M
Tris-HCl buffer with 5% urea (pH 10) at a continuous boil for twenty minutes.
Sections were then treated with a blocking agent (1% bovine serum albumin;

Fig. 2
Figs. 2-A and 2-B Axial SPGR MRI scans of the right lower thigh of a man
who had died at the age of seventy-one years. VI = vastus intermedius, VL =
vastus lateralis, and VM = vastus medialis. Fig. 2-A Muscle bundles of the
articularis genus can be seen anteromedially (arrow) and laterally (ar-
rowheads). Fig. 2-B The lateral muscle bundle of the articularis genus
appears to be divided into two sub-bundles in this image.

and the most distal point, and the location where it inserted into the su-
prapatellar bursa and/or the capsule was recorded relative to the proximal pole
of the patella. Muscle length (measured both in centimeters and as a percentage
of the femoral length) was determined as the distance between the lowest point Fig. 3
of the most inferior fascicle and the highest point of the most superior fascicle Examples of complete (Fig. 3-A) and incomplete (Fig. 3-B) superior knee
relative to the proximal pole of the patella. Individual fascicles within each joint plicae (arrowheads) lying between the knee joint cavity and the su-
muscle bundle were then removed, and the length and volume of each fascicle prapatellar bursa. The proximal pole of the patella (*), the proximal border
was measured with use of electronic calipers (Ted Pella, Redding, California)
and a volumetric cylinder (10 ± 0.2 mL). These data were used to calculate the of the midpoint of the bursa (M), the bisected patella (P), and the areolar
13 tissue (AT) that acts as an intermediate point of insertion of the superficial
physiological cross-sectional area of each fascicle and the mean volume and
cross-sectional area of each bundle and of the articularis genus as a whole. The bundles of the articularis genus (AG) into the bursa are also shown.
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Preliminary immunohistochemical staining of the midportion of all

individual fascicles from a single articularis genus muscle bundle showed
consistent proportions of type-I and II muscle fibers across the bundle, and
therefore the most medial fascicle of each bundle was subsequently selected as
representative of the whole bundle. In addition, fiber typing of two fascicles
from the vastus intermedius, the deepest fascicle (closest to the articularis
genus) and the fascicle immediately superficial to it, was performed. Staining of
both fiber types in the first two lower limb muscles demonstrated that the stains
were entirely complementary, and therefore only type-II muscle fibers were
stained in the other two limbs.

Stereology
Slides were examined with use of a light microscope (BH2; Olympus, Tokyo,
Japan) equipped with a motorized stage drive (H128 version 3; Prior Scientific,
Cambridge, England) and a CCD video camera (WV-15; Panasonic, Osaka,

Fig. 4
Schematic illustration of the three layers of the articularis genus. Bundles
A, B, and F comprise the superficial layer; bundles E, G, H, I, and J (not
shown) comprise the intermediate layer; and bundles C and D comprise the
deep layer. The curved dashed line represents the margins of the supra-
patellar bursa.

Sigma-Aldrich, St. Louis, Missouri) and 10% normal goat serum (Sigma-
Aldrich) for fifteen to twenty minutes at room temperature. Skeletal muscle
fiber types were identified with use of two primary antibodies: anti-fast skeletal
myosin heavy chain MY32 (1:200; Sigma-Aldrich), which is a mouse mono-
clonal antibody that stains type-II (fast) muscle fibers; and anti-slow skeletal
15
myosin heavy chain NOQ7.1.1A (1:100; courtesy of Dr. Robin Fitzsimons ),
which is a mouse monoclonal antibody that stains type-I (slow) muscle fibers.
Slides were incubated with primary antibodies overnight at 4C, washed in
phosphate buffered saline solution three times for five minutes each, and
blocked and incubated at 4C for two hours with the secondary antibody,
biotinylated goat anti-mouse immunoglobulin G (1:200; Amersham Biosci-
ences, Buckinghamshire, UK). The VECTASTAIN Elite ABC kit (Standard)
(Vector Laboratories, Burlingame, California) containing diaminobenzidine
(FAST DAB with Metal Enhancer Tablets, Sigma-Aldrich) as the chromagen for Fig. 5
detection of horseradish peroxidase was used for secondary detection. Color Figs. 5-A, 5-B, and 5-C The muscle bundles of the three layers of the
development was monitored by eye for three to five minutes before the slide was
articularis genus. M = midpoint of the suprapatellar bursa, and VI = vastus
dehydrated with use of ethanol and xylene, cover-slipped with DPX (a synthetic
mounting medium of distrene, plasticizer, and xylene), and examined with use intermedius tendon. Fig. 5-A The superficial layer (bundles A, B, and F). Fig.
of light microscopy. Positive controls (rat quadriceps muscle) and negative 5-B The intermediate layer (bundles E and G). Fig. 5-C The deep layer
controls (processed in the absence of primary antibody) were also analyzed. (bundles C and D).
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seventeen of eighteen specimens; in nine specimens the plicae

were incomplete and in the other eight there was no visible
communication between the bursa and the knee joint (Fig. 3).
A fat pad extended into the bursa in nine specimens and was
located laterally in all but one of these specimens (Fig. 1). The
mean length of the fat pad, if present, was 3.4 ± 1.6 cm (range,
1.1 to 5.8 cm) and the mean width was 1.3 ± 0.5 cm (range, 0.7
to 1.9 cm).
The architecture of the articularis genus was variable. It
consisted of a mean of 7 ± 1.8 (range, four to ten) staggered
bundles organized into three layers: superficial, intermediate, and
deep (Figs. 4, 5, and 6). Overall, eleven different muscle bundles
were identified (Table II); the presence and position of six were
relatively consistent. The largest and most superficial was a cen-
tral bundle (A), which was flanked by a lateral (B) and a medial
(F) bundle (Fig. 4). Two short bundles in the deep layer, lateral

Fig. 6
Medial (Fig. 6-A) and lateral (Fig. 6-B) view of bundles of the articularis
genus inserting into the suprapatellar bursa and the deep surface of the
vastus intermedius tendon (elevated by the forceps). A through I corre-
spond to the muscle bundles shown in Figure 4.

Japan) connected to a computer. The C.A.S.T. stereology program (Olympus,

Ballerup, Denmark) was used to achieve systematic representative sampling across
individual fascicles and to calculate the relative proportion of type-I and II fibers.

Source of Funding
There was no external funding source for this study.

Results
MRI Findings

T he articularis genus was visualized in all MRI scans as

discrete muscle bundles, distinct from the vastus inter-
medius, originating on the femoral shaft and coursing distally
(Fig. 2-A). The precise margins of the suprapatellar bursa were
difficult to identify, and therefore the distal insertion of the
muscle bundles could not be accurately assessed with use of
MRI. The number of muscle bundles ranged from two to five,
with a mean (and standard deviation) of 3.8 ± 0.8 bundles per
muscle (Table I). Distally, the majority of the muscle bundles
appeared to divide into smaller, discrete sub-bundles (Fig. 2-
B); up to nine sub-bundles were observed within an individual
articularis genus muscle. The number of sub-bundles was
symmetrical in only two cadavers (Table I). Fig. 7
Photomicrographs demonstrating type-I and type-II muscle fibers (·10).
Dissection Findings These sections were taken from the articularis genus muscle of an eighty-
The mean length of the suprapatellar bursa was 4.6 ± 0.7 cm year old man (cadaver 10) and demonstrate complementary immunohis-
(range, 3.7 to 5.8 cm) and the mean width was 3.0 ± 0.3 cm tochemical staining of type-I (Fig. 7-A) and type-II (Fig. 7-B) fibers. Atrophy
(range, 2.3 to 3.3 cm). Suprapatellar plicae were present in of the type-II muscle fibers was noted in this specimen. Scale bar = 50 mm.
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articularis genus inserted into the suprapatellar bursa, the distal

TABLE IV Articularis Genus Muscle Bundles Identified by MRI tendon of the vastus intermedius, and the knee joint capsule
and Dissection (N = 18 Lower Limbs)
(Table II; Figs. 1, 5, and 6). Fascicles inserted directly into the
No. (%) of Specimens proximal and/or posterior wall of the suprapatellar bursa or
Bundle Dissection MRI
indirectly via a thin areolar membrane that was 1.7 ± 0.7 cm
(range, 0.6 to 3.9 cm) in length. The areolar membrane was
A 18 (100) 7 (39) continuous with the proximal margin of the suprapatellar bursa
B 17 (94) 16 (89) and constituted an intermediate insertion site for two of the
C 15 (83) 9 (50) superficial muscle bundles (A and B) (Fig. 3-B). In addition,
D 12 (67) 5 (28)
several superficial fascicles inserted into the deep surface of the
distal tendon of the vastus intermedius (Fig. 6); this was ob-
E 10 (56) 8 (44)*
served in all limbs for bundle A, in seven limbs for bundle B,
F 15 (83) 10 (56) and in eight limbs for bundle F. In total, five of the eleven
G 15 (83) 8 (44) identifiable muscle bundles inserted into the knee joint capsule
H 9 (50) 4 (22) (Table II).
I 8 (44) 1 (6) The articularis genus had a mean physiological cross-
J 3 (17) 0 (0) sectional area of 1.5 ± 0.7 cm2 (range, 0.5 to 3.3 cm2). The
K 4 (22) 0 (0) mean number of fascicles within each bundle ranged from one
to five, with bundle A containing the most. These data, together
*In seven of eight specimens this may instead have been bundle I. with the mean fascicle length and the bundle volume and cross-
sectional area, are shown in Table III. As expected, the most
proximal and superficial bundles (A, B, and F) contained the
(C) and medial (D), and one central bundle in the intermediate longest fascicles. There was no significant correlation between
layer (G) were present in most specimens (Table II). Other mean fascicle length and femoral length (r = 20.06, p = 0.85).
intermediate-layer muscle bundles were less consistently pre- Bundle orientation (n = 9) was more or less longitudinal
sent. Finally, one lateral bundle (K) was indentified in four (1 to 5 of angulation with respect to the reference line) except
specimens but was difficult to distinguish from the vastus in- for three bundles: bundle C was angled slightly laterally (11 ± 5)
termedius. The number of muscle bundles in paired lower and bundles D and K were angled slightly medially (14 ± 9 and
limbs was identical in four cadavers, differed by one bundle in 15 ± 4, respectively).
three, and differed by three or four bundles in two (Table I).
Proximally, bundles originated in a staggered fashion from Comparison of MRI and Dissection Findings
the anterior, anterolateral, or anteromedial surface of the distal Significantly fewer muscle bundles were observed with use of
aspect of the femur (Figs. 5 and 6). The articularis genus had a MRI compared with dissection (p < 0.0001) (Tables I and IV).
mean length of 13.9 ± 1.1 cm (range, 12.3 to 17.4 cm), covering Bundle B, the lateral bundle in the superficial layer, was ob-
the distal 32% of the femur (range, 29 to 42 cm). The mean served most frequently on imaging, and in a similar number of
highest point of insertion was 12.4 ± 2.9 cm (range, 7.2 to 17.4 specimens to that found on dissection. Bundle A, the central
cm) proximal to the proximal pole of the patella, and the mean superficial muscle bundle, which was present in all dissections,
lowest point was 3.3 ± 2.8 cm (range, 0 to 10.4 cm). Distally, the was observed in only seven of the eighteen MRI scans.

TABLE V Fiber Typing of the Articularis Genus and Vastus Intermedius Muscles (N = 4 Lower Limbs)*

Mean Ratio of
Muscle Cadaver Specimen Type-I Fibers (%) Type-II Fibers (%) Type-II:Type-I Fibers

Articularis genus 10 Right 68.0 (19.2) 32.0 (19.2) 0.6 (0.4)

Left 76.4 (20.3) 23.6 (20.3) 0.4 (0.6)
11 Right 39.9 (11.5) 60.1 (11.5) 1.7 (0.9)
Left 42.0 (16.2) 58.0 (16.2) 1.8 (1.5)
Vastus intermedius 10 Right 73.4 (6.6) 26.6 (6.6) 0.4 (0.1)
Left 61.7 (5.6) 38.3 (5.6) 0.6 (0.1)
11 Right 56.7 (21.5) 43.3 (21.5) 0.9 (0.7)
Left 57.2 (19.7) 42.8 (19.7) 0.9 (0.6)

*The values are given as the mean, with the standard deviation in parentheses.
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Immunohistochemistry
The proportion of fiber types varied widely between the muscles
from the two cadavers (Table V). However, the proportion in the
right-limb muscle of each cadaver was similar to that in the
corresponding left-limb muscle. The results for cadaver 11 may
be more reliable than those for cadaver 10 because the type-II
fibers in cadaver 10 appeared atrophic in some sections (Fig. 7).
Discussion
T he articularis genus was present in all of the specimens and
was located deep to and blended with the vastus inter-
medius, as noted in previous studies5,6,8,16. It was composed of
layered muscle bundles originating in a staggered fashion from
the distal third of the anterior surface of the femur and in-
serting distally into the proximal or posterior aspect of the
suprapatellar bursa. Some muscle bundles also attached to the
knee joint capsule or to the deep surface of the distal tendon of
the vastus intermedius.
Our study confirmed that the articularis genus can be
visualized with use of MRI8, but the number of muscle bundles
was significantly underestimated compared with dissection, at
least in cadaveric specimens from elderly donors. Only the lateral
superficial bundle (bundle B) was consistently identified. In-
terestingly, the central superficial bundle (bundle A) was espe-
cially difficult to see, which may reflect its proximity to the vastus
intermedius. The majority of bundles split into sub-bundles,
and it is possible that these represent some of the discrete bun-
dles that were observed during dissection. In the only previous
MRI study of the articularis genus, Puig et al.8 identified a mean
of 2.4 ± 0.7 muscle bundles in five healthy young adults, which
was even fewer than the 3.8 ± 0.8 identified in our study. They
also commented on the difficulty of distinguishing some muscle
bundles from the adjacent quadriceps femoris muscle. Thus,
regardless of the difficulties involved in visualizing the articularis
genus with use of MRI in embalmed cadaveric specimens from
elderly donors, this imaging modality may underestimate the
number of individual muscle bundles.
Before understanding the function(s) of the articularis
genus, we need to know its precise morphology, which is rel-
atively complex. Previous reports have disagreed regarding its
length and the number and arrangement of its constituent
muscle bundles5,6,16. Our study showed that the muscle was
approximately 14 cm long and covered the distal third of the
anterior surface of the femur. This contrasts with some inves-
tigations that have estimated the muscle length to be between
6.2 and 9.0 cm5,6,16. Related to this, we noted that the muscle
extended a mean distance of 12.4 ± 2.9 cm proximal to the
proximal pole of the patella, which is greater than the 6.2 cm
(range, 3.8 to 8.5 cm)16, 6.4 ± 5.1 cm8, and 10.5 cm (range, 8 to
16 cm)6 reported in previous studies. The measurement tech-
nique was only briefly described in those previous reports, and
the difference between the previous findings and ours may
therefore be related partially to methodological differences.
The articularis genus was arranged in three main layers
(superficial, intermediate, and deep) with no intervening adipose
tissue. Although some previous studies also described a layered
A R T I C U L A R I S G E N U S : A N A N AT O M I C AND MR I
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arrangement6,7,16, only Kimura and Takahashi12 documented
this in detail. On the basis of architecture and innervation,
these authors observed two muscle layers (superficial and deep)
separated by fat; two components (medial and lateral) formed
the superficial layer, but the number of muscle bundles in this
layer was not stated, making comparison with our results dif-
ficult. Our dissection findings showed that the articularis genus
comprised a mean of seven muscle bundles; this contrasts with
the results of Kimura and Takahashi12 , who commented that
the muscle contained at least ten bundles in Japanese cadavers.
Other authors have reported a variable number of muscle
bundles, typically ranging between one and seven5,6,16. The dis-
parities among studies may also reflect differences in method-
ologies and/or definitions of the articularis genus and its
constituent muscle bundles. We also found that fascicle length
varied according to bundle location, an observation that had
been noted in two previous studies8,12. In our study, the most
proximal, superficial bundles contained the longest fascicles and
the distal, deeper bundles contained the shortest. Since fascicle
length is directly proportional to maximal muscle excursion17, it
is possible that this arrangement allows longer fascicles to ac-
commodate the changes in muscle length that occur with knee
joint flexion and extension.
What is the function of the articularis genus? With respect
to architectural parameters, the physiological cross-sectional area
of a muscle is proportional to the maximum force that the muscle
is capable of generating14. The cross-sectional area of the articu-
laris genus (1.5 ± 0.7 cm2) , which has not been previously re-
ported to our knowledge, is diminutive compared with that of the
overlying quadriceps muscles such as the vastus lateralis (21.6 ±
7.7 cm2)18. The small cross-sectional area and the low pennation
angle of the articularis genus indicate that it is capable of gener-
ating only a small force. Because of the staggered arrangement of
its bundles, the muscle was observed to insert into a relatively
extensive area of the proximal and/or posterior margin of the
suprapatellar bursa. This morphological arrangement supports
previously proposed theories that the articularis genus may retract
or elevate the bursa during knee joint extension5,6,9,12,16. However,
direct evidence for this function is limited to one study that briefly
reported that stimulation of the branch of the femoral nerve
supplying the articularis genus muscle in three individuals un-
dergoing surgical amputation elevated the capsule and suprapa-
tellar bursa during extension of the limb5. To our knowledge, the
proprioceptive function of the articularis genus has not been
studied. Fiber typing can assist in understanding muscle function,
but with only two pairs of specimens, one of which had signs of
muscle atrophy, and the variable ratio of type-I to type-II fibers,
we could not establish whether the articularis genus was pre-
dominantly a postural muscle. Further investigations such as
dynamic MRI studies should offer better insights into its function,
particularly its action on the suprapatellar bursa during knee
movement. Such investigations might also clarify the role of the
articularis genus muscle fibers that we and other researchers6,12
observed to insert into the knee joint capsule.
The relationship between the articularis genus and the
vastus intermedius has been debated5,6,12,16,19. Although the bulk
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of the articularis genus appears to be separate from the vastus
intermedius, several anatomic features make the distinction
less clear-cut. First, no distinct investing fascia separated the
articularis genus from the vastus intermedius, a finding that
concurs with those of two previous studies12,19 but differs from
others5,6,16. Second, it has been shown that both muscles share a
common nerve supply from the femoral nerve12. Third, like
Kimura and Takahashi12, we noted that a small proportion of
the superficial fascicles in the superficial layer of the articularis
genus inserted into the deep surface of the distal tendon of the
vastus intermedius. Finally, one lateral bundle (bundle K)
identified in four specimens could not be categorically desig-
nated as being part of either the articularis genus or the vastus
intermedius. Despite these comments, the gross morphology
and limited histological data presented in our study lend sup-
port to the identification of these muscles as separate entities.
We support the suggestion of Kimura and Takahashi12 that the
articularis genus is best defined by its distal insertion sites, such
that any muscle bundles arising from the femur and inserting
into the suprapatellar bursa and/or the knee joint capsule are
deemed to be part of the muscle.
Our study has several limitations. One important limita-
tion is that the articularis genus was investigated in embalmed
cadaveric specimens from elderly donors. Age-related muscle
atrophy, which was particularly evident in two of the four limbs
used for immunohistochemistry, may well have distorted some
results. The physiological cross-sectional area data are not likely
to be representative of normal healthy adults. In addition, em-
balmed tissue has been reported to shrink by 2.2% to 12%20,21,
and this could have affected absolute values for variables such as
fascicle length. Nevertheless, the fundamental architecture of the
muscle is likely to have been preserved22. Our sample size pre-
cluded any meaningful analysis of the influence of sex, which
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Mark D. Stringer, MS, FRCP(UK), FRCS(Engl)
Department of Anatomy, Otago School of Medical Sciences,
University of Otago, P.O. Box 913,
Dunedin 9054, New Zealand.
E-mail address for S. Woodley: stephanie.woodley@anatomy.otago.ac.nz
Christopher P. Latimer, BPhty, MSc
Rangiora Physiotherapy, 215 King Street,
Rangiora 7400, New Zealand
Grant R. Meikle, MBChB, FRANZCR
Department of Radiology,
Southern District Health Board,
Private Bag 1921,
Dunedin 9054, New Zealand
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