The foot pdf - Lower limb

490

CHAPTER 10

to absorb shocks, such as in jumping.

shape to uneven surfaces. It also serves as a resilient spring

structed in the form of arches, which enable it to adapt its

age for walking and running. It is unique in that it is con

The foot supports the body weight and provides lever

(see Fig. 10.48).

The fat and the large tendo calcaneus lie behind the ankle

Structures That Lie Directly behind the Ankle

rate sheaths.

beneath the inferior peroneal retinaculum, they have sepa

10.59) share a common synovial sheath. Lower down,

The peroneus longus and brevis tendons (Figs. 10.48 and

Malleolus beneath the Superior Peroneal

Structures That Pass behind the Lateral

Small saphenous vein (see Fig. 10.48)

The sural nerve

Malleolus Superficial to the Superior Peroneal

Structures That Pass behind the Lateral

lum, it is surrounded by a synovial sheath.

As each of these tendons passes beneath the flexor retinacu

Flexor hallucis longus (Figs. 10.48 and 10.49)

Tibial nerve

Posterior tibial artery with venae comitantes

Flexor digitorum longus

Tibialis posterior tendon

From Medial to Lateral

Malleolus beneath the Flexor Retinaculum

Structures That Pass behind the Medial

Saphenous nerve (Figs. 10.48 and 10.51)

Great saphenous vein

Structures That Pass in Front of the Medial

oneus tertius share a common synovial sheath.

The tendons of extensor digitorum longus and the per

extensor retinacula, it is surrounded by a synovial sheath.

As each of the above tendons passes beneath or through the

Peroneus tertius (Fig. 10.48)

Extensor digitorum longus tendons

Deep peroneal nerve

Anterior tibial artery with venae comitantes

Extensor hallucis longus tendon

Tibialis anterior tendon

Extensor Retinacula from Medial to Lateral

Structures That Pass Beneath or Through the

(Fig. 10.48)

Superficial peroneal nerve (medial and lateral branches)

the medial malleolus)

(in front of

Saphenous nerve and great saphenous vein

Retinacula from Medial to Lateral

Structures That Pass Anterior to the Extensor

identify as many of the structures as possible.

to lateral. At the same time, examine your own ankle and

in Figure 10.48; on it, identify the structures from medial

A transverse section through the ankle joint is shown

site for fractures, sprains, and dislocations.

joint. From the clinical standpoint, the ankle is a common

the tendons, arteries, and nerves in the region of the ankle

a student have a sound knowledge of the arrangement of

Before learning the anatomy of the foot, it is essential that

See pages 496 and

Medial and lateral plantar nerves:

to the ankle joint.

Articular branch

skin over the medial surface of the heel (Fig. 10.49).

supplies the

medial calcaneal branch

The

Cutaneous:

gus, flexor hallucis longus, and tibialis posterior.

to the soleus, flexor digitorum lon

Muscular branches

Branches in the Leg (Below the Popliteal Fossa)

The Lower Limb

■

497.

The Region of the Ankle

Anterior Aspect of the Ankle

■

Malleolus

■

Posterior Aspect of the Ankle

■

Retinaculum

■

Retinaculum

The Foot

-
-

plantar aponeurosis

The

Deep Fascia

the sole (Figs. 10.1 and 10.54).

which innervate the lateral third of

lateral plantar nerve,

the medial two thirds of the sole; and branches from the

which innervate

medial plantar nerve,

branches from the

tibial nerve, which innervates the medial side of the heel;

of the

medial calcaneal branch

foot is derived from the

to the skin of the sole of the

sensory nerve supply

The

large numbers.

the sites of skin movement. Sweat glands are present in

ous fibrous bands. The skin shows a few flexure creases at

firmly bound down to the underlying deep fascia by numer

The skin of the sole of the foot is thick and hairless. It is

The Sole of the Foot

Skin

is a triangular thickening of the

into the toes.

base of the aponeurosis divides into five slips that pass

the medial and lateral tubercles of the calcaneum. The

vessels, and muscles (Fig. 10.54). Its apex is attached to

deep fascia that protects the underlying nerves, blood

Basic Anatomy

491

digital branches of medial plantar nerve

digital branches

of lateral plantar nerve

decussating fibers of

flexor digitorum brevis

branches of lateral

plantar nerve

branches of sural nerve

plantar aponeurosis

medial calcaneal nerve

branches of saphenous nerve

branches of medial

plantar nerve

tendon of flexor

digitorum brevis

tendon of flexor

digitorum longus

fibrous flexor sheath

FIGURE 10.54

Plantar aponeurosis and cutaneous nerves of the sole of the right foot.

Plantar Fasciitis

tion in the posterior attachment of the aponeurosis, forming

Plantar fasciitis, which occurs in individuals who do a great

deal of standing or walking, causes pain and tenderness of the

sole of the foot. It is believed to be caused by repeated minor

trauma. Repeated attacks of this condition induce ossifica-

a calcaneal spur.

C L I N I C A L N O T E S

Muscles of the Sole of the Foot

alis posterior tendon

Interossei, peroneus longus tendon, tibi

Fourth layer:

flexor digiti minimi brevis

Flexor hallucis brevis, adductor hallucis,

Third layer:

tendon

digitorum longus tendon, flexor hallucis longus

Quadratus plantae, lumbricals, flexor

Second layer:

abductor digiti minimi

Abductor hallucis, flexor digitorum brevis,

First layer:

layers from the inferior layer superiorly.

The muscles of the sole are conveniently described in four

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492

CHAPTER 10

passing behind the medial malleolus beneath the flexor

The flexor digitorum longus tendon enters the sole by

Flexor Digitorum Longus Tendon

Long Tendons of the Sole of the Foot

10.59 and are described in Table 10.8.

The muscles of the sole are seen in Figures 10.55 through

used in most people.

suggest control of individual toes, this function is rarely

porting the arches of the foot. Although their names would

few delicate functions and are chiefly concerned with sup

Unlike the small muscles of the hand, the sole muscles have

The Lower Limb

retinaculum (Figs. 10.47 and 10.56). It passes forward across

dons then enter the fibrous sheaths of the lateral four toes

forward, giving origin to the lumbrical muscles. The ten

now divides into its four tendons of insertion, which pass

the insertion of the quadratus plantae muscle. The tendon

a strong slip. It is here that it receives on its lateral border

the tendon of flexor hallucis longus, from which it receives

the medial surface of the sustentaculum tali and then crosses

(Fig. 10.54). Each tendon perforates the corresponding ten

flexor digitorum profundus in the hand (see page 400).

the method of insertion is similar to that found for the

into the base of the distal phalanx. It should be noted that

don of flexor digitorum brevis and passes on to be inserted

decussating fibers of flexor digitorum brevis

medial plantar arte

flexor retinaculum

flexor digitorum brevis

lateral plantar artery

digital nerves and arteries

lateral plantar nerve

abductor digiti minimi

plantar aponeurosis

medial calcaneal nerve

abductor hallucis

medial plantar nerve

FIGURE 10.55

First layer of the plantar muscles of the right foot. Medial and lateral plantar arteries and nerves are also shown.

Muscles of the Sole of the Foot

T A B L E 1 0 . 8

transverse head from

metatarsal bones;

2nd, 3rd, and 4th

Oblique head bases of

into lateral side of base of

of big toe; lateral tendon

of base of proximal phalanx

Medial tendon into medial side

See Table 10.7

remainder: lateral

plantar nerve;

First lumbrical: medial

Tendons of flexor digito

longus in flexing

Assists flexor digitorum

Tendon of flexor digitorum

perforated by those of

of middle phalanx; tendons

toes—inserted into borders

Four tendons to four lateral

toe; braces medial

Flexes and abducts big

Muscle

Origin

Insertion

Nerve Supply

Nerve Root

Action

First Layer

Abductor hallucis

Medial tuberosity of

calcaneum and flexor
retinaculum

Base of proximal phalanx of

big toe

Medial plantar nerve

S2, 3

longitudinal arch

Flexor digitorum

brevis

Medial tubercle of

calcaneum

flexor digitorum longus

Medial plantar nerve

S2, 3

Flexes lateral four toes;

braces medial and
lateral longitudinal
arches

Abductor digiti

minimi

Medial and lateral tuber-

cles of calcaneum

Base of proximal phalanx of

fifth toe

Lateral plantar nerve

S2, 3

Flexes and abducts fifth

toe; braces lateral
longitudinal arch

Second Layer

Quadratus plantae

Medial and lateral sides

of calcaneum

longus

Lateral plantar nerve

S2, 3

lateral four toes

Lumbricals (4)

rum longus

Dorsal extensor expansion;

bases of proximal phalan-
ges of lateral four toes

plantar nerve

S2, 3

Extends toes at inter-

phalangeal joints

Flexor digitorum

longus tendon

Flexor hallucis

longus tendon

Third Layer

Flexor hallucis

brevis

Cuboid, lateral cunei-

form, tibialis posterior
insertion

proximal phalanx of big toe

Medial plantar nerve

S2, 3

Flexes metatar-

sophalangeal joint
of big toe; supports
medial longitudinal
arch

Adductor hallucis

plantar ligaments

Lateral side of base of proxi-

mal phalanx of big toe

Deep branch lateral

plantar nerve

S2, 3

Flexes metatar-

sophalangeal joint
of big toe; holds
together metatarsal
bones

Flexor digiti minimi

brevis

Base of 5th metatarsal

bone

Lateral side of base of proxi-

mal phalanx of little toe

See Table 10.7

Tibialis posterior

See Table 10.6

joints and extends

metatarsophalangeal

Adduction of toes; flexes

Lateral plantar nerve

S2, 3

Flexes metatar-

sophalangeal joint of
little toe

Fourth Layer

Interossei

Dorsal (4)

Adjacent sides of meta-

tarsal bones

Bases of proximal phalan-

ges—first: medial side of
second toe; remainder:
lateral sides of second,
third, and fourth toes—also
dorsal extensor expansion

Lateral plantar nerve

S2, 3

Abduction of toes;

flexes metatar-
sophalangeal joints
and extends inter-
phalangeal joints

Plantar (3)

Inferior surfaces of

3rd, 4th, and 5th
metatarsal bones

Medial side of bases of proxi-

mal phalanges of lateral
three toes

Lateral plantar nerve

S2, 3

interphalangeal joints

Peroneus longus

tendon

The predominant nerve root supply is indicated by boldface type.

494

CHAPTER 10

The Lower Limb

first lumbrical

flexor hallucis longus

flexor digitorum longus

quadratus plantae

lateral plantar

lateral plantar ne

plantar arch

th lumbrical

third lumbrical

four

digital nerve

deep branch of

lateral plantar nerve

rve

artery

medial plantar artery

medial plantar nerve

digital nerves

second lumbrical

FIGURE 10.56

oot. Medial and lateral plantar arteries and nerves are also

Second layer of the plantar muscles of the right f

from behind the lateral malleolus and runs obliquely across

The peroneus longus tendon (Fig. 10.59) enters the foot

Peroneus Longus Tendon

by synovial sheaths (Figs. 10.49 and 10.57).

cis longus and the flexor digitorum longus are surrounded

The tendons of the flexor hallu

Synovial Flexor Sheaths

blind tunnel in which lie the flexor tendons of the toe (Fig.

of the phalanges and the interphalangeal joints, forms a

398). The fibrous sheath, together with the inferior surfaces

arrangement is similar to that found in the fingers (see page

is attached to the sides of the phalanges (Fig. 10.54). The

tal phalanx, is provided with a strong fibrous sheath, which

from the head of the metatarsal bone to the base of the dis

The inferior surface of each toe,

Fibrous Flexor Sheaths

the distal phalanx.

fibrous sheath of the big toe and is inserted into the base of

tendon, to which it gives a strong slip. It then enters the

lum tali and crosses deep to the flexor digitorum longus

flexor retinaculum. It runs forward below the sustentacu

sole by passing behind the medial malleolus beneath the

The flexor hallucis longus tendon (Fig. 10.56) enters the

Flexor Hallucis Longus Tendon

shown.

10.57).

Basic Anatomy

495

fibrous flexor sheath of second toe

digital synovial sheaths

flexor digitorum longus

synovial sheath

of peroneus brevis

synovial sheath

of peroneus longus

synovial sheath

of flexor hallucis longus

tibialis posterior

synovial sheath

of flexor digitorum

longus

flexor hallucis

longus

FIGURE 10.57

Synovial sheaths of the tendons seen on the sole of the right foot.

arises beneath the flexor retinaculum and passes forward

branches of the posterior tibial artery (see page 488). It

The lateral plantar artery is the larger of the terminal

Lateral Plantar Artery

articular branches.

its course, it gives off numerous muscular, cutaneous, and

supplying the medial side of the big toe (Fig. 10.55). During

deep to the abductor hallucis muscle (Fig. 10.49). It ends by

arises beneath the flexor retinaculum and passes forward

branches of the posterior tibial artery (see page 488). It

The medial plantar artery is the smaller of the terminal

Medial Plantar Artery

Arteries of the Sole of the Foot

a synovial sheath.

third, and fourth metatarsals. The tendon is surrounded by

cuboid and the cuneiforms and to the bases of the second,

osity of the navicular. Small tendinous slips pass to the

the sustentaculum tali to be inserted mainly into the tuber

flexor retinaculum and runs downward and forward above

from behind the medial malleolus. It passes beneath the

The tibialis posterior tendon (Fig. 10.59) enters the foot

Tibialis Posterior Tendon

and is surrounded by a synovial sheath (Fig. 10.57).

where it is held in position by the long plantar ligament

The tendon grooves the inferior surface of the cuboid

sal bone and the adjacent part of the medial cuneiform.

the sole to be inserted into the base of the first metatar-

496

CHAPTER 10

The Lower Limb

adductor hallucis

transverse head

oblique head

tendon of abductor

digiti minimi

flexor digiti minimi brevis

metatarsal arteries

plantar arch

deep branch of

lateral plantar nerve

long plantar ligament

flexor hallucis brevis

tendon of abductor hallucis

sesamoid bones

FIGURE 10.58

Third layer of the plantar muscles of the right foot. The deep branch of the lateral plantar nerve and the plantar

deep to the abductor hallucis and the flexor digitorum

arterial arch are also shown.

brevis (Figs. 10.49, 10.55, and 10.56). On reaching the base
of

one, the artery curves medially to

the 5th metatarsal b

nerve (see page 489). It arises beneath the flexor retinacu

The medial plantar nerve is a terminal branch of the tibial

Nerves of the Sole of the Foot

olus to form the posterior tibial venae comitantes.

sponding arteries, and they unite behind the medial malle

accompany the corre

lateral plantar veins

Medial

Veins of the Sole of the Foot

plies the cleft between the big and second toes.

The first plantar metatarsal artery, which sup

Branches

ately joins the lateral plantar artery (Fig. 10.59).

sal interosseous muscle, the dorsalis pedis artery immedi

On entering the sole between the two heads of the first dor

of the Foot)

he Dorsal Artery

Dorsalis Pedis Artery (

arch gives off plantar digital arteries to the toes.

muscular, cutaneous, and articular branches. The plantar

artery (Fig. 10.59). During its course, it gives off numerous

of the first intermetatarsal space joins the dorsalis pedis

(Fig. 10.58) and at the proximal end

plantar arch

form the

-
-

and

-
-

Medial Plantar Nerve

lum (Fig. 10.49) and runs forward deep to the abductor

Basic Anatomy

497

third dorsal interosseous

plantar ligaments of

metatarsophalangeal joints

deep transverse ligaments

fourth dorsal interosseous

third plantar interosseous

metatarsal arteries

plantar arch

deep branch of

lateral plantar nerve

peroneus longus

short plantar ligament

long plantar ligament

tibialis posterior

dorsalis pedis artery

first plantar metatarsal artery

second plantar interosseous

first plantar interosseous

second dorsal interosseous

first dorsal interosseous

sesamoid bones

FIGURE 10.59

Fourth layer of the plantar muscles of the right foot. The deep branch of the lateral plantar nerve and the plan

tar arterial arch are also shown. Note the deep transverse ligaments.

hallucis, with the medial plantar artery (Fig. 10.55). It

deep branches (Fig. 10.56).

of the fifth metatarsal bone, it divides into superficial and

the lateral plantar artery (Fig. 10.56). On reaching the base

hallucis and the flexor digitorum brevis, in company with

lum (Fig. 10.49) and runs forward deep to the abductor

nerve (see page 489). It arises beneath the flexor retinacu

The lateral plantar nerve is a terminal branch of the tibial

palm of the hand.

Compare with the distribution of the median nerve in the

and the tips of the toes.

nerves extend onto the dorsum and supply the nail beds

sides of the medial three and a half toes (Fig. 10.54). The

run to the

Cutaneous branches: Plantar digital nerves

lumbrical muscle.

digitorum brevis, the flexor hallucis brevis, and the first

to the abductor hallucis, the flexor

Muscular branches

Branches

and the flexor digitorum brevis.

comes to lie in the interval between the abductor hallucis

■

Lateral Plantar Nerve

498

CHAPTER 10

longus tendons. On the medial side lies the tendon of extensor

nal part of the deep peroneal nerve and the extensor digitorum

digitorum brevis (Fig. 10.60). On its lateral side lie the termi

inferior extensor retinaculum and the first tendon of extensor

(Fig. 10.59). It is superficial in position and is crossed by the

joins the lateral plantar artery and completes the plantar arch

two heads of the first dorsal interosseous muscle, where it

It terminates by passing downward into the sole between the

a continuation of the anterior tibial artery (see page 485).

The dorsalis pedis artery begins in front of the ankle joint as

of the Foot)

Dorsalis Pedis Artery (the Dorsal Artery

Artery of the Dorsum of the Foot

atarsal bone.

malleoli and distally to the level of the base of the fifth met

sheath extends proximally for a short distance above the

they pass beneath the extensor retinacula (Fig. 10.60). The

dons are surrounded by a common synovial sheath as

The extensor digitorum longus and peroneus tertius ten

Digitorum Longus

Synovial Sheath of the Tendon of Extensor

dons of insertion of the interosseous and lumbrical muscles.

The dorsal expansion, as in the fingers, receives the ten

distal phalanx (Fig. 10.60).

eral parts, which converge to be inserted into the base of the

inserted into the base of the middle phalanx, and two lat

expansion splits into three parts: a central part, which is

Near the proximal interphalangeal joint, the extensor

sion.

extensor expan

joins the fascial expansion called the

On the dorsal surface of each toe, the extensor tendon

side by a tendon of extensor digitorum brevis (Fig. 10.60).

third, and fourth toes, each tendon is joined on its lateral

toes. Opposite the metatarsophalangeal joints of the second,

out over the dorsum of the foot and pass to the lateral four

muscle (Fig. 10.60). The tendon divides into four, which fan

extensor retinaculum, in company with the peroneus tertius

the superior extensor retinaculum and through the inferior

The tendon of extensor digitorum longus passes beneath

The Insertion of the Long Extensor Tendons

Table 10.9.

The muscle is seen in Figure 10.60 and described in

Muscles of the Dorsum of the Foot

pass through the interosseous spaces.

digital veins and communicating veins from the sole, which

of the blood from the whole foot drains into the arch via

back of the leg is described on page 487. The greater part

into the leg behind the lateral malleolus. Its course in the

is described on page 451. The small saphenous vein ascends

the leg in front of the medial malleolus. Its further course

nous vein leaves the dorsum of the foot by ascending into

into the small saphenous vein (Fig. 10.19). The great saphe

side into the great saphenous vein and on the lateral side

the heads of the metatarsal bones and drains on the medial

The dorsal venous arch lies in the subcutaneous tissue over

Dorsal Venous Arch (or Network)

lateral plantar nerves (see above).

of the terminal phalanges are supplied by the medial and

The nail beds and the skin covering the dorsal surfaces

margin of the foot and the lateral side of the little toe.

lateral malleolus and supplies the skin along the lateral

(Fig. 10.1) enters the foot behind the

sural nerve

The

the head of the first metatarsal bone.

the skin along the medial side of the foot as far forward as

foot in front of the medial malleolus (Fig. 10.2). It supplies

passes onto the dorsum of the

saphenous nerve

The

cent sides of the big and second toes (Fig. 10.2).

supplies the skin of the adja

deep peroneal nerve

The

fourth, and fifth toes.

of the big toe; and the adjacent sides of the second, third,

supply the skin on the dorsum of the foot; the medial side

divides into medial and lateral cutaneous branches that

muscle in the lower part of the leg (see page 486). It now

the peroneus brevis and the extensor digitorum longus

emerges from between

superficial peroneal nerve

The

nerves.

nerve, assisted by the deep peroneal, saphenous, and sural

dorsum of the foot is derived from the superficial peroneal

(Fig. 10.2) to the skin on the

sensory nerve supply

The

mobile on the underlying tendons and bones.

The skin on the dorsum of the foot is thin, hairy, and freely

palm of the hand.

Compare with the distribution of the ulnar nerve in the

branch above).

those in the fourth intermetatarsal space (see superficial

and fourth lumbricals; and all the interossei, except

and supplies the adductor hallucis; the second, third,

branch curves medially with the lateral plantar artery

(Fig. 10.59). This

From the deep terminal branch

the dorsum and supply the nail beds and tips of the toes.

of the lateral one and a half toes. The nerves extend onto

metatarsal space. Plantar digital branches pass to the sides

minimi and the interosseous muscles of the fourth inter

to the flexor digiti

From the superficial terminal branch

of the lateral part of the sole.

abductor digiti minimi; cutaneous branches to the skin

to the quadratus plantae and

From the main trunk

Branches

The Lower Limb

■

The Dorsum of the Foot

Skin

Extensor Digitorum Brevis

sor tendons opposite the bases of the metatarsal bones

which runs laterally under the exten

Arcuate artery,

foot just below the ankle joint (Fig. 10.60).

which crosses the dorsum of the

Lateral tarsal artery,

Branches

Its pulsations can easily be felt.

hallucis longus (Fig. 10.60).

■

(Fig. 10.60). It gives off metatarsal branches to the toes.

passing deep to the extensor retinacula on the lateral side

The deep peroneal nerve enters the dorsum of the foot by

Deep Peroneal Nerve

Nerve Supply of the Dorsum of the Foot

sides of the big toe (Fig. 10.60).

which supplies both

First dorsal metatarsal artery,

■

Basic Anatomy

499

superior extensor retinaculum

perforating branch of peroneal artery

lateral malleolus

inferior extensor retinaculum

extensor digitorum brevis

peroneus brevis

peroneus tertius

extensor digitorum brevis tendons

extensor digitorum longus tendons

fourth dorsal interosseous

third dorsal interosseous

extensor expansion

second dorsal interosseous

first dorsal interosseous

medial terminal branch

of deep peroneal nerve

first dorsal metatarsal artery

extensor hallucis longus

dorsalis pedis artery

arcuate artery

lateral tarsal artery

tibialis anterior

medial malleolus

anterior tibial artery

FIGURE 10.60

Structures in the dorsal aspect of the right foot.

Muscle of the Dorsum of the Foot

T A B L E 1 0 . 9

Muscle

Origin

Insertion

Nerve Supply

Nerve Root

Action

Extensor digitorum

brevis

Anterior part of

upper surface of

the calcaneum

and from the

inferior extensor

retinaculum

By four tendons

into the proximal

phalanx of big

toe and long

extensor ten-

dons to second,

third, and fourth

toes

Deep peroneal

nerve

S1, S2

Extends toes

500

CHAPTER 10

the condyles of the tibia and their cartilaginous menisci

Above are the rounded condyles of the femur; below are

Articulation

Note that the fibula is not directly involved in the joint.

between the patella and the patellar surface of the femur.

the corresponding condyles of the tibia, and a gliding joint,

between the medial and lateral condyles of the femur and

in the body. Basically, it consists of two condylar joints

The knee joint is the largest and most complicated joint

The hip joint is fully described on page 467.

articular branches to the joints of the foot.

sor digitorum brevis muscle. Both terminal branches give

ond toes (Fig. 10.60). The lateral branch supplies the exten

supplies the skin of the adjacent sides of the big and sec

terminal, medial, and lateral branches. The medial branch

of the dorsalis pedis artery (see page 485). It divides into

The Lower Limb

-
-

Joints of the Lower Limb

Knee Joint

(Fig. 10.35); in front is the articulation between the lower

tellar bursa

suprapa

beneath the quadriceps tendon, forming the

permitting the synovial membrane to pouch upward

the joint. On the front of the joint, the capsule is absent,

surfaces and surrounds the sides and posterior aspect of

The capsule is attached to the margins of the articular

vial joint of the plane gliding variety.

possible. The joint between the patella and femur is a syno

the hinge variety, but some degree of rotatory movement is

The joint between the femur and tibia is a synovial joint of

Type

tibial plateaus

referred to clinically as the medial and lateral

faces of the medial and lateral condyles of the tibia are often

covered with hyaline cartilage. Note that the articular sur

The articular surfaces of the femur, tibia, and patella are

end of the femur and the patella.

Capsule

(Fig.

h side of the patella, the

10.35). On eac

above to the lateral condyle of the femur and below to the

is cordlike and is attached

lateral collateral ligament

The

the common tendon of the quadriceps femoris muscle.

10.35). It is, in fact, a continuation of the central portion of

der of the patella and below to the tuberosity of the tibia (Fig.

is attached above to the lower bor

ligamentum patellae

The

Extracapsular Ligaments

capsule and those that lie within the capsule.

The ligaments may be divided into those that lie outside the

Ligaments

permits the tendon of the popliteus to emerge (Fig. 10.35).

An opening in the capsule behind the lateral tibial condyle

(Fig. 10.35).

oblique popliteal ligament

muscle called the

is strengthened by an expansion of the semimembranous

vastus lateralis and medialis. Behind the joint, the capsule

capsule is strengthened by expansions from the tendons of

head of the fibula (Fig. 10.35). The tendon of the popliteus

and below to the medial surface of the shaft of the tibia

attached above to the medial condyle of the femur

medial collateral ligament

The

meniscus (Fig. 10.61).

muscle intervenes between the ligament and the lateral

is a flat band and is

(Fig. 10.35).

popliteal bursa

popliteus, forming the

longed downward on the deep surface of the tendon of the

At the back of the joint, the synovial membrane is pro

muscle (Fig. 10.35).

articularis genus

called the

ment of a small portion of the vastus intermedius muscle,

. This is held in position by the attach

suprapatellar bursa

cle for three fingerbreadths above the patella, forming the

which extends up beneath the quadriceps femoris mus

10.61). On the front and above the joint, it forms a pouch,

to the margins of the articular surfaces (Figs. 10.35 and

The synovial membrane lines the capsule and is attached

Synovial Membrane

it is relatively immobile.

meniscus is also attached to the medial collateral ligament,

tibia by anterior and posterior horns. Because the medial

Each meniscus is attached to the upper surface of the

cushions between the two bones.

to receive the convex femoral condyles; they also serve as

tion is to deepen the articular surfaces of the tibial condyles

surfaces are in contact with the tibial condyles. Their func

faces are in contact with the femoral condyles. The lower

forms a free edge (Figs. 10.35 and 10.61). The upper sur

capsule, and the inner border is thin and concave and

tilage. The peripheral border is thick and attached to the

The menisci are C-shaped sheets of fibrocar

Menisci

being pulled posteriorly.

With the knee joint flexed, the PCL prevents the tibia from

prevents anterior displacement of the femur on the tibia.

medial femoral condyle (Figs. 10.35 and 10.61). The PCL

be attached to the anterior part of the lateral surface of the

of the tibia and passes upward, forward, and medially to

ament (PCL) is attached to the posterior intercondylar area

The posterior cruciate lig

Posterior Cruciate Ligament

from being pulled anteriorly.

tibia. With the knee joint flexed, the ACL prevents the tibia

ACL prevents posterior displacement of the femur on the

the lateral femoral condyle (Figs. 10.35 and 10.61). The

be attached to the posterior part of the medial surface of

of the tibia and passes upward, backward, and laterally, to

ment (ACL) is attached to the anterior intercondylar area

The anterior cruciate liga

Anterior Cruciate Ligament

tibia throughout the joint’s range of movement.

ligaments are the main bond between the femur and the

to their tibial attachments (Fig. 10.61). These important

10.35). They are named anterior and posterior, according

ments that cross each other within the joint cavity (Fig.

are two strong intracapsular liga

cruciate ligaments

The

Intracapsular Ligaments

strengthens the posterior aspect of the capsule (Fig. 10.35).

sion derived from the semimembranosus muscle. It

is a tendinous expan

oblique popliteal ligament

The

(Fig. 10.61).

meniscus

It is firmly attached to the edge of the medial

. A bursa is

osed

interp