Distal motor branches of the femoral nerve to the vastus lateralis enter the muscle throughout its length, with the most distal branches at the knee level supplying the vastus lateralis oblique (VLO) fibres that contribute to lateral patellar traction.
The distal VL branches at the knee level are targeted in selective neurectomy for refractory lateral patellar subluxation — weakening the lateral patellar pull. In TKA, the peripatellar nerve plexus including these distal VL branches is disrupted, contributing to anterior knee pain in the patellar region post-arthroplasty. EMG of the distal VL at the knee level confirms femoral nerve distal branch involvement.
Excessive lateral patellar traction from hyperactive distal vastus lateralis motor branch innervation producing lateral patellar maltracking, addressed by lateral release or selective neurectomy alongside MPFL reconstruction.
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