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1850SappeyMPC

 

The author expresses the opinion that the primary role of the ligamentum capitis femoris (LCF) is to protect the blood vessels supplying the femoral head. We believe that 1820PallettaGB was the first to express such a point of view. M.P.C. Sappey describes the macro and microanatomy of the LCF and draws attention to its three bundles, which attach to various parts of the acetabulum. However, the anatomist does not indicate that LCF originates from the transverse ligament of the acetabulum.


 

SappeyMPC. Manuel d’anatomie descriptive et de préparations anatomiques. Tome premièr. Ostéologie, Arthrologie, Myologie et Aponévrologie, avec 114 figures intercalées dans le texte. Paris: Germer Baillière, 1850. [fragments]

Quote p. 96

La tête fémorale est une éminence de forme sphérique, dirigée en haut et en dedans, lisse et revêtue de cartilages dans sa partie supérieure et interne pour s'articuler avec la cavité cotyloïde, et déprimée à son sommet pour l'insertion du ligament rond.

The head of the femur is a prominence of spherical shape, directed upwards and inwards, smooth and covered with cartilage in its upper and inner part for articulation with the acetabulum, and depressed at the apex for the attachment of the round ligament.

Quote pp. 143-144

2° Ligament interarticulaire. Ce cordon fibreux, appelé aussi ligament rond, s'étend de la dépression qu'on observe au centre de la surface articulaire du fémur, à la dépression correspondante de la cavité cotyloïde, au niveau de laquelle il se décompose en trois bandelettes : l'une plus courte qui s'insère à la partie la plus interne de cette dépression, les deux autres plus longues qui s'attachent aux bords de l'échancrure destinée au passage des vaisseaux de l'articulation; ainsi disposé ce cordon constitue une gaîne infundibuliforme qui a pour usage, moins d'unir le fémur au bassin, que de loger et de protéger les vaisseaux intra-articulaires dans le trajet qu'ils parcourent depuis l'échancrure de la cavité cotyloïde jusqu'à la tête fémorale; car en l'absence de cet étui protecteur les vaisseaux fémoraux deviendraient évidemment impossibles; comment des vaisseaux aussi grêles supporteraient-ils les tractions violentes auxquelles ce ligament est soumis dans certains mouvements? ils se rompraient et disparaîtraient bientôt. Mais ces efforts étant supportés par une enveloppe fibreuse qui offre moins de longueur, ils demeurent intacts et le sang les parcourt librement.

Le tissu cellulo-graisseux qui occupe la dépression de la cavité cotyloïde est une sorte de coussinet sur lequel le ligament rond s'étale dans les divers mouvements du membre inférieur, et où il se trouve à l'abri de toute compression capable de suspendre la circulation dans les vaisseaux qu'il renferme.

La synoviale de l'articulation coxo-fémorale entoure ce ligament inter. articulaire, lui forme une sorte de petit mésentère, et se prolonge ensuite sur la face interne de la capsule fibreuse; elle est lâche en arrière et communique souvent en avant avec la bourse séreuse située au-dessous des muscles psoas et iliaque.

2. Interarticular ligament. This fibrous band, also known as the round ligament, extends from the depression observed in the center of the articular surface of the femur to the corresponding depression of the acetabulum, where it divides into three strips: one shorter, which attaches to the innermost part of this depression, and two longer ones attached to the edges of the notch, and intended for the passage of the joint vessels. Constructed in this way, this cord has a funnel-shaped sheath, the purpose of which is not so much to connect the femur to the pelvis, but to accommodate and protect the intra-articular vessels along the path from the notch of the acetabulum to the head of the femur; because without this protective sheath the hip vessels would obviously become impossible; how could such thin vessels withstand the strong tension to which this ligament is subjected during certain movements? They would soon rupture and disappear. But due to the fact that these loads are shunted by a fibrous membrane that has a shorter length, the vessels remain intact and blood flows freely through them.

The adipose tissue occupying the acetabular fossa is a kind of cushion on which the round ligament spreads out during various movements of the lower limb and is protected from any compression capable of impeding the circulation in the vessels it contains.

The synovial membrane of the hip joint surrounds this interarticular ligament, forming a kind of small mesentery, and then extends onto the inner surface of the fibrous capsule; it is loose at the back and often communicates at the front with the bursa located below the psoas and iliacus muscles.

Quote pp. 495-496

5o Artère circonflexe interne. Elle naît ordinairement de la profonde sur un point très rapproché de son origine et quelquefois du tronc de la fémorale. Son volume assez considérable est tantôt égal et tantôt supérieur à celui de la musculaire superficielle. Située à son origine au côté interne du tendon commun des muscles psoas et iliaque, elle s'introduit bientôt entre le pectiné et le col du fémur qu'elle contourne de dedans en dehors, de même que la circonflexe scapulaire postérieure contourne le col chirurgical de l'humerus, et arrive en longeant l'obturateur externe, au niveau du bord inférieur du muscle carré sous lequel elle se divise en deux branches terminales.

Avant sa bifurcation elle fournit:

1° Une branche articulaire qui se porte en haut, en avant et en dedans, parallèlement au ligament capsulaire sur lequel elle est appliquée, et pénètre dans l'articulation coxo-fémorale par l'échancrure de la cavité cotyloïde, en passant sous le cordon fibreux qui convertit en trou cette échancrure; parvenue à la base du ligament rond elle se partage: en rameaux cotyloïdiens qui se perdent soit dans le tissu cellulo-adipeux de l'arrièrefond de la cavité cotyloïde, soit dans les parois de cette cavité; et en rameaux femoraux qui traversent l'axe du ligament rond pour se rendre dans la tête du fémur au sommet de laquelle ils se distribuent.

2o Des branches périostiques fort remarquables qui traversent l'extrémité inférieure de la capsule articulaire et rampent de bas en haut, à la surface du col du fémur, sous la synoviale dont ils reçoivent au voisinage de la tête fémorale une enveloppe complète. Ces branches, très nombreuses, s'avancent jusqu'au niveau de la couche cartilagineuse, en s'anastomosant par des ramuscules latéraux; du périoste elles passent au col et à la tête du fémur, où les plus élevées communiquent avec les rameaux transmis par le ligament rond. A la suite d'une fracture intra-articulaire du col, ces derniers sont les seuls vaisseaux nutritifs qui arrivent à la tête du fémur; quoique d'une extrême ténuité, ils suffisent pour entretenir la vitalité de ce fragment et permettre à un travail de consolidation osseuse ou fibreuse de s'accomplir.

 

 

Internal circumflex artery. It usually arises from the deep artery very close to its origin and sometimes from the femoral artery trunk. Its quite significant volume sometimes equals, and sometimes exceeds, the volume of the superficial muscular artery. Starting its course from the inner side of the common tendon of the lumbar and iliac muscles, it soon penetrates between the pectineus muscle and the neck of the femur, which it circumvents from the inside to the outside, similar to how the posterior circumflex humeral artery circumvents the surgical neck of the humerus, and reaches along the external obturator muscle, at the level of the lower edge of the quadratus femoris muscle, where it divides into two terminal branches.

Before its bifurcation, it provides:

1. An articular branch that extends upward, forward, and inward, parallel to the capsular ligament on which it is applied, and enters the hip joint through the acetabular notch, passing beneath the fibrous fibers that convert this notch into a hole; upon reaching the base of the round ligament, it divides into: acetabular branches, which are lost either in the adipose tissue at the bottom of the acetabulum or in the walls of this cavity; and femoral branches, which cross the axis of the round ligament and reach the head of the femur, where at the apex they branch.

2. Very remarkable are the periosteal branches which cross the lower end of the joint capsule and follow from below upward along the surface of the femoral neck, under the synovial membrane, from which they receive a complete sheath in the region of the femoral head. These branches, very numerous, reach the level of the cartilaginous layer, anastomosing with the lateral branches; from the periosteum they pass to the neck and head of the femur, where higher branches connect with branches passing through the round ligament. After an intra-articular fracture of the neck, the latter are the only nutrient vessels reaching the head of the femur; although they are extremely thin, they are sufficient to maintain the viability of this fragment and allow the process of osteo- or fibrous regeneration to begin.





External links

Sappey MPC. Manuel d’anatomie descriptive et de préparations anatomiques. Tome premièr. Ostéologie, Arthrologie, Myologie et Aponévrologie, avec 114 figures intercalées dans le texte. Paris: Germer Baillière, 1850. [archive.org , books.google]

 

Authors & Affiliations

 

Marie Philibert Constant Sappey (1810-1896) was a French anatomist, a Professor of anatomy in Paris, President of the Académie Nationale de Médecine. [wikipedia.org]

 

Portrait of Constant Sappey (1871)
Photography Pierre Petit; Gualbert the copyright holder of this work; original in the 
wikimedia.org collection (GNU Free Documentation License, Version 1.2, color correction)

  

Sappey, Marie Philibert Constant (1894)
The author of the image is S. Reymond? (see 
Corlieu A. Centenaire de la Faculté de Médecine de Paris (1794-1894). Paris, 1894.); original in the BIU Santé Médecine collection, image: CIPN21614 (Licence Ouverte / Open License, color correction)



Keywords

ligamentum capitis femoris, ligamentum teres, ligament of head of femur, role, significance, anatomy, blood supply, vascularization, stroma, microanatomy, structure

                                                                     .

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