In conclusion, the findings of the present study revealed a complex but constant architecture of a three-layered quadriceps tendon which is formed by six elements. These are 1. lateral aponeurosis of the vastus intermedius, 2. deep and 3. superficial medial aponeurosis of the vastus intermedius, 4. vastus lateralis, 5. tensor vastus intermedius and 6. rectus femoris. These elements of the extensor apparatus join each other proximal to the patella in a complex onion-like architecture. Its two-layered intermediate layer shows variable fusions points. The vastus medialis contributes to the quadriceps tendon with its medial insertion into all layers of the quadriceps tendon. Further studies are needed to translate the anatomical findings into clinical relevance in patellofemoral pathology or knee surgery.