New Insights into the Function of the Vastus

Medialis with Clinical Implications

HECHMI TOUMI1,2, GEORGES POUMARAT2, MIKE BENJAMIN1, THOMAS BEST3, SLIM F’GUYER4,
and JOHN FAIRCLOUGH5
1
Cardiff School of Biosciences, University of Cardiff, Museum Avenue, Cardiff, UNITED KINGDOM; 2University of Auvergne
Medical School, Clermont-Ferrand, FRANCE; 3Division of Sports Medicine, Department of Family Medicine, Ohio State
University, Columbus, OH; 4Department of Pediatrics, University of Illinois–Chicago, Chicago, IL; and 5School of Sport and
Physical Recreation, University of Wales Institute Cardiff, UNITED KINGDOM

ABSTRACT
TOUMI, H., G. POUMARAT, M. BENJAMIN, T. BEST, S. F’GUYER, and J. FAIRCLOUGH. New Insights into the Function of the
Vastus Medialis with Clinical Implications. Med. Sci. Sports Exerc., Vol. 39, No. 7, pp. 1153–1159, 2007. Purpose: To investigate the
gross anatomy of the distal portion of the quadriceps, and to compare the relative contributions of the vastus medialis oblique (VMO)
and vastus lateralis (VL) during dynamic weight-bearing conditions. Methods: Dissection was carried out on 10 cadavers by a
longitudinal incision from the anterior superior iliac spine to the patella and completed with upper and lower transverse cuts to
reinvestigate the gross anatomy and innervation patterns of the quadriceps femoris. A biomechanical test of knee kinematics was
conducted on 10 healthy male volunteers. Maximal isometric force, squat jump, and drop movement jump exercises were performed on
a force plate and filmed using a Saga-3 3D system, and surface EMG activity was recorded for the VMO and the VL. Results: The
oblique fibers of the vastus medialis (VM) are not only attached to the medial border of the patella, but they also have a small region of
direct continuity with the patellar tendon. Furthermore, VMO fibers in the middle and proximal thirds of the thigh attached to vastus
intermedius, whereas distally, the fibers were independent. Both parts of the VM (proximal and distal) had independent motor points.
During jumping exercises, the VMO and VL were activated in a coordinated manner in a squat jump using both legs. However, in a
single-leg squat jump (which challenged the stability of the knee joint more acutely), VMO activation was higher during landing.
Conclusion: VMO activity was pronounced during the weight-bearing conditions, with increased medial and lateral knee movements.
This suggests that the VM should not be considered simply as a knee extensor or as a muscle whose main role is to maintain normal
patellar tracking. Key Words: KNEE, PATELLOFEMORAL, EMG, QUADRICEPS, WEIGHT BEARING, ANATOMY

A
lthough the quadriceps femoris is the major
extensor of the knee and stabilizes the patella
within the trochlear groove (15,16), the role of its
individual muscles during dynamic knee function is
incompletely understood. This is particularly the case with
the obliquely orientated, distal fibers of the vastus medialis
oblique (VMO). It is unclear whether the quadriceps acts as
a single unit or whether the VMO can function indepen-
dently (17). This is an important issue that could aid in our
understanding of patellofemoral pain, which is common in
many sporting injuries and accounts for 25% of all sports-
related knee injuries (8).
There are several clinical observations suggesting that the
action of the VMO should be considered independently
Address for correspondence: Hechmi Toumi, Ph.D., School of Biosciences,
Cardiff University, Museum Avenue, PO Box 911, Cardiff CF10 3US, UK;
E-mail: toumih@cardiff.ac.uk.
Submitted for publication September 2006.
Accepted for publication February 2007.
0195-9131/07/3907-1153/0
MEDICINE & SCIENCE IN SPORTS & EXERCISEÒ
Copyright Ó 2007 by the American College of Sports Medicine
DOI: 10.1249/01.mss.0b013e31804ec08d
APPLIED SCIENCES
from that of the rest of the quadriceps. It is well known that
degeneration of the patellofemoral region is most common
laterally and that individuals with anterior knee pain often
have lateral patellar tilting or lateral subluxation, which
leads to increased patellofemoral contact forces (10,18).
This observation suggests an imbalance exists between the
action of the VMO (attempting to maintain the patella in
the trochlear groove) and the forces that tend to move the
patella laterally because of the Q angle. In people without
knee pain, the ratio of EMG activity of the VMO relative
to the vastus lateralis (VL) is approximately 1:1 throughout
the range of knee movement (18), and in such individuals,
the VMO and the VL are activated simultaneously (4).
However, a change in the relative onset of activity of these
muscles has been associated with dysfunction; people with
patellofemoral pain have a reduced ratio of VMO:VL
activity, and the onset of their VMO activity is delayed
relative to that of the VL (4).
Although previous authors have investigated the specific
role of the VMO in knee function, the majority of studies
have been based on non–weight-bearing conditions
(1,11,13). This most likely does not allow us to evaluate
accurately the role of the VMO during dynamic, weight-
bearing movements of the knee, which are common in daily

1153

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 life and sport. Certainly, force transmission from the
quadriceps tendon–patella–patellar tendon–tibia and the
contact between the femoral condyles and the patella differs
greatly in weight-bearing conditions. This is apparent
clinically if the contact areas between the femoral condyles
and the tibial plateau are compared in x-rays of the knee joint
taken in weight-bearing conditions. Recent studies have
attempted to clarify the role of the lower-limb musculature,
especially that of the quadriceps femoris components during
weight-bearing conditions such as jumping and running
(5,7). However, the primary aim of these was to investigate
the possible cause of the increased incidence of ACL
damage in the female. The investigators were able to show
that there was differential activity in the VMO and VL, but
the studies were not designed to investigate the relative
contributions and temporal activity of these muscles in
relation to changing angle of the knee joints and loading.
The purpose of the present paper is to further clarify the
relative contributions of both the VMO and the VL during
dynamic weight-bearing conditions that challenge knee
stability. To interpret the physiological and biomechanical
findings, we also reinvestigated the gross anatomy of the
distal portion of the quadriceps as a further strategy for
clarifying the function of the quadriceps during weight-
bearing conditions (jump landing).
MATERIAL AND METHODS
This study was conducted, with the approval of the ethics
committee, on 10 male students in the University of Clermont
Ferrand (France) who gave their informed consent and who
APPLIED SCIENCES
had no previous history of knee pain or pathology. Their
ages, heights, and body mass (means T standard deviation)
were 25 T 3 yr, 180 T 4 cm, and 76 T 8 kg, respectively.
Biomechanical tests. A leg press (PANATTA
SPORT, DPS, Clermont Ferrand, France) was used to
measure maximal isometric force (all participants were
familiarized with its correct use beforehand). Further details
of the procedure have been given previously (21,22).
The subjects performed three maximal isometric leg press
extensions, and the best result was recorded. The knee angle
was standardized at 70-—a position that was selected
because pilot tests demonstrated that the force–angle
relationship was maximum around this angle. Data were
collected at 2000 Hz and stored in a PC computer (Intel
Pentium; PSI instruments; Clermont Ferrand, France).
A force plate (9981C, KISTLER Instrument AG Winterhur,
Switzerland) was used to measure force (dN; 1 dN = 10 N)
during squat (SJ) and drop (DJ) jumps on both feet and one
foot. The SJ consisted of a pure, maximal, concentric knee
extension, and the drop jump was performed from 50 cm,
according to the protocol of Komi et al. (12). Subjects
performed each jump three times in random order, and all
performances were recorded.
Kinematic assessment. A Saga-3 3D system (Saga-3,
Biogesta Denain, Clermont Ferrand, France) was used to
1154 Official Journal of the American College of Sports Medicine
Copyright @ 2007 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
analyze kinematic data for the greater trochanter of the hip
(H), the lateral femoral epicondyle of the knee (K), and the
lateral malleolus of the ankle (M) during each exercise.
Subjects were filmed at 100 Hz, and the coordinated marker
points were filtered using spline functions. Each jump was
divided into three phases: two eccentric phases (ECC1 and
ECC2) and one concentric (CON) phase (Fig. 1). The time
of initiation of ECC1 was calculated using the force plate
data (corresponding to the instant at which vertical force
began to decrease continually). The end of the CON phase
was defined as the instant at which the subject lost contact
with the force platform (corresponding to the instant at
which the vertical component of the ground-reaction forces
was zero). The initiation of the ECC2 phase corresponded
to the time when the subject first contacted the force plate
on landing. The end of both ECC phases and the beginning
of the CON phase was defined using the kinematic data for
the knee joint.
Motor point procedures and EMG recordings. To
locate the motor points of the quadriceps femoris, each
muscle was investigated by moving a monopolar probe over
its belly. Electrical stimulation was delivered by a Biostim
stimulator (model 6050, Mazet Electronique, France). The
current was composed of symmetrical biphasic square wave
pulses (duration of 200 ms) delivered percutaneously to the
muscle at a frequency of 80 Hz. Electrophysiological tests
showed that both parts of the vastus medialis (VM)—the
proximal part of the muscle and the distal fibers that
comprise the VMO—had independent motor points, in
contrast to the VL, where only one motor point was
observed. The EMG signal was then recorded over the
motor points of the VMO and the VL. Bipolar surface
electrodes (sensors, 10 mm) were placed longitudinally over
the muscle belly with an interelectrode distance of 20 mm.
The skin was shaved at each recording point, swabbed with
alcohol, and temporarily marked for the duration of testing.
FIGURE 1—Knee joint angle (A), reaction force curve (B), EMG
activity for VL (C), and EMG activity for VMO during the drop jump
movement phase, divided into an eccentric phase (ECC1), a concentric
phase (CON), and an eccentric phase (ECC2) according to force plate
and kinematic data.
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FIGURE 2—Knee joint angle (A), reaction force curve (B), normalized
RMS value for VMO (C), normalized RMS value for VL (D), and
differences in normalized RMS values between VMO and VL (E)
during one-leg squat jump. Note that during the CON phase between
40 and 0- of flexion and during the ECC2 phase between 60 and 40- of
flexion, the VMO was activated to a greater extent than VL (arrow
heads).
A large strip of sticking plaster was used to cover and fix
the electrical contact to the skin, and a reference electrode
was placed on the patella. Signals were preamplified,
filtered using a band-pass filter (15–1000 Hz), and sampled
at 2000 Hz. RMS values were calculated and normalized
to the maximal RMS values recorded during MVC, to
account for differences in electrical impedance and
electrode placement. Because comparing the activation
of VMO and VL was of primary interest, values of the
root mean square (RMS) for each muscle and the ratio of
difference between VMO and VL (100  [VMO j VL]/
VMO) were obtained. Maximal RMS values and the
corresponding knee-flexion angle were calculated with the
knees at 80 to 60, 60 to 40, 40 to 20, and 20 to 0- of
flexion, for each phase (ECC1, ECC2, and CON). The
starting position (80-) was chosen because pilot tests
showed that all subjects were comfortable beginning squat
jumps in this position and because subjects did not go
below 80- during landing.
Gross anatomy. Ten dissecting room cadavers
donated to Cardiff University (UK) under the provision of
the 1984 Human Anatomy Act were used to reinvestigate
the gross anatomy of the quadriceps femoris. The skin and
superficial fascia were removed in the region of the
quadriceps muscle by making a longitudinal incision from
the anterior superior iliac spine (ASIS) to the patella,
followed by upper and lower transverse cuts. The upper
transverse cut extended from the ASIS to the pubic
symphysis, and the lower cut was made at the level of the
lower pole (apex) of the patella. The femoral nerve and its
branches to VM were carefully dissected beneath the deep
fascia, in a craniocaudal direction, commencing in the femo-
ral triangle.
ANATOMY AND FUNCTION OF THE VASTUS MEDIALIS
Copyright @ 2007 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
Statistical methods. All statistical analyses were
performed with MatLab software (Version 7.0.4.365
(R14)). Means and SD were calculated from individual
measurements for each exercise. The changes between
variables of each exercise were analyzed using general
linear model analysis of variance with repeated measures.
When significant differences were found, Fischer post hoc
tests were used. In each case, the level of significance was
set at P G 0.05.
RESULTS
Kinematic Assessment
Jump exercises showed that although both the VMO and
VL were activated simultaneously in both the squat and
drop jumps on either one or both legs (Figs. 2–5), the
relative contribution of each muscle varied with the knee
angle and the type of contraction (eccentric or concentric)
(Tables 1 and 2).
Squat jumps. During the concentric phase (push-off),
there was no significant difference in RMS value between
the VL and the VMO at 80 to 60- and 60 to 40- of flexion
for squat jumps performed on either one or both legs.
However at 40 to 20- and 20 to 0- of flexion, the VMO was
activated to a greater extent than the VL (P = 0.003). The
ratio of difference between the two muscles at 40 to 20- and
20 to 0- of flexion averaged 26.9 T 4.5 for single-legged
squat jumps and 21.3 T 5.7 for two-legged squat jumps. The
maximum values reached were 34.8 T 3.9 (at 27 T 8-
flexion for single-legged jumps) and 22.4 T 6.6 (at 12 T 6-
flexion for two-legged jumps). During two-legged squat
APPLIED SCIENCES
jumps, both the VMO and the VL were highly activated
during the eccentric phase in landing (ECC2), and there was
no significant difference (P = 0.12) between the activity of
FIGURE 3—Knee joint angle (A), reaction force curve (B), normalized
RMS value for VMO (C), normalized RMS value for VL (D), and
differences in normalized RMS values between VMO and VL (E)
during squat jump with both legs. Note that during the CON phase
between 40 and 0- of flexion, the VMO was activated to a greater
extent than VL (arrow heads).
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FIGURE 4—Knee joint angle (A), reaction force curve (B), normalized
RMS value for VMO (C), normalized RMS value for VL (D), and
differences in normalized RMS values between VMO and VL (E)
during one-leg drop jump. Note that during ECC1 between 60 and 40-
of flexion, during the CON phase between 40 and 0- of flexion, and
during the ECC2 phase between 60 and 40- of flexion, VMO was
activated to a greater extent than VL (arrow heads).
the two muscles. However, in single-legged jumps, the
VMO was activated more than the VL between 60 and 40-
of flexion. The ratio of difference between the VMO and
the VL at 60 to 40- of flexion averaged 23.6 T 8.7 and
reached a maximum of 43.5 T 7.2 at 49 T 8- of flexion.
Drop jumps. In the ECC1 phase of two-legged drop
jumps (landing from the box on the force plate), the VMO
and VL were activated in a coordinated manner, and the
APPLIED SCIENCES
muscle. Although the VM was strongly bound to the vastus
intermedius proximally, the VMO was easy to separate from
the remainder of the muscle group by blunt dissection
(Fig. 6E). It was also evident that the fibers of the VMO
were not only attached to the medial border of the patella,
but they also had a small region of direct continuity with
the patellar tendon (Fig. 6A, E, and F). The VMO has an
independent nerve supply from that of the rest of the
muscle. The femoral nerve gave off a short branch, which
rapidly ramified into four or five smaller branches that
supplied the proximal part of the VM (Fig. 7). However,
there was also a long thin branch (the ‘‘nerve to VM’’),
which traversed the subsartorial canal alongside the femoral
vessels and supplied the distal part of the muscle (i.e., the
VMO (Fig. 7)). This observation that the VMO is inner-
vated by a distinct branch of the femoral nerve was made
in all six cadavers that were examined for this purpose.
DISCUSSION
The combined anatomical and biomechanical/physiological
approaches used herein to investigate the role of the
quadriceps muscle group during dynamic knee function
suggest that the structure and function of the VM is more
complex than previously recognized. Although this muscle is
part of the quadriceps, its distal oblique fibers (i.e., the VMO)
have their own distinct nerve supply. They attach not only to
the quadriceps tendon, but also to the medial border of the
patella, and they can be directly continuous with the patellar
tendon. Furthermore, the more proximal fibers of the VM

(which comprise the bulk of the muscle) are more firmly

ratio of difference between the two muscles approached
attached to the vastus intermedius than to the rectus femoris, as
zero. However in single-legged jumps, the VMO was
activated more than the VL between 60 and 40- of flexion.
At this angle, the ratio of difference between the muscles
averaged 28.8 T 5.7 and reached a maximum of 71.2 T 12.7
at 51 T 10-. During the concentric phase of both single- and
double-legged drop jumps, there was no significant differ-
ence between the two muscles at 80 to 60- or 60 to 40- of
flexion. Between 40–20- and 20–0- for both jumps, the
VMO was activated more than the VL (P = 0.03). The ratio
of difference between the VMO and VL at 40 to 20 and
20 to 0- of flexion averaged 17.2 T 5.2 for double-legged
jumps (maximum 27.6 T 5.6 at 22 T 6-) and 0.28.9 T 5.7 for
single-legged jumps (maximum 40.6 T 8.3 at 18 T 8-).
During the ECC2 phase of both jumps, the VMO was
activated more than the VL between 40 to 20 and 20 to 0-
flexion (P = 0.04). For double-legged jumps, the ratio of
difference between the muscles averaged 19.2 T 3.9 (maxi-
mum 38.4 T 11.6 at 27 T 9-), and for single-legged jumps
it averaged 26.6 T 3.5 (maximum 46.7 T 10.4 at 33 T 10-). FIGURE 5—Knee joint angle (A), reaction force curve (B), normalized
RMS value for VMO (C), normalized RMS value for VL (D), and
Gross anatomy. The gross anatomy of the quadriceps differences in normalized RMS values between VMO and VL (E)
muscle complex and the attachment of the quadriceps during drop jump with both legs. Note that during ECC1, no
tendon to the patella is shown in Figure 6. The distal fibers significant difference was observed between the two muscles. However,
during the CON phase between 40 and 0- of flexion, and during the
of the VM (i.e., the fibers of the VMO) are obliquely ECC2 phase between 60 and 40- of flexion, VMO was activated to a
orientated and independent of those of the rest of the greater extent than VL (arrow heads).

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TABLE 1. Ratio of difference between vastus medialis oblique (VMO) and vastus lateralis (VL), and means and standard deviations (SD), calculated with the knees at 80 to 60, 60 to
40, 40 to 20, and 20 to 0- of flexion, for each phase (concentric and second eccentric) during the squat jump.
Knee Angle
Concentric Phase 80 to 60- 60 to 40- 40 to 20- 20 to 0-
Squat jump with one leg j3.4 T 2.1 j5.6 T 3.2 31.2 T 6.8* 22.6 T 4.8*
Squat jump with two legs 1.9 T 1.3 4.5 T 2.8 19.4 T 7.2* 23.1 T 5.5*

Knee Angle
Eccentric Phase 0 to 20- 20 to 40- 40 to 60- 60 to 80-
Squat jump with one leg 3.1 T 2.8 6.6 T 2.2 23.6 T 8.7* 4.6 T 2.3
Squat jump with two legs 5.9 T 3.3 j3.4 T 2.5 3.4 T 2.3 4.4 T 1.9

others have suggested (13). Although our current anatomical
dissection findings demonstrated that there is a separate branch
of the femoral nerve to the VMO, as confirmed by previous
authors, (14,23), it contradicts the recent findings of Peeler
et al. (17), who have indicated that the nerve never enters VM
at more than one site. Our observation of a distinct branch of
the femoral nerve entering the VMO was made in all six
cadavers examined and is thus unlikely to reflect anatomical
variation between individuals. There were no special
features associated with these cadavers or any specific
dissection techniques employed to demonstrate the nerve.
Thus, the reason for the difference between our findings and
those of Peeler et al. (17) cannot be readily explained,
although it was noted that the nerve was small and could
easily be missed or torn in dissection. It should be noted
that clinical evidence points to the likelihood of an
independent nerve supply to VMO; this part of the muscle
can be stimulated independently in the treatment of anterior
knee pain and patellar subluxation (6). This has been
confirmed by our electrophysiological tests where both parts
We have shown that the relative contribution of the VMO
compared with the VL varied according to the type of
contraction (eccentric or concentric) and the knee angle.
Our results contradict earlier studies showing that the VMO
is more active at 90- of knee flexion during both concentric
and eccentric contractions (3,19). Although both muscles
were activated simultaneously when the knee was flexed 40
to 80-, VMO activity became more pronounced in our study
between 40- of flexion and full knee extension. This may
reflect the fact that the primary role of the VL is knee
extension (because its fibers are predominantly longitudi-
nal), whereas the VMO is much less effective as an
extensor, in part because of its oblique fiber orientation.
The finding that the EMG activity of VMO became most
pronounced at full extension emphasizes the importance of
this part of VM in maintaining medial patellar stability,
because lateral displacement of the patella typically occurs
in the initial few degrees of flexion before the patella comes
to lie in the trochlear groove (9). A greater activity ratio of
VMO was also found while the subject was in the air. This

of the VM (i.e., the proximal fibers and the VMO) were
found to have independent motor points.
It is clear that activation of the VM in the weight-bearing
conditions used in the present study differs from that which
occurs in the isokinetic or isometric protocols used by
previous workers (1,11,13,15). The fact that VMO activity
was pronounced during weight-bearing conditions that
prevail in landing from a jump may relate to the increase
in medial and lateral knee movements and the challenges
that such movements place on patellar alignment (20,24).
APPLIED SCIENCES
suggests that the VMO is required to act as a stabilizing
medial force whenever the patella is in a position where
it could be dislocated. It is possible that the direct attach-
ment of the VMO fibers to the patella (rather than an
indirect attachment via the quadriceps tendon) ensures that
the medially directed pull of VMO maintains the position
of the patella within the trochlear groove. Our dissections
(Fig. 6D) contradict the earlier studies of Peeler et al. (17),
who have suggested that only a small part of VM (G 10%)
attaches directly to the medial aspect of the patella; the

TABLE 2. Ratio of difference between vastus medialis oblique (VMO) and vastus lateralis (VL), and means and standard deviations (SD), calculated with the knees at 80 to 60, 60 to
40, 40 to 20, and 20 to 0- of flexion, for each phase (first eccentric, concentric, and second eccentric) during the drop jump.
Knee Angle
First Eccentric Phase 0 to 20- 20 to 40- 40 to 60- 60 to 80-
Drop jump with one leg 5.2 T 3.8 j7.6 T 4.2 28.8 T 5.7* 5.6 T 3.1*
Drop jump with two legs j4.9 T 3.2 j6.3 T 3.5 5.4 T 3.4* 5.4 T 3.9*

Knee Angle
Concentric Phase 80 to 60- 60 to 40- 40 to 20- 20 to 0-
Drop jump with one leg j5.1 T 3.1 j2.5 T 1.2 25.7 T 8.2* 28.4 T 6.8*
Drop jump with two legs 4.1 T 2.3 6.1 T 2.3 21.5 T 5.8* 12.5 T 4.9*

Knee Angle
Second Eccentric Phase 0 to 20- 20 to 40- 40 to 60- 60 to 80-
Drop jump with one leg 28.5 T 7.9* 24.6 T 8.5 4.8 T 2.7* 4.5 T 3.6
Drop jump with two legs 16.5 T 5.2* 21.7 T 6.7 5.8 T 3.9* 5.1 T 3.3

ANATOMY AND FUNCTION OF THE VASTUS MEDIALIS Medicine & Science in Sports & Exercised 1157

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 FIGURE 6—Gross anatomy of the quadriceps muscle complex. A) Frontal view of the VL, VM, and RF. Arrows shows the direct continuity between
the vastus medialis and the patellar tendon. B) Frontal view showing that the RF tendon attaches directly to the patella relatively independent of the
rest of the quadriceps tendon. C ) Frontal view showing that the VM does not attach to the RF, but to the VI. D) A posterior view of the quadriceps
tendon attachment, showing that the VM tendon is shorter than the rest of quadriceps tendon and that its insertion angle is different. E ) Frontal view
of the quadriceps tendon attachment, showing the differences in the insertion angle between the VM and the rest of the quadriceps muscles. Note the
continuity of the VM and patellar tendons (arrow). F) Posterior view of the quadricep-tendon attachment to the patella. Note that the direct link
between the VM and the patellar tendons is also visible in this deep surface view (arrows).

patellar attachment is frequently more extensive. We note standard deviation 24 T 5 cm); this challenges knee stability
APPLIED SCIENCES

that the VMO fibers are identified as a distinct entity at during landing to a greater extent. Our results contradict those
surgery, because they are dissected free from the medial of earlier reports (5,7) where no significant differences were
border of the patella and are advanced obliquely across the found between VMO and VL during landing. However, this
surface of this bone in the Insall procedure, which is used may reflect methodological differences between the studies.
for controlling patellar subluxation (2). It also is important to note that Fagenbaum et al. (7) did not
The pattern of EMG activity of the VMO differs
according to whether jumps were performed on one or
both legs, indicating a difference in motor unit recruitment.
During single-legged jumps, there was a greater relative
contribution of the VMO compared with the VL, perhaps
reflecting a role of the VMO in maintaining the stability of
a subject whose center of gravity is displayed laterally
during a single-legged jump. Our study did not show any
difference between VMO and VL activity in landing from a
squat jump performed on both legs. There was only a
difference in relative muscle activity when such jumps were
performed on one leg, or when the subjects performed drop
jumps. It is possible that one-legged squat jumps and drop
jumps both destabilize the knee joint to a greater extent than
two-legged squat jumps. The fact that drop jumps
FIGURE 7—Gross anatomy of the vastus medialis nerve supply. The
performed on both legs were also associated with pro- femoral nerve gave off a short branch, which rapidly ramified in four
nounced activity of the VMO, compared with the VL, may or five smaller branches that supplied the proximal part of vastus
relate to differences in jump height between drop and squat medialis (arrows). However, there was also a long nerve (arrow head;
the ‘ nerve to vastus medialis’’), which traversed the subsartorial canal
jumps. Drop jump heights (mean T standard deviation 36 T alongside the femoral vessels (star) and supplied the distal part of the
7 cm) were greater than squat jump heights (mean T muscle (i.e., the VMO).

1158 Official Journal of the American College of Sports Medicine http://www.acsm-msse.org

Copyright @ 2007 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
seek specifically to compare VMO activity with that of VL,
and thus they did not apply any statistical tests to the EMG
data obtained from these muscles when the subjects landed
at different knee angles. Moreover, the surface EMG
electrodes in Fagenbaum et al._s (7) study were attached to
the skin at approximately one third of the distance from the
knee joint space to the greater trochanter. Consequently,
they may have been located over the proximal fibers of the
VM, rather than over VMO. In our study, motor points were
detected using electromyostimulation, and the surface
electrodes for the VMO were located more distally.
In summary, the separate nerve supply and attachment of
the VMO suggest that the distal part of the VM performs a
different function compared with the proximal part. Our
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ANATOMY AND FUNCTION OF THE VASTUS MEDIALIS
Copyright @ 2007 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
electromyographic results, which show an increase in VMO
activity in conditions where the knee was destabilized
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helps to maintain the positional stability of the patella.
However, our results also show that the VMO and VL can
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during certain phases of concentric and eccentric exercise.
This suggests that the VMO is also an active knee extensor.
Thus, the VM should not simply be considered a knee
extensor or a muscle whose main role is to maintain normal
patellar tracking. We suggest that it is a muscle that
performs both roles according to the task performed.
This work was supported by Zimmer UK.
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