Pes anserinus: Layered supportive structure on the medial side of the knee

The pes anserinus is composed of a combination of tendinous insertions of the sartorius, gracilis and semitendinosus muscles. Precise knowledge of the structures on the medial side of the knee and the relationships between fascia and tendons is critical for diagnosis, surgery, and the development of improved operative procedures of the knee. To obtain precise data on the layered structures associated with the fascia cruris on the medial side of the knee and the fibrous bundles attached to them, we dissected nine legs of five adult cadavers. We observed a superficial longitudinal fibrous bundle on the superficial surface of the sartorius and a deep longitudinal fibrous bundle on the aponeurotic membrane covering the tendon of the gracilis muscle. The distal parts of the tendons of the gracilis and semitendinosus were found to have aponeurotic membranes, and these membranes were fused with the fascia cruris. These two longitudinal fibrous bundles and the aponeurotic membranes from the gracilis and semitendinosus tendons fused with the fascia cruris, and a small tendinous expansion from the semimembranosus muscle fused with the aponeurotic membrane from the semitendinosus tendon and tibial collateral ligament as well as the fascia covering the medial head of the gastrocnemius and fascia cruris. Based on the considerable tension from the sartorius, gracilis, semitendinosus, semimembranosus and gastrocnemius muscles, these bundles, membranes, and muscles may act as a complex tensor fasciae cruris muscle and play a significant role as stabilizers of the medial side of the knee joint in the upright posture.