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Distal vastus intermedius tendon

The distal vastus intermedius tendon is the terminal tendinous portion of the vastus intermedius muscle, one of the four quadriceps femoris muscles. It forms part of the quadriceps tendon, contributing to extension of the knee joint. This tendon lies deep to the distal vastus lateralis, vastus medialis, and rectus femoris tendons, and has close relationships with the patella and knee joint capsule.

It is clinically significant in quadriceps tendon ruptures, anterior knee pain syndromes, and postoperative evaluation of knee surgery.

Synonyms

  • Terminal tendon of vastus intermedius

  • Quadriceps femoris deep tendon (central portion)

  • Deep quadriceps tendon slip

Origin and Insertion

  • Origin:

    • Arises as the distal continuation of the vastus intermedius muscle fibers, located on the anterior and lateral shaft of the femur

  • Course:

    • Forms a flat, strong tendon that descends deep to the rectus femoris tendon

    • Merges distally with the quadriceps tendon near the superior pole of the patella

  • Insertion:

    • Inserts onto the base and superior pole of the patella, blending with the quadriceps tendon fibers that continue as the patellar ligament to the tibial tuberosity

Relations

  • Anteriorly: Rectus femoris tendon (superficial slip of quadriceps tendon)

  • Posteriorly: Suprapatellar bursa and anterior knee joint capsule

  • Laterally: Distal vastus lateralis tendon

  • Medially: Distal vastus medialis tendon

  • Inferiorly: Patella and continuation into patellar tendon

Nerve Supply

  • Femoral nerve (L2–L4) via branches to quadriceps femoris muscle

Arterial Supply

  • Femoral artery (muscular branches)

  • Lateral circumflex femoral artery

  • Genicular arteries around the knee

Venous Drainage

  • Femoral vein via muscular tributaries

  • Genicular veins around the knee

Function

  • Extension of the leg at the knee joint

  • Provides central deep stabilization to the quadriceps tendon complex

  • Works with other quadriceps components to maintain patellar alignment

MRI Appearance

T1-weighted images:

  • Tendon appears as a low-signal (dark) linear structure merging with the quadriceps tendon

  • Fat around tendon appears bright, providing contrast

T2-weighted images:

  • Normal tendon shows uniformly low signal

  • Partial tears or degeneration show focal bright hyperintense areas within the tendon

STIR (Short Tau Inversion Recovery):

  • Normal tendon remains dark

  • Tendinopathy, edema, or tears appear bright against suppressed fat background

Proton Density Fat-Saturated (PD FS):

  • Normal tendon: dark low signal

  • Pathology: bright hyperintense signal in regions of strain, degeneration, or tear

T1 Fat-Sat Post-Contrast:

  • Normal tendon enhances minimally or not at all

  • Inflammation, granulation tissue, or postoperative changes may enhance heterogeneously

  • Abscess or severe pathology may show rim enhancement with central non-enhancing component

CT Appearance

Non-Contrast CT:

  • Tendon is seen as a linear soft tissue density deep to rectus femoris tendon, attaching to patella

  • Chronic calcific tendinopathy may show calcifications within distal tendon

  • Fat planes around tendon visible as low-density regions

Post-Contrast CT:

  • Normal tendon shows little or no enhancement

  • Pathology (inflammation, postoperative change, neoplasm) may show focal enhancement

  • Peritendinous enhancement may indicate bursitis or adjacent synovitis

MRI images

Distal vastus intermedius tendon axial cross sectional anatomy 3T MRI AI enhanced radiology anatomy image-img-00000-00000

MRI images

Distal vastus intermedius tendon sagittal cross sectional anatomy 3T MRI AI enhanced radiology anatomy image-img-00000-00000

CT image

Distal vastus intermedius tendon axial ct image

CT image

Distal vastus intermedius tendon ct sagittal image