Muscle knots in the Vastus Intermeidus, a deep quadriceps muscle, can develop muscle knots that refer pain to the front of the thigh. This referred pain is often described as a deep ache in the anterior thigh, and it can sometimes extend down towards the kneecap. Due to its hidden location, Vastus intermedius muscle knots are often overlooked, leading to persistent thigh pain that might be misdiagnosed as other conditions.