The superficial layer of the quadriceps tendon was formed by the tendon of the rectus femoris. Proximal to the meeting points of the two-layered intermediate layer, the aponeurosis of the rectus femoris was located directly on the lateral part of the vastus intermedius aponeurosis (= deep layer of the quadriceps tendon). In other words, 56 mm (range, 30 to 90 mm) proximal to the superior border of the patella, an intermediate layer was missing (Table 1). Therefore, at this site the quadriceps tendon was seen to be composed of two layers only, separated by thin partitions of fat. In contrast, distal to the meeting points of the two-layered intermediate layer, the quadriceps tendon was composed of four layers (Fig. 3b). The various layers of the quadriceps tendon were joined to each other through light, divisible crosswise fibers. The latter had also inlets of fatty tissue to a differing extent. Distally the superficial medial vastus intermedius aponeurosis and the deep gliding aponeurosis of the vastus medialis fused with the tendon of the rectus femoris and the patella. Together with parts of rectus femoris tendon the vastus medialis occupied the supero-medial half of the upper semi-circle of the patella (Fig. 4). Remainder of the aponeurosis of the rectus femoris continued superficial to the patella to join the patellar ligament.Table 1Fusion points of the two-layered intermediate layer of the quadriceps tendonCase Nr.sideDeep intermediate layer (mm)Superficial intermediate layer (mm)Distances between the fusion points (mm)1right3018122left4530153left7253194right9049415left8146356right5936237right6641258right4625219left34191510right341321mean55.73322.7max905341min301312Table 1 indicates the individual data (n = 10) of the fusion points (distances to the patella in millimeters) of the two-layered intermediate layer of the quadriceps tendon. The medial deep layer of the vastus intermedius aponeurosis fused with the aponeurosis of the tensor vastus intermedius (deep intermediate layer). The medial superficial layer of the vastus intermedius aponeurosis fused with the aponeurosis of the vastus lateralis (superficial intermediate layer). The meeting point of the superficial intermediate layer was always distal (23 mm, range 12 to 41 mm, SD +/− 0.9) to the meeting point of the deep intermediate layer. All elements of the quadriceps tendon fused over a region proximal to the patella ranging from 13 to 90 mm (Fig. 3b)