The situation becomes complex and confusing when the quadriceps tendon is viewed at different cross sections. There is a high variability regarding the fusing point of the superficial and deep intermediate layer (between 13 and 90 mm proximal to the superior base of the patella). This and the oblique orientation of the two-layered intermediate layer appear to be the major reasons for the published diversity of the architecture of the quadriceps tendon (Waligora et al. 2009; Zeiss et al. 1992). Depending on the level of transection or MRI cut one finds two, three or four layers (Fig. 3b). Additionally, depending on the direction of the plane the corresponding layers can be complete or incomplete. An oblique transection or MRI cut could easily lead to the impression of a complex multi-layered arrangement of the quadriceps tendon. Furthermore, the aponeurosis of the vastus lateralis, can separate into two or three fiber bundles (Fig. 4) causing additional confusion. Zeiss et al. studied the MRI appearance of 52 knees with normal tendons. They described that the interpretation of the architecture of the quadriceps tendon is especially difficult in its intermediate layer. They found that the number of laminations was variable, with either two (30 %), three (56 %) or four layers (6 %). In 8 % of the knees, the laminations were barely visible (Zeiss et al. 1992).