Anatomical variability of the pes anserinus tendons: prevalence and patterns of accessory bands of the semitendinosus, gracilis, and sartorius tendons and a new classification.

Authors

Kamil Możdżeń, Grzegorz Fibiger, Michał Malczak, Henryk Liszka, Artur Gądek, Wiktoria Błachut, Tomasz Kozioł, Arseniya Biazhko, Karol Jaszewski, Kacper Stolarz, Jerzy A Walocha, Przemysław Pękala

Published in

Folia morphologica. Volume 85. Pages e01726178.

Abstract

The pes anserinus constitutes a complex anatomical region on the medial side of the knee, formed by the tendons of the semitendinosus, gracilis, and sartorius muscles. Accessory tendon bands within this region have been described in numerous anatomical studies; however, their reported prevalence, morphology, and distal attachment patterns vary considerably. These inconsistencies largely result from non-standardized terminology and classification systems that often fail to capture the anatomical complexity of this structure.
A total of 62 formalin-fixed adult lower limbs obtained from 41 cadavers were examined using a standardized dissection protocol. The presence, number, and distal attachment sites of accessory tendon bands originating from the semitendinosus, gracilis, and sartorius tendons were recorded. Morphometric parameters included accessory band length, width, and the distance between the tibial insertion of the pes anserinus and the origin of each band. Analyses were performed for the entire sample and additionally stratified by sex.
Accessory tendon bands were frequently observed and were most commonly derived from the semitendinosus tendon. At least one accessory semitendinosus band was present in 58 of 62 limbs (93.5%). A single primary band was identified in 28 limbs (45.2%), while an additional secondary band occurred in 30 limbs (48.4%) and a tertiary band in 2 limbs (3.2%). Accessory gracilis bands were found in 14 limbs (22.6%), whereas accessory bands of the sartorius tendon were uncommon (2 limbs, 3.2%). In total, fourteen distinct pes anserinus configurations were recognized, with type 1-1-3ba representing the most frequent pattern (29.0%). Primary semitendinosus accessory bands were most commonly insertedonto the tibia, whereas secondary and tertiary bands were typically attached to the crural fascia. Male specimens demonstrated greater distances between the semitendinosus tibial footprint and the origin of accessory bands.
Accessory tendons of the pes anserinus, particularly those arising from the semitendinosus, should be regarded as frequent anatomical configurations rather than uncommon variants. The proposed open, modular classification system incorporating both numerical multiplicity and attachment topology offers a structured method for describing the anatomical diversity of the pes anserinus and may enhance consistency in future anatomical and surgical reports.

PMID:
42755278
Bibliographic data and abstract were imported from PubMed on 18 Sep 2026.

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