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SOME ANATOMICAL DETAILS R. Lecturer in LAST, J. Royal In current is believed proposed the texts, that to give an attachment of account the capsule true it order to is advisable the capsule being end of the UP1)C the tihial fibula are attached circumference of the round the articular The capsule the a ga’), articular is attache(l. At is stage contains the tWo menisci. Lateral ligament of of a result tibia from of the and the below the with tibial the tibia synovial joint. process of the (having been passes. This current British part lateral ligament above to (tibial) border over the The arcuate lateral popliteus lateral of peroneus of the already part thus separating ligament \‘OI.. 1). them of current 30 B, NO. 4, at The of (luring structure, the patella. horizontal short external It of the The surfaces of firmly attached . to the meniscus. joint into long the the which the lateral true to fibula. lateral surface part fibula. of the the of of the The tendon 1941). part head tendon long of biceps It short medial lying ligament the external lateral into superficial arch of I). the terminology arises biceps (Fig. (or degenerated tendon from external of the of and border, of old be of the It is attached posterior ligament Haines upper the ; in part posterior arcuate to may terminology deep process free end is lacking of popliteus capsule. the upper the stvloid Its terminology) upper joint constitutes its as the capsule tendon of old described of the below \Vheeler the ligament be external the deep of the divides from which thereto, of current with tibia of the towards 1884, 1948 1 . over might and head adherent Sutton head . part part femur in continuity them popliteus of the is that name. the knee margin fibula) It represents attached terminology) NOVEMBER that conjoined lateral of the firmly the occur joint them no surface Between the 1:1G. is the It is inserted (Fig. which diarthrodial including ; and The the joint. (Bland described. deep it by and femur, changes knee sinks with it has of the longus epicondyle and lateral capsule. Morphologically, ligament the the of is a simple stvloid capsule is meniscus. the end and upper ligament ligaments articulates from fascia trace joint tibio-fibular knee the . joint- epicondvle of ligaments, of growth dovn of the of the is of ligament’ and “ lateral it It is excluded terminology the accessory and value. upper . original stolen ‘ ‘ of the Popiteus upper pull and and surfaces already head the of the details, be LIGAMENTS femur joint superior fibula joint, capsule the patella fibula The a prolongation the in certain might surface rate ; its the Scholar, tubular its knee l)lateau at joint foetus, the margins the the joint precision foetus of the the different fIbula, knee lack the articular of . As Research interrupted the to surface this the a simple at by vhich by the with end attached femur. anteriorly Sutton important of of In the around upper surrounded Bland ACCESSORY in articulates and is joint structure. fibula which capsule this arrangement the adult plateau AND the consider of the JOINT muscles. appreciate to development KNEE of England joint of CAPSULE In knee anatomy of of certain and of Surgeons of the the THE ENGLAND Curator, College descriptions revision LONDON, Anatomical Anatomy, OF the lateral fibula, lateral ligament lateral femoris ligament and to the is inserted, (lateral deep parts. 683 684 Medial ligament consists of the of J. R. short the of the It so more and but that deep the part to the into flat, medial part is The structure, over the lateral and in meniscus fibres .. I are anterior meniscus. the anterior meniscus Medial firmly of adductor magnus of Comparative of the deep or parts medial a separated and single below by membranosus them which medial --.- The medial ligament of the knee joint. nerve. border of ligament backwards, i’e;ision Foetal and abduction. the of the patella. plateau of the tibia which herniates of The in the joint, into of the of lower, expansion inserted the into the it is inserted medial ligament by the passage beneath genicular vessels and fibres upper the from part of medial the medial the medial ligament passes meniscus. ligaments the flexion, moreover, These flexion, the being are semi- forwards the experience Still plateau. in or is are the passes This as of behind viz., cruciate joint-Between the capsule the tibial joint state capsule From the In the the lateral from which 3). edge medial placed they of the knee axis of rotation a smaller two factors rotation joint in and lateral taut of responsible passively flexion in femoral surface are and ligaments are of the the for induced contributes to infra). adult beta! and flexion. with (ride of the being in of mobility surface of fat relaxed mobility capsule of the extent joint retinacular anterior The tendinous, but the tibia inferior border the joint. knee expansion is or above, ; in Strong knee of the an tibia. from medial anterior joint medial is in contact increased the attachments are degree the of a greater upper They adduction towards flexion ligaments-Both condvles greater curve Iii exposing their femoral front 2). of the condyles. this patella thus extension, the the (1:ig. the is separated it of the 2 1:1G. into nerve, From this the vertical structure described meniscus only -=-- sciatic ligament (Fig. is often presemiAnatomy), superficial tendon between The (the of the the medial into the ligament capsular, of the fused . the niagnus. adductor tubercle. . is represented by it to (1884) morphologically, adductor by its meniscus; Sutton of the the situation attachment part innervated is joint, overlaps medial Bland is, the this of to knee border it free the part of the below in far posterior anterior and on epicondyle level tendon into downwards part the to the is muscle is is by medial vertical part inserted . point which and According membranosus which behind. Posteriorly 683), border its the and Its 2). page in front the above is part tibia into strong. attached hamstring magnus . and It and the below (Fig. on degenerated :Adductor > tibia, directions described terminology femur part, from is very opposite medial ligament joint tubercle handsbreadth possibly old terminology. knee of the in of the superficial adductor condvle is oblique British of the ligament named margins capsule of one medial part, current meniscus. triangular internal in the the deep articular the a distance border ligament, The the below the lateral name to medial for posterior widest no with arises surface (short has is continuous is inserted its the parts. is attached important, is a broad, vertical, It intimately the femur joint. ligament, and subcutaneous its joint-Like distinct, joint. aspects is attached and knee lateral of the medial larger of internal capsule their It of the morphologically two, LAST the is still lower present margin is separated joint and raises medial with of the from its patella underlying a median circular fold THE to gap the synovial called the JOURNAL OF ligaments, filled by anterior across the margin membrane BONE AND of the by ligamentum the articular a pad mucosum, JOINT SURGERY SOME extending into folds the extend, is Haines the deep to the joint. the popliteus Thus stant. is the tendon added also of posterior part oblique of ligaments of the joint. the femur rather its of on the Loose bodies covery at ligament is several lodge irregular from the the to above the of . a . within the they leaves their of posterior tense of the Medial and attachment strongly VOL. 30 B, tendons ligaments respectively, of Attachn medial Ii to the rn I show of joint into the The NO. 4, and lateral NOVEMBER are Edwards horns and really them; They posterior meniscus 1948 by letter medial consist avascular The tissue; part of any of the attached are tense them fibrocartilage, medial for superficial to the the joint. zone Lateral in at is attached at the extension, circumference medial tibia the their to up. a narrow the from essential curved meniscus elsewhere over surfaces, named in of winds lateral are position rotation except 1948). is likewise in is l)otted soleus. forward and They ligament lax fibrous anterior ‘ ‘ of It is as though carrying They X. ‘ ‘ cruciate is membrane. behind, superiorly. the menisci section. synovial their joint. right indicates from except of neither the invests anterior unwinds posterior capsule 2). but within which limbs The line membrane uncovered the menisci-The cross not synovial knee attachment POsteriOraspect . lie membrane like tibia conthey but 3 FIG. bands joint. (Davies the incon- band). and surfaces flexed and to (Fig. are benestrated knee flexion, lateral anterior bursa. they degenerated lateral ligaments femur, synovial knee in its a strong . cross in wedge-shaped joint of the rotation at ver’ the and stability of of posterior origins, but extend cruciate herniated a fold tibial occur, great ligamentous of the been themselves of surface to main to capsule had but . tibia allowing STRUCTURES pair the oe dis- not popliteal ligaments-The consist necting cord rise INTRA-ARTICULAR Cruciate gaps, suprapatellar posterior which the two the above femur. elude does prolongations give appearance and figure and lying handsbreadth a the oblique rounded ligament femur its condyle encroaches here, 3-The may and perforates bursa semlm_ notch, of The thick a has with bursae femur, Tenc’- is a prolongation surface may (Fig. strength lateral so that operation. ; it phylogenetically the This of W’inslow; membrane popliteal a (Wheeler the intercondylar margin, synovial joint medial the There joint suprapatellar extending adult the the across the the limb is wrong. from capsule. ligament and above upwards little true to it and alar morphological knee a large Two no septa vertebrate communicating by have semimembranosus laterally is any between with ligaments. They with adult other Posteriorly cruciate intra-articular in in the the expansion of posterior attachment present longus, an the the provided peroneus of 685 JOINT of the patella, communication and and relics the in KNEE mucosum. communicates and for THE existed above is still insertion upwards are and emerge, reinforced; extends upper capsule OF surfaces ever thereafter capsule strengthen joint the to the they septa capsule magnus greatly ligamentum tendon, foetal The adductor anterior the and tendon in the that quadriceps gaps as of original walks the far primitive The DETAILS side statement infant the as each that 1941). when Other on The evidence fl() joint one significance. ANATOMICAL ligament both horns; shape their to and points the tibia is attached of the knee in addition 686 J. R. its posterior horn attached to posterior cruciate (Figs. 4 is the and by tissue of femur, the forming These that fibrous condyle ligament, 5). unfortunate slung medial ligaments their names should LAST in the ligaments are strong have ligaments ‘ ‘ and of Humphry and from The of . opliteui but the knee and . femoris of 4 Ln of the cf the medial and! accompanied by resulting by the (the the and partly from fibres of vastus from this thus by allows this relaxation from lateral the rotation rotation of the ligaments; the fact contact tibia! position the are posterior and tibia rotates with it the lateral, fibrocartilages on it forms on the the the femur. In In rotation femur. move in w’ith which the two femur on lateral and not the tendon state(l off in most is limited ligament. which by Full is to some tension extension degree is passive, is flexion. In 1:1G. 5 ligament flexion separate, the results which of of popliteus surface around edge as medial from also cruciate axis rounds ; extension cruciate Interior is taut in which anterior femoral in meniscus leg per- results plateau of the back- which and mobility a smaller the tibia tibia rotation moving flexed, freedom lateral greater that with flexed the medial, arcuate backarch of tibia. is and of left knee joint from behind. the extension the tibia the tibia. but of fibres joint lateralis, joint The upper first) the of the hamstrings. the begins of vastus the of lowest the rotating \Vhen ten(lon JOINT a movement “ of the popliteus fibres the shorter up flexing the lowest used tibia medially by articular ‘ ‘ In position the of cruciate is on the antagonists. and it pull of the deep texts. behind anterior tibia, being KNEE parts the of the condvle that THE soft and shape lateralis. and formed this the locked medial in so movement are the femoral medial, Popliteus, ligaments, rotation from than the lateral lateral AT is limited! lateral partFy surfaces joint the (capsule) the popliteus, current front. MOVEMENTS Flexion at freely the condvle, of from is muscle to the meniscus ensure of the posterior 1)osterir tibia! joint by in medial It is the of the FIG. is fixed it from of the meniscus flexed tibia. rotation knee thus ligament attachment wards left it (F’ig. I). Firm attachment ligament to the meniscus, 01 tne l)1)1IteUS ligament and ward! drawing . Insertion of quad riceps of and meniscus Biceps Interior is joint the nomenclature. elsewhere lateral are of latter, separated the of popliteus the arcuate tendon Lateral the British being part slings respectively meniscus horns, mobile, The attachment \Vrisberg current lateral its ligament femur. the especially dropped Lateral the behind structures, been to “ front often in the the This flexed is a menisci, the characteristic simultaneous, THE fixed position the tibia, menisci, OF BONE of take AND move especially feature movements JOURNAL to JOINT all joint place-for SURGERY SOME example and the true down temporo-mandibular hinge ment medial take The clavicle in also the (MacConaill play joint Quadriceps of patella, is inserted of the the deepest thigh, border of of influence are in quadriceps. the tibia vhich is a very patellar bursa anterior surface is attached the superior not fibres VOL. joint the the 30 over around the side lateral the immediately of biceps and superficial the the rounded tendon diverges towards is true NOVEMBER the but lateral 1948 split head by “ the capsule of the The cord-like of the fibula quadriceps of so the 1946). the over lateral ; the part, The part (between part external pitted (Fig. lateral sends an of the the of the of infra- rough, ligament joint that which ligament deep in is inserted groove (Hughes the rapidly tibia-the oblique but and indispensable patellae superficial long the contraction transverse ligament by lowermost atrophy an the formed the 6). knee tendon long and ten(!On of ligament, expansion and across tibia. and from of the of the to it true of by the The an ligamentum tubercle, lateral exert during patellae the to and which above of the a lamina contribute tubercle terminology). part margin joint the old the is medialis. patella below ‘ ‘ of the not The of is not part of tendon ligamentum tibia upper patella, limited of the of popliteus arise the edge posterior vastus the The the medialis of is part ligament described, 4, of posterior lateral part area smooth ligaments the of aponeurosis. as the the shining #{149} tibia. of downwards and do of vastus the tendon tendon NO. the rounded The portion not head to as smooth, of the seldom B, of lateralis a head is continued into in direction, into such substantial around! actually horizontal epiphvsis. lateral the vastus synovitis. ligament from portion the by is inserted acute knee tibio-fibular Although ; it covered 6 1G. the of as1)CCt intermedius of Popliteus-From arcuate of each vastus fibres the it the displacement external wraps of lateral femoris-The biceps the intermediate directly these lies, between of tendon almost Anterior In are surface edges 1’ lowermost It wraps short patella. surfaces The over receives bursa lamina anterior is on lower. rounded the quadriceps inserted of the and the in )reventing It affections . the medialis, They flexion in trilaminar intermedius central vastus tendon. that place region anterior at contiguous patel!a. the of the vastus of the the confluence joint takes and move- immediately of the covers lamina knee up rotary components the forms border which the a flattens separately and aponeurosis lies of the or accepted! in Anteriorly, upper of horizontal rotation compartment permits fluid some four and femoris Biceps true upper which THE into femoris the middle that inserted rectus which joint. and while part attachments are above in its joint inaccurate. tendon. tendon is, shows are muscle quadriceps into movement sterno-clavicular compartment, svnovial NEAR femoris-The this fibres gliding 687 JOINT JOINT of muscle knee rectus KNEE lnfrapatellar dissection descriptions edge of THE is substantially important film has the compartment ATTACHMENTS Careful of lateral upper an KNEE the in the OF I 931). MUSCLE of and It the lubricating which lower; compartment. place menisci spreading in its of the in the DETAILS joint movement movement extension ANATOMICAL of origin its that from meniscus, the insertion a very the arcuate a fact fan-shaped on muscle the substantial itself. has been beneath surface portion ligament which emerges popliteal of Some noted this of the muscle of the in very the tibia. arises uppermost few texts. 688 Moreover, the the the arcuate arcuate the arcuate muscle fibres ligament ligament ligament is cannot Protection of the lateral to the be lateral primary lateral in muscle. In with the of meniscus and bevels the from tibia. of the superficial was from and Bonney the fibula and in (around arch popliteus muscle tendon of popliteus tibia! to the the arcuate muscle. its It ascent to the to axis of the lateral nipped the popliteus articulates between position, lateral posterior cruciate articular by the pull but the lateral the when out synovial precludes that femur be controlled the surface of the of the of way ; the ligaments meniscus membrane of which is prolonged to the muscle, between it and the joint. Fixation of the posterior ligament is possible the condyle meniscus The lies deep tibio-fibular rather flexed and condyle. which superior likely the ligament) is the er se of the especially, femoral lateral the lateral the along of the mobility but of of pop!iteus arcuate the and, the posteriorly the that tibial origin medial border that line from Illo-tibial an band-As front of of on has fascia, on the area the deep in the man the formation primary origin of any is a secondary stated to be the soleal the muscle has a much surface ridges-one of soleus above derived from deep surface above the known is the is received the the two is well generally appreciated the ilio-tibial band three-quarters of soleus is usually of the tibia. Actually aponeurosis this arise the not by muscle of are is not of the aspect attached the popliteus ridge the aponeurosis soleus posterior away It margin strong seen the place glides is not of But specimen. of to when bursa of the muscle event (Taylor 1905). Soleus-The third of the be push popliteus the takes as the popliteus bursa, communicates with the on menisci attachment attachment injury, surface part true of the It lower a museum the Wrisberg flexion. tibia way from and a smaller condyle pulled posterior surface Only not by the 3) ; their attachment which disappears for ‘ ‘ that injury. immune the beneath the cleaned ‘ ‘ indirectly Humphry joint the Wrisberg. the joint It often the on femoral does of is from relatively pass 1 and manner is suggested and uncomplicated femur is actively Humphry it and Consequently muscle meniscus ; consequently lateral It injury-It knee during the tibia. the plateau the from directly, tendon away. the ligaments of the thereto (Figs. up in a sinuous when the makes the flexion surfaces ligament) the by tibial rotation (both which gained articular meniscus LAST leave adherent muscle dissected out protecting meniscus mobility truly itself made meniscus factor which are firmly draws the popliteus on J. R. fact into lateral tibial gluteus maximus soleal the fascia arises and one the semimembranosus of soleus is attached. line on lata the popliteus attaches that the ribbon-like a smooth non-pitted condyle. This muscle from below. line more and the generous the soleal To the tendon The fascia around the line. upper ; to fleshy (Fig. tibia! facet marks the to the tensor It is the lower fibres of condyles. insertion, will ridge 3). condensation which facet which stands out in addition middle origin. Less constitutes prominently therefore, fasciae latae of (Fig. 6). Acknowledgment-The author wishes to express his appreciation of the work of the Prosector to the Royal College of Surgeons, D. H. Tompsett, Ph.D., who not only made many of the dissections (which will be incorporated into the Human Anatomy Section of the Museum) but also drew the illustrations. REFERENCES BRANTIGAN, DAVIES, HAINES, HUGHES, MAcCONAILL, SUTTON, TAYLOR, F. (1946): Journal of Bone and Joint Surgery, 28, 66. W. (1948): Annals of the Royal College of Surgeons of England, R. WHEELER (1941-42): Journal of Anatomy, 76, 270. E. S. R., and SUNDERLAND, S. (1946): Anatomical Record, 96, 439. M. A. (1931-32): Journal of Anatomy, 66, 210. J. BLAND (1884): Journal of Anatomy and Physiology, 18, 225. G., and BONNEY, V. (1905-06): Journal of Anatomy, 40, 34. 0. D. C., V., and and VOSHELL, EDWARDS, A. D. A. THE JOURNAL OF BONE AND JOINT 2, 142. SURGERY