Neurovascular structures in human vastus lateralis muscle and the ideal biopsy site

Chen, Xin; Abbey, Steve; Bharmal, Adam; Harris, Sophie; Hudson, Edward; Krinner, Lisa; Langan, Emma; Maling, Alex; Nijran, Jagdip; Street, Hannah; Wooley, Charlotte; Billeter, Rudolf

Abstract

A density model of neurovascular structures was generated from 28 human vastus lateralis muscles isolated from embalmed cadavers. The intramuscular portion of arteries, veins and nerves was dissected, traced on transparencies and digitised before adjustment to an average muscle shape using Procrustes analysis to generate density distributions for the relative positions of these structures.

The course of arteries, veins and nerves was highly variable between individual muscles. Nevertheless, a zone of lower average neurovascular density was found between the tributaries from the lateral circumflex femoral and the deep femoral arteries. While the area with the lowest density was covered by the iliotibial tract and would therefore not be suitable for biopsies, another low‐density area was located in the distal portion of vastus lateralis. This was just anterior to the iliotibial tract, in a zone that has been described as a good needle biopsy site. The reported complication rates of needle biopsies (0.1‐4%) are in the range of expectations when simulated based on this model.

It is concluded that the optimal human vastus lateralis biopsy site is in the distal portion of the muscle, between ½ and ¾ of the length from the greater trochanter to the lateral epicondyle, just anterior to the iliotibial band.

Citation

Chen, X., Abbey, S., Bharmal, A., Harris, S., Hudson, E., Krinner, L., …Billeter, R. (2019). Neurovascular structures in human vastus lateralis muscle and the ideal biopsy site. Scandinavian Journal of Medicine and Science in Sports, 29(4), 504-514. https://doi.org/10.1111/sms.13369

• Journal Article Type: Article
• Acceptance Date: Dec 11, 2018
• Online Publication Date: Dec 18, 2018
• Publication Date: 2019-04
• Deposit Date: Jan 14, 2019
• Publicly Available Date: Dec 18, 2019
• Journal: Scandinavian Journal of Medicine & Science in Sports
• Print ISSN: 0905-7188
• Electronic ISSN: 1600-0838
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 29
• Issue: 4
• Pages: 504-514
• DOI: https://doi.org/10.1111/sms.13369
• Keywords: Physical Therapy, Sports Therapy and Rehabilitation; Orthopedics and Sports Medicine
• Public URL: https://nottingham-repository.worktribe.com/output/1450305
• Publisher URL: https://onlinelibrary.wiley.com/doi/abs/10.1111/sms.13369
• Additional Information: This is the peer reviewed version of the following article: Chen, X. , Abbey, S. , Bharmal, A. , Harris, S. , Hudson, E. , Krinner, L. , Langan, E. , Maling, A. , Nijran, J. , Street, H. , Wooley, C. and Billeter, R. (2019), Neurovascular structures in human vastus lateralis muscle and the ideal biopsy site. Scand J Med Sci Sports. Accepted Author Manuscript], which has been published in final form at https://doi.org/10.1111/sms.13369. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.