Lower limb Joints and Ligaments | Anatomy2Medicine
lower limb joints table

Lower limb Joints and Ligaments

    • Hip (coxal) joint
      • Is a multiaxial ball-and-socket synovial joint
      • Is stabilized by the acetabular labrum; the fibrous capsule; and capsular ligaments such as the iliofemoral, ischiofemoral, and pubofemoral ligaments.
      • Has a cavity that is deepened by the fibrocartilaginous acetabular labrum
      • transverse acetabular ligament bridges and converts the acetabular notch into a foramen for passage of nutrient vessels and nerves.
      • Receives blood from branches of the medial and lateral femoral circumflex, superior and inferior gluteal, and obturator arteries.

 

  • The posterior branch of the obturator artery gives rise to the artery of the ligamentum teres capitis femoris (MCQ)

 

    • Fibrous and Cartilaginous Structures
      • Fibrous Capsule
        • Encloses part of the head and most of the neck of the femur.
        • Is reinforced
          • anteriorly by the iliofemoral ligament
          • posteriorly by the ischiofemoral ligament
          • inferiorly by the pubofemoral ligament.
    • Ligaments
      • Iliofemoral Ligament
        • Is the largest and most important ligament
        • reinforces the fibrous capsule anterIorly and is in the form of an inverted Y.
        • Resists hyperextension and lateral rotation at the hip joint during standing
      • Ischiofemoral Ligament
        • It limits extension and medial rotation of the thigh.
      • Pubofemoral Ligament

 

  • It limits extension and abduction.

 

      • Ligamentum Teres Capitis Femoris (Round Ligament of Head of Femur)

 

  • Arises from the floor of the acetabular

 

        • Provides a pathway for the artery of the ligamentum capitis femoris (foveolar artery) from the obturator artery
        • obturator artery represents a significant portion of the blood supply to the femoral head during childhood.
      • Transverse Acetabular Ligament
    • Knee joint
      • Is the largest and most complicated joint.
      • structurally it resembles a hinge joint
        • it is a condylar type of synovial joint between two condyles of the femur and tibia. it includes a saddle joint between the femur and the patella.
      • fibrous capsule
        • thin, weak, and incomplete,
        • surrounds the lateral and posterior aspects of the joint.
      • full extension is accompanied by medial rotation of the femur on the tibia, pulling all ligaments taut.
      • Is stabilized laterally by the biceps and gastrocnemius (lateral head) tendons, the iliotibial tract, and the fibular collateral ligaments.

 

  • Is stabilized medially by the sartorius, gracilis, gastrocnemius (medial head), semitendinosus, and semimembranosus muscles and the tibial collateral ligament.

 

      • Receives blood from the
        • genicular branches (superior medial and lateral, inferior medial and lateral, and middle) of the popliteal artery
        • descending branch of the lateral femoral circumflex artery
        • articular branch of the descending genicular artery
        • anterior tibial recurrent artery.
        • Ligaments
    • Intracapsular Ligaments
      • Anterior Cruciate Ligament
        • Lies inside the knee joint capsule but outside the synovial cavity of the joint.

 

  • Arises from the anterior intercondylar area of the tibia and passes upward, backward,and laterally to insert into the medial surface of the lateral femoral condyle.

 

        • Is slightly longer than the posterior cruciate ligament.
        • Prevents forward sliding of the tibia on the femur (or posterior displacement of the femur on the tibia) and prevents hyperextension of the knee joint.
        • Is taut during extension of the knee and is lax during flexion
        • The small, more anterior band is taut during flexion

 

  • May be torn when the knee is hyperextended.

 

      • Posterior Cruciate Ligament
        • Lies outside the synovial cavity but within the fibrous joint capsule.
        • Arises from the posterior intercondylar area of the tibia

 

  • passes upward, forward, and medially to insert into the lateral surface of the medial femoral condyle.

 

        • Is shorter, straighter, and stronger than the anterior cruciate ligament.
        • Prevents backward sliding of the tibia on the femur
        • Prevents anterior displacement of the femur on the tibia
        • limits hyperflexion of the knee.
        • Is taut during flexion of the knee and is lax during extension.
        • The small posterior band is lax during flexion and taut during extension

 

  • Medial Meniscus

 

        • Lies outside the synovial cavity but within the joint capsule.
        • Is C shaped (i.e., forms a semicircle)
        • is attached to the medial collateral ligament and interarticular area of the tibia.
        • Acts as a cushion or shock absorber
        • It lubricates the articular surfaces by distributing synovial fluid in a windshield-wiper manner.
      • Lateral Meniscus
        • Lies outside the synovial cavity but within the joint capsule.
        • Is nearly circular
        • acts as a cushion, and facilitates lubrication.
        • Is separated laterally from the fibular (or lateral) collateral ligament by the tendon of the popliteal muscle and
        • aids in forming a more stable base for the articulation of the femoral condyle.
      • Transverse Ligament
        • Binds the anterior horns (ends) of the lateral and medial menisci

 

  • Extracapsular Ligaments

 

      • Medial (Tibial) Collateral Ligament
        • Is a broad band that extends from the medial femoral epicondyle to the medial tibial condyle.
        • Is firmly attached to the medial meniscus
        • injury to the ligament results in concomitant damage to the medial meniscus.

 

  • Prevents medial displacement of the two long bones and thus abduction of the leg at the knee.

 

        • Becomes taut on extension and thus limits extension and abduction of the leg.
      • Lateral (Fibular) Collateral Ligament
        • Is a rounded cord
        • It is separated from the lateral meniscus by the tendon of the popliteus muscle and also from the capsule of the joint.
        • Extends between the lateral femoral epicondyle and the head of the fibula.
        • Becomes taut on extension and limits extension and adduction of the leg.
      • Patellar Ligament (Tendon)
        • Is a strong flattened fibrous band
        • it is the continuation of the quadriceps femoris tendon

 

  • Its portion may be used for repair of the anterior cruciate ligament.

 

        • Extends from the apex of the patella to the tuberosity of the tibia.
      • Arcuate Popliteal Ligament
        • Arises from the head of the fibula

 

  • Oblique Popliteal Ligament

 

        • Is an oblique expansion of the semimembranosus tendon and passes upward
        • obliquely across the posterior surface of the knee joint from the medial condyle of the tibia.

 

  • Resists hyperextension of the leg and lateral rotation during the final phase of extension.

 

      • PopliteusTendon
        • Arises as a strong cord-like tendon from the lateral aspect of the lateral femoral condyle
        • runs between the lateral meniscus and the capsule of the knee joint deep to the fibular collateral ligament.
        • Bursae
      • Suprapatellar Bursa
        • Lies deep to the quadriceps femoris muscle
        • the major bursa communicating with the knee joint cavity (the semimembranosus bursa also may communicate with it).

 

  • Prepatellar Bursa

 

        • Lies over the superficial surface of the patella

 

  • Infrapatellar Bursa

 

        • Consists of a
          • subcutaneous infrapatellar bursa over the patellar ligament
          • deep infrapatellar bursa deep to the patellar ligament.

 

  • Anserine Bursa (Known as the Pes Anserinus [Goose’s Foot])
  • Lies between the tibial collateral ligament and the tendons of the sartorius, gracilis, and semitendinosus muscles.

 

    • Tibiofibular joints
      • Proximal Tibiofibular Joint
        • Is a plane-type synovial joint
        • Occur between the head of the fibula and the tibia
        • allows a little gliding movement.
      • Distal Tibiofibular Joint
        • Is a fibrous joint between the tibia and the fibula.
    • Ankle (talocrural) joint
      • Is a hinge-type (ginglymus) synovial joint
      • Occurs between the
        • tibia and fibula superiorly
        • trochlea of the talus inferiorly
      • permit dorsiflexion and plantar flexion.
    • Articular Capsule
    • Is reinforced
      • medially by the medial (or deltoid) ligament
      • laterally by the lateral ligament, which prevents anterior and posterior slipping of the tibia and fibula on the talus.
    • Ligaments
      • Medial (Deltoid) Ligament
        • Has four parts

 

  • Tibionavicular
  • tibiocalcaneal,
  • anterior tibiotalar

 

          • posterior tibi- otalar ligaments
        • Extends from the medial malleolus to the navicular bone, calcaneus, and talus
        • Prevents overeversion of the foot
        • helps maintain the medial longitudinal arch.
      • Lateral Ligament
        • Consists of the
          • anterior talofibular ligament
          • posterior talofibular ligament
          • calcaneofibular (cord- like) ligament
        • Resists inversion of the foot
        • torn during an ankle sprain (inversion injury) (MCQ)
    • TARSAL JOINTS
    • Intertarsal Joints

 

  • Talocalcaneal (Subtalar) Joint

 

        • Is a plane synovial joint (part of the talocalcaneonavicular joint), and is formed between the talus and calcaneus bones.
        • Allows inversion and eversion of the foot

 

  • Talocalcaneonavicular Joint

 

        • Is a ball-and-socket joint (part of the transverse tarsal joint
        • formed between the head of the talus (ball) and the calcaneus and navicular bones (socket).
        • Is supported by the spring (plantar calcaneonavicular) ligament

 

  • Calcaneocuboid Joint

 

        • Is part of the transverse tarsal joint
        • resembles a saddle joint between the calcaneus and the cuboid bones.
        • Is supported by the

 

  • short plantar (plantar calcaneocuboid)
  • long plantar ligaments
  • tendon of the peroneus longus muscle.
  • Transverse Tarsal (Midtarsal) Joint

 

      • Is a collective term for the talonavicular part of the talocalcaneonavicular joint and the calcaneocuboid joint
      • Is important in inversion and eversion of the foot.

 

    • Surgical Anatomy
      • Posterior dislocation of the hip
        • accounts for approximately 90% of hip dislocations
        • It results in
          • rupture of posterior acetabular labrum
          • rupture of ligamentum capitis femoris
          • injury of the sciatic nerve.

 

  • It results in the affected lower limb being shortened, flexed, adducted, and medially rotated.

 

      • Anterior dislocation of the hip joint
        • femoral head is displaced anteroinferior to the acetabulum or the pubic bone.
        • The affected limb is slightly flexed, abducted, and laterally rotated.
      • Medial (central or intrapelvic) dislocation of the hip joint
        • occurs through a medial tearing of the joint capsule

 

  • dislocated femoral head lies medial to the pubic bone.

 

        • accompanied by acetabular fracture and rupture of the bladder.

 

  • Coxa valga

 

        • angle made by the axis of the femoral neck to the axis of the femoral shaft exceeds 135 degrees

 

  • femoral neck becomes straighter.

 

      • Coxa vara
        • angle made by the axis of the femoral neck to the axis of the femoral shaft is less than 135 degrees
        • femoral neck becomes more horizontal.

 

  • Drawer sign
  • anterior drawer sign

 

          • forward sliding of the tibia on the femur
          • due to a rupture of the anterior cruciate ligament
        • posterior drawer sign
          • backward sliding of the tibia on the femur
          • caused by a rupture of the posterior cruciate ligament.

 

  • medial meniscus is more frequently torn in injuries than the lateral meniscus because of its strong attachment to the tibial collateral ligament.

 

      • Unhappy triad or O’Donoghue’s triad of the knee joint
        • occur when a football player’s cleated shoe is planted firmly in the turf
        • knee is struck from the lateral side
        • It is indicated by a knee that is markedly swollen, particularly in the suprapatellar region

 

  • results in tenderness on application of pressure along the extent of the tibial collateral ligament.

 

        • It is characterized by

 

  • rupture of the tibial collateral ligament, as a result of excessive abduction
  • tearing of the anterior cruciate ligament, as a result of forward displacement of the tibia
  • injury to the medial meniscus, as a result of the tibial collateral ligament attachment.

 

      • Knock-knee (genu valgum)
        • is a deformity in which the tibia is bent or twisted laterally.
        • It may occur as a result of collapse of the lateral compartment of the knee and rupture of the medial collateral ligament.
      • Bowleg (genu varum)
        • is a deformity in which the tibia is bent medially.
        • It may occur as a result of collapse of the medial compartment of the knee and rupture of the lateral collateral ligament.
      • Patellar tendon reflex:

 

  • Both afferent and efferent limbs of the reflex arc are in the femoral nerve (L2–L4).

 

      • A portion of the patella ligament may be used for surgical repair of the anterior cruciate ligament of the knee joint

 

  • The tendon of the plantaris muscle may be used for tendon autografts to the long flexors of the fingers.

 

      • Prepatellar bursitis (housemaid’s knee)

 

  • inflammation and swelling of the prepatellar bursa.

 

      • Infrapatellar (superficial) bursitis (clergyman’s knee)
        • inflammation of the infrapatellar bursa
      • Popliteal (Baker’s) cyst
        • swelling behind the knee
        • caused by knee arthritis, meniscus injury, or herniation or tear of the joint capsule
        • It impairs flexion and extension of the knee joint
        • pain gets worse when the knee is fully extended, such as during prolonged standing or walking. I
        • it can be treated by draining and decompressing the cyst.
      • Bunion

 

  • localized swelling at the medial side of the first metatarsophalangeal joint (or of the first metatarsal head)

 

        • caused by an inflammatory bursa

 

  • unusually associated with hallux valgus

 

    • Hallux valgus
      • lateral deviation of the big toe
      • frequently accompanied by swelling (bunion) on the medial aspect of the first metatarsophalangeal joint.