Bauhaus-Universität Weimar

Titel:
The Cyclopaedia of Anatomy and Physiology, vol. 3: Ins-Pla
Person:
Todd, Robert Bentley
PURL:
https://digitalesammlungen.uni-weimar.de/viewer/image/lit29464/54/
46 
NORMAL ANATOMY OF THE KNEE-JOINT. 
sixth of an inch, at the outer margin or thickest 
part. They are both composed of concentric 
fibres, the extremities of which are fixed to the 
central parts of the head of the tibia, before and 
behind the crucial ligaments, with whose fibres 
they intermingle ; the anterior extremities are 
usually joined together by a transverse liga¬ 
ment, but this is sometimes wanting. 
The ligamentum patella, of vast importance 
in the actions of the knee-joint, is yet the most 
distant from its articular surfaces ; it extends, 
broad and flat, from the lower somewhat point¬ 
ed portion of the patella to the inferior part of 
the tubercle of the tibia, being in the adult 
about two inches in length. It forms a strong 
inelastic but inflexible bond of union of the 
patella with the tibia, and may with propriety 
be looked upon as a continuation of the ex¬ 
tensor tendons which are inserted into the 
upper and lateral margins of the former bone; 
some fibres indeed pass over its anterior sur¬ 
face, but it is only through this bone and its 
ligament that the extensor muscles can act 
upon the leg. The patella is thus seen to be 
placed in a situation analogous to that of the 
sesamoid bones, in the tendons which play 
over bony surfaces, in the hands and feet. The 
ligament of the patella is covered anteriorly by 
dense integument, and the fascia of the leg : 
posteriorly a cushion of fat is interposed be¬ 
tween it and the joint at the upper part, while 
below it is separated from the bone by a bursa, 
whose situation was pointed out in the descrip¬ 
tion of the tibia. (See/tg. Ill, b, vol. i. p. 252.) 
More closely applied to the joint are the lateral 
ligaments, the posterior and the crucial liga¬ 
ments ; and portions of the synovial capsule which 
are described by some anatomists as alar and 
mucous ligaments. The lateral ligaments have 
a vertical direction at each side of the knee, and 
are placed nearer to the posterior than the ante¬ 
rior boundary of the joint ; the upper attach¬ 
ment is in fact to the tuberosity at the centre 
of the smaller curve which the articular sur¬ 
faces of the condyles form at their back part. 
The internal lateral ligament descends from 
the tuberosity of the internal condyle of the os 
femoris to beneath the head of the tibia ; it is 
nearly three inches in length, of a flattened 
form, narrow at its commencement, but en¬ 
larging considerably opposite the joint, to the 
synovial membrane of which as well as to the 
internal semilunar cartilage it adheres; infe- 
riorly it again contracts in width. Its upper 
attachment is covered by the fascia lata ; below, 
it is inserted into the shaft of the tibia just 
beneath the head of the bone, and anterior to 
its inner angle ; and the tendons of the sarto- 
rius, gracilis, and semitendinosus cross over it. 
The external lateral ligament (lig. laterale 
externum ) arises from the tuberosity on the 
external condyle of the femur, and descends, 
inclining backwards, partly covered by the 
tendon of the biceps, to be inserted with it 
into the head of the fibula ; the attachment of 
its upper extremity is immediately above the 
origin of the popliteus tendon, which it crosses 
in its descent, so that this tendon enveloped by 
its synovial sheath is situated between the liga¬ 
ment and the joint. The deviation of this 
ligament from the perpendicular direction is 
perceived most distinctly in the state of exten¬ 
sion ; when the joint is flexed, the upper at¬ 
tachment of the ligament is brought more into 
the perpendicular over its fibular attachment, 
the ligament is relaxed and assumes the per¬ 
pendicular direction ; hence, in the flexed con¬ 
dition of the joint, the external condyle of the 
femur, or the tibia on it, admits of a more free 
motion. This ligament is contrasted by its 
less length and more rounded form with the 
internal lateral, and is composed like it of 
shining tendinous fibres ; a still shorter set of 
fibres sometimes passes more posteriorly from 
the condyle to the head of the fibula, or 
from the sheath of the popliteus tendon, and 
has been called the short external lateral liga¬ 
ment. 
The posterior ligament (lig. posticum Win- 
slowii) is a portion of the tendon of the semi¬ 
membranosus muscle which is given off near 
its insertion at the posterior and inner margin 
of the head of the tibia ; the portion under con¬ 
sideration forms a flat and dense fascia which 
passes upwards and outwards to the external 
condyle, where it becomes adherent to the sy¬ 
novial capsule and mingling with the tendinous 
origin of the outer head of the gastrocnemius : 
posterior to it lie the popliteal vessels, and in 
front of it there is a quantity of firm granulated 
fat, into which some of its fibres penetrate. 
When the posterior ligament and the fat just 
spoken of are removed, and the joint is ex¬ 
tended, the two crucial ligaments (ligamenta 
cruciata*) are brought into view ; they may be 
seen on the anterior aspect by dissecting down 
the patella from the fore part of the joint, and 
putting it in a state of flexion ; in the former 
view, the posterior crucial ligament is best 
seen ; in the latter, the anterior : the upper 
extremities of both are fixed in the fossa be¬ 
tween the condyles of the os femoris; their 
lower extremities are attached to the head of 
the tibia between the two articular surfaces. 
The anterior crucial ligament passes from 
the inner and back part of the outer condyle 
downwards and forwards to the depression in 
frontof the spine ofthe tibia,where some portion 
becomes continuous with the anterior extre¬ 
mity of the internal semilunar cartilage. The 
posterior extends from the fore and outer part 
of the internal condyle downwards and back¬ 
wards to the notch at the posterior margin of 
the head of the tibia, where it becomes like¬ 
wise attached to the posterior extremity of the 
external semilunar cartilage. The crucial liga¬ 
ments thus derive their name from decussating 
one another like the strokes of the letter X ; 
the crossing is, however, considerably above 
their centre : the anterior passes to the outer 
side of the posterior. 
The synovial capsulef entirely surrounds the 
* [It is useful to bear in mind that these ligaments 
are called anterior and posterior with reference to 
their insertions into the tibia, the one in front of, 
the other behind, the spine of that bone.—Ed,.] 
+ [Weber recommends as a good way of demon¬ 
strating the full extent and connexions of the
        

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