A photocopy and preliminary translation of a forgotten scientific article dedicated to the anatomy of the ligamentum capitis femoris (LCF). The work was published as a chapter in the book «Haematologia sive Sanguinis Historia» (Hematology or the History of Blood, 1743) by Professor of Anatomy and Surgery Thomas Schwencke. The author mentions his experiments demonstrating the function of LCF, describes its shape, dimensions, attachment sites, mechanical properties, movements, injuries, as well as its role in the pathogenesis of certain hip joint diseases.
On the Ligament Connecting the Femoral Head to the
Acetabulum, Internally.
Whenever, for several years, in public lectures or
anatomical demonstrations on the Acetabulum of the Ischium, the spherical head
of the Femur, its ligaments and gland [fat pad] secreting mucous fluid were
discussed, I have been amazed as many times, wondering how, if the ligament
were indeed a round cord emerging from the bottom of the acetabular cavity, double
as some assert, or a triple one, as others claim, it could originate and be
inserted into the spherical cavity of the head, and yet provide such subtle
movement as we observe in this joint (which anatomists call the hip joint),
without pain or obvious injury, given that the head of the Femur would seem to
press considerably on that ligament during rotation or any other movement. This
apparent difficulty prompted me to examine and investigate the structure of
this joint quite carefully and thoroughly; then I noticed the following. That
largest and roundest cavity of the Ischium bone, covered with the smoothest
cartilage, is anteriorly bordered and narrowed by cartilaginous margins,
extending more than halfway around the sphere's circumference, as shown in Tab.
2. Fig. 1. F. F. F. Fig. 2. G. G. G. It encompasses more than half the sphere's
circumference, but the mouth of this cavity, or its eyebrow, protrudes more on
the upper part; then, retreating slightly on either side, particularly
laterally, it forms a hollow that encompasses the entire head of the Femur,
which, however, is most supported by the prominent upper eyebrow, hence less
pressure is observed on the lower and inner edge.
Then the circular ligament, (in some cases a very robust
capsular membrane), densely woven with many muscles of the Femur, emerges from
the circumference or margin of the Acetabulum, externally looser and rougher,
polished and lubricated below, embracing the entire neck of the Femur, as shown
in Tab. 2. Fig. 1. I.I.I. Here it surrounds the head of the femur on all sides,
covered with smooth cartilage, and firmly anchors and restrains it right up to
the margin of the socket, Tab. 2. Fig. 1. H.H.H., in the Acetabulum, congruent
in capacity with the size of the globe. However, the head, emerging from the
neck and inserted obliquely into the cavity, forms an obtuse angle with the
Femur itself and is mainly supported, but mostly limited by prominent margins,
especially in the anterior and inferior regions, do not impede the adduction of
the femur toward the oval opening of the Acetabulum.
In the skeleton, the substance of the edge of the bone is
interrupted, and between the anterior bony prominences of the Acetabulum, near
the oval opening, there is a defect, Tab. 2. Fig. 1. K.K. See also Vesalius
Tab. 29. Fig. 2. litt. H., but in fresh bones, a cartilaginous ligament [lig. transversum
acetabuli], attached to the lunar horns of the margins on both sides, binds and
connects them, so that in fresh bones, there is no deficiency from the margin
and roundness of the socket; on the contrary, its cavity is enlarged. There are
those who posit that the lower part of this cartilaginous ligament is
membranous, which is true on the inner part of the Acetabulum; however, I will
not attempt to further explain this structure, and therefore, I will not debate
it further. It suffices to know that the cartilaginous ligament, by augmenting
the margin, does not completely fill the defect of the bone, for beneath it,
like under a prominent bridge, nerves, arteries, and veins, immersed in
abundant fat, along with the membrane stretched from the periosteum into the
cavity of the Acetabulum through a sufficiently large opening, situated between
the cartilage and the margin of that large sinus osseous, enclosed by incumbent
fibers and fat, are entirely protected from the overlying cartilaginous
ligament, and, given a gateway, they are led into the gland [fat pad], enclosed
by a singular uneven sinus and not covered by cartilage, as depicted in Tab. 2.
Fig. 2. L., are inserted, and they oversee the gland.
That sinus, carved within the very cavity of the Acetabulum,
extends towards the anterior and inferior part, where the substance of the
Acetabulum ends, providing a connection from the cavity of the Acetabulum to
the oval opening in the skeleton through the intervention of a channel, between
the extended horns. However, in a cadaver, the mucous gland, along with the
opening under the cartilaginous ligament, is covered and sealed by a membrane sensitive
to nervous impulses, of the same nature as the periosteum, which, though
attached to the margin of the sinus and also to the internal opening, loosely
covers and protects the gland, ligament, nerves, and vessels, all situated in
the deeper part of the sinus. By virtue of this structure, the gland, and
ligament, along with the nerve membrane, which covers but does not protrude
above the edge of the sinus, perform their function immune to pressure. Hence,
the head of the Femur moves in the Acetabulum and is supported by the prominent
lunate surface of the socket, encircling it like a gland, and in motion, stirs
the viscous, translucent fluid for joint lubrication.
Furthermore, when the body is in an upright position,
inclination, or reclination, the superior and posterior, or superior and
anterior part of the Acetabulum sustains the greatest friction of the head of
the Femur as it moves within its cavity, causing the gland, along with other
enclosed structures, located towards the anterior and inferior parts, to
undergo less force, especially the lesser pubic bone.
According to the ligament, which is internal, it is rightly
judged by Winslow to be falsely named teres [rounded] or round [see 1725AndryN],
since it is not round at all. However, he and others, as many as I have read,
describe the origin and location of the ligament in the acetabular fossa near
the mucous gland with a twofold beginning, not far apart from each other,
although elsewhere Winslow derives the origin from the one margin of the cleft,
then saying that fibers are collected on both sides, which, when collected into
the fossa of the round head of the Femur, form the ligament, indeed near its
insertion, is indeed round from as a cord-like structure, but from this towards
its origin, it is compressed and broad. Others claim it to be generated from a
triple principle.
However, since the denomination and principle are derived
from the predominant part, it is evident in the examination of this joint that
the ligament does not originate from the acetabular fossa at all, but rather
tendonous from many fibers, as shown in Tab. 2. Fig. 1. A. A. A. A. on the
lower and anterior part of the external rim, Tab. 2, Fig. 2. M. M. M. where the
substance of the acetabulum is extended near the oval opening and the position
adjacent to the external obturator muscle, then the fibers are collected in
Tab. 2. Fig. 1. C. and the most robust, white, and shining surface above the
fossa part of the ischium external bone, Tab. 2. Fig. 2. N. N. firmly adheres,
below the cartilage, or cartilaginous ligament connecting the edges of the bone
and increasing the cavity of the acetabulum, as if a taut above trochlea, and
through the fossa, enters the sculpted socket, as if nestled in the groove,
Tab. 2. Fig. 1. D. then, ascending towards the interior, in the obliquely
positioned head of the Femur, the fossa is inserted, Tab. 2. Fig. 1. B. Tab. 2.
Fig. 2. P. Q., which fills the entire external part but minimally from the
internal part, Tab. 2. Fig. 2. Q. This fossa is small but deep, uneven, and
situated beneath the midpoint of the round head, so that it is about 2/3 from
the upper part Tab. 2. Fig. 2. F. and 1/3 from the lower part Tab. 2. Fig. 2.
E. away from the edge of the round head.
This ligament, near its origin, is four lines wide [~9 mm]
and more than two lines thick [~4.5 mm], but towards its insertion, it appears
rounder, positioned transversely, as shown in Tab. 2. Fig. 2. R., and it
strengthens the most robust structure of the joint, and as it transitions with
the membrane, as shown in Tab. 2. Fig. 2. O., covering the gland, vessels, and
other structures, while also covering and connecting the foramen, and it is
enveloped by the same. However, it becomes wider and thicker afterward, and I
would like you to know how this occurs.
At the entrance of the ligament, beneath the cartilaginous
bridge, a sensitive and nervous membrane arises from all sides of the sinus
margin, through which vessels enter, and it spreads around the ligament like a
funnel, with its wider base connected to the edge of the sinus, gradually
narrowing towards the edge of the rim, ultimately tightening the ligament, with
a previously inserted fibrous layer, which together with the aforementioned
membrane, envelops the ligament from all sides. This can be easily demonstrated
by inserting a tube under the cartilaginous ligament in the substance thereof
in the cadaver, and expanding it with air: as is often done elsewhere, this
structure lubricates the ligament to prevent overheating or drying out due to
movement.
Then, another set of fibers originates from the upper and
lateral part under the edge of the sinus, carved into the acetabulum, as shown
in Tab. 2. Fig. 2. I. I., tightly bound to it, as depicted in Tab. 2. Fig. 2.
K., and running anteriorly and downwards, it merges under the covering membrane
with the previously inserted fibrous layer, as shown in Tab. 2. Fig. 2. S. This
series of fibers barely constitutes an eighth part of the larger ligament,
which then joins the common membrane with the preceding ligament, forming an
acute angle with it; this band, running beneath the previous one, descends
mainly into the inner part of the lower head of the femur near the fibers of
the previous ligament, where, however, a small empty cavity is observed in the
femoral head, which is not filled by the ligament.
Finally, the entire membrane covering the gland, fat, and
cavity emits its fibers from all sides, which are gathered and surround the
entire ligament, perhaps dividing into multiple origins of the internal
ligament from many. This ligament, moistened by the glandular mucus, is free
from all pressure, which otherwise, if it were entirely located in the
acetabular sinus, I hardly believe could have been achieved; however, due to
its current position and connection, although thick, like an extended or retracted
ligament, it continually withdraws itself in every movement of the femur, as
necessity dictates. Originating outside the acetabulum, covered with a lot of
fat under the cartilage in a little cavity, it eludes all pressure; however,
the femur is moved, it easily follows, forming an obtuse angle during
adduction, an acute angle during abduction, and when in an erect posture, it
forms almost a right angle, if the femur is moved anteriorly, and the contact
points hardly change in that place; if moved to the posterior part, even less,
because at that point, the recession of the femoral head from the acetabulum is
hardly noticeable, which is always occupied, so it should be considered almost
like a fixed point and moves as if around an axis.
I have often publicly demonstrated over the years the origin
and insertion of this ligament, wrongly named round [see 1725AndryN], and at
the same time presented to the spectators and listeners how much this ligament
resists dislocation and luxation of the femoral head, and what amount of pain
it may cause.
I have often said that if the cartilaginous ligament, which
connects the horns of the acetabulum, is ruptured, the femoral head can easily
be pushed above the oval opening. Because only a small part of the ligament,
namely the one closest to the head, remains intact during dislocation, it
causes the circular ligament around the femoral head at that point to be
strongly compressed and painful tension on the opposite upper and outer part.
If, however, the aforementioned cartilaginous rim is not
destroyed, thus blocking the path to dislocation, with the femoral head
remaining above the oval foramen [foramen obturatum], the entire ligament,
commonly known as the teres ligament, assuming the shape of an inverted letter
S, is significantly stretched and painful, because, above and beyond the
cartilaginous margin, or the cartilaginous-membranous ligament along with the
ball being pushed out, it runs the risk of rupture.
In the rest of these dislocations, the ligament is mostly
torn due to significant pulls.
However, after discovering cellulose in the deeper part of
the acetabulum, which is also located in a small cavity between the acetabular
horns under the nerve membrane covering the gland, wrapping the ligament with
interposed cellulose, and initially loosely, then more tightly, cinching it to
the end of the ligament inserted into the femoral head, as previously
described, many things become clear that were previously obscure in practice.
For the fact that the cellulose membrane of the ligament
alone, or together with the one covering the gland and into which the gland is
immersed, can cause joint edema, or can do so, causing the spherical head of
the femur to be pushed away and moved painfully in the cotyloid cavity,
compressing the injected parts, is evident in itself; and hence joint hydrops
arises.
With the help of this cellulose, which has communication
with the outside under the cartilaginous bridge connecting the acetabular
horns, diseases are brought here through metastasis (or originating elsewhere
outside the acetabulum), as is also the case in other cellulose parts of the
body.
There is also a disease of infants, otherwise very healthy,
when they cannot bear weight [of body] due to this swollen cellulose in the
acetabular fossa, and it often occurs within a very short time. However, it is
revealed if they do not feel any pain while resting but are severely affected
when standing on their feet, particularly from the spherical head of the femur,
which fills the cavity and compresses it partly: and this is why they tend to
lead a sedentary life, avoiding this action.
How severely they suffer, those who are affected at the
onset of the joint by swelling, then stagnant fluid, which excites the swelling
and irritates and corrodes the internal, and then even the external parts,
those who, through months and years, diligently attended to such ulcers, for
slowly those ulcers generate numerous sinuses, pouring out a remarkable
quantity of ichor every day, affecting the leg with atrophy, and then the whole
body, or, with the joint eroded, produce an inevitable and incurable ankylosis.
With the swelling of the gland and the cellulose membrane,
the head is slowly pushed towards the outside, where, with the cavity filled,
dislocation becomes slow, but no art can restore it unless the disease is
detected and treated in time. In scirrhus, both the gland and the ligaments
unite and solidify as if into one mass, with all motion of the joint abolished.
Recent specimens of the cadaver of a 22-year-old female,
dissected and exposed to air, are presented here, although the bones of the
ischium, pubis, and ilium appear slightly drier. However, the acetabulum with
the femoral head, cartilage, ligaments, and vessels have always been moistened
and preserved, appearing almost in a natural state, except for the margin of
the acetabulum in the second figure, which has experienced slightly warmer air
and is therefore slightly drier, but otherwise can be considered natural.
Explanation of the Figures
The first figure shows the right innominate bone with the
globular head of the femur, ligaments, and vessels of the female skeleton.
A. A. A. A. Origin of the external ligament from the bone
near the ischial prominence, below its line with various fibers.
B. Its insertion into the femoral head.
C. Collection of fibers under the margin, or cartilaginous
ligament of the acetabulum before its entrance, similar to under a bridge.
D. The ligament wrapped and fortified by its membrane entering
the acetabulum.
E. Location of the cartilaginous ligament, under which
vessels, nerves, and a cellulose membrane enter the acetabulum, as if under a
bridge, next to the teres ligament.
F. F. F. Cartilaginous prominence of the acetabulum, which
enlarges the cavity, called the margin or rim.
G. G. G. Blood vessels and nerves, protected by a cellular
membrane containing oil; the upper G denotes an artery, while another is seen
directly from this, at a distance of three lines, which is not marked by a
letter.
H. H. H. Smooth cartilage margin, covering the femoral head,
indicating the area until the head is contained within the acetabulum.
I. I. I. Severed neck of the femoral head.
K. K. Oval-shaped hole.
The second figure shows the left innominate bone.
A. A. A. Cut margin of the pubic bones on both sides, to
better observe the internal acetabulum.
B. Cartilaginous prominences, or raised edges with the lower
part of the bone below, towards the same end.
C. Neck.
D. Oval hole.
E. End of the cartilaginous crust of the femoral head, where
the distance to the insertion of the external ligament is shorter, about 1/3
compared to the opposite side.
F. Terminus where the head is contained in the acetabulum,
where the distance is 2/3 of the previous.
G. G. G. Cartilaginous rims of the acetabulum.
H. H. H. Rims of the sinus, sculpted into the acetabulum,
covered with a membrane that protrudes with the rest of this acetabular part,
fortified with cartilage.
I. I. Slightly depressed area of the sinus, from which the
small ligament, or acceding, arises.
K. Lower area, from which the last fibers originated, merge
with the previous ones, forming an obtuse angle with them.
L. A sinus, inscribed with the acetabulum, devoid of
periosteum, receiving the gland, cellulose membrane, and others, covered with a
membrane originating from rim H. H. H.
M. M. M. Origin of the large external ligament from the
outer edge of the acetabular bone.
N. N. Outer rims of the acetabulum, to which the large
ligament, originating externally, is strongly attached, before its entry into
the acetabulum under the cartilaginous ligament, connecting the lunate bone on
both sides.
O. Exposed part of the large ligament, covered by a membrane
towards the femoral head, under which lies cellulose.
P. Insertion of the ligament into the femoral head, showing
the convex part of the semicircle, filling the sinus.
Q. From this side, a recessed ligament is observed, under
which lies the sinus sculpted into the femoral head, not entirely filled with
ligament.
R. The ligament, devoid of its covering,
is of a very firm and white substance.
S. The site where the internal ligament joins,
and, wrapped in the same membrane, is inserted into the
acetabular cavity of the femoral head. The small ligament itself, however, lies
naked, but in a natural state and position, it rests against the other, as in
the previous figure.
T. The cut edge of the bone, forming part of the acetabulum.
V. The prominent crescent-shaped edge of the bone, on the
opposite side of which a smaller one is visible, and both are covered with
cartilage.
Authors & Affiliations
Author: Thomas Schwencke (1694-1767) was Professor of Anatomy and Surgery and Lecturer in Obstetrics at the Surgical School (Hague, Netherlands). [more details: pubmed.ncbi.nlm.nih.gov]
.jpg) |
| Portrait of Thomas Schwencke (1725-1749) The author of the image is Mattheus Verheyden; Copied from the website of the Netherlands Institute of Art History research.rkd.nl (CC0 – Public Domain, color correction) |
External links
Schwencke T. Haematologia, sive sanguinis historia, experimentis passim superstructa. Accedit observatio anatomica de acetabuli ligamento interno, caput femoris firmante, cum binis tabulis adjectis. Hagae: Jon. Mart. Husson, 1743. [books.google]
Keywords
ligamentum capitis femoris, ligamentum teres, ligament of head of femur, hip dislocation, anatomy, observation, role
.
NB! Fair practice / use: copied for the purposes of criticism, review, comment, research and private study in accordance with Copyright Laws of the US: 17 U.S.C. §107; Copyright Law of the EU: Dir. 2001/29/EC, art.5/3a,d; Copyright Law of the RU: ГК РФ ст.1274/1.1-2,7
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