1879MorrisH

 

Fragments of the book Morris H. The anatomy of the joints of man (1879) dedicated to ligamentum capitis femoris (LCF). The author discusses the anatomy of the LCF and describes his experiments to study its movement. 

Quote pp. 318-319

The acetabulum is partly articular, partly non-articular. The articular portion is of horseshoe shape, and extends inwards from the margin, more or less. It is altogether deficient at the cotyloid notch, which corresponds with the gap of the horseshoe. It is the widest at the iliac part, where it is over one inch from without inwards; then it very gradually gets narrower along the ischium, but widens out again at the ischial end of the cotyloid notch ; forwards from the pubo-iliac suture it narrows more rapidly, and does not extend quite up to the pubic end of the cotyloid notch. At its narrowest point in an adult bone it measures half an inch in width. When coated with cartilage, and fringed round with the cotyloid ligament, it fits very closely upon the head of the femur, so as entirely to exclude .air from between the apposed surfaces of the bones ; and thus the joint derives support from without to the full extent of the pressure of the atmosphere.

The non-articular part extends from the cotyloid notch as a rough recess in the floor of the acetabulum, and corresponds to the area enclosed by the horseshoe. It varies in form and size, but is generally quadrilateral, with its longer axis directed upwards and somewhat backwards from the cotyloid notch; following the curve of the bone it measures two inches in this direction, and about an inch and three-quarters transversely. The anterior superior angle of the recess is the highest point, and is situated above and in front of the mid-spot of the cotyloid notch; the posterior superior angle is near the line of union of the ilium and ischium, or a little below it. The recess widens as it passes upwards; it gives lodgment to a quantity of fatty tissue, with which, however, it is but slightly connected, and is the area over which the ligamentum teres plays, although in some cases it is certainly too extensive to allow the ligament to reach its upper limits. 

Quote p. 320

The articular surface, where the head is passing into the neck of the bone, is limited by a sinuous, not an even outline. This sinuous outline only imperfectly corresponds to the limits of the movements of the head of the bone; for when these are carried to an extreme degree it passes within the margin of the acetabulum. A little below the level of the anterior and upper angle of the great trochanter, the articular cartilage is prolonged further outwards than elsewhere. The position of the fossa for the ligamentum teres is just below and behind the middle point of the articular surface. If two lines be drawn at right angles to one another, the one vertically and the other horizontally, across the middle point, the pit is seen near this point in the lower and posterior quarter. The form of the fossa in the recent state is somewhat triangular, the base of the triangle being in front and nearly vertical, while the apex is behind; the long axis is directed nearly horizontally backwards, but with an inclination downwards as well as backwards. The fossa is usually larger, and is always deeper before the articular cartilage has been removed than in the dried bone. It is also deeper in front than behind, so as to resemble a little pit, with a groove running off from it. The round ligament is attached only to the anterior part of the fossa, i.e., the pit, and lies in the posterior part of it, i.e., the groove, only when the ligament is in action, viz., in flexion, with outward rotation. In the bottom of the dimple are two or three foramina for blood vessels.

 

Quote pp. 321-322

LIGAMENTS. There are three ligaments and a circumferential or marginal fibro-cartilage in the hip-joint; these are named the capsular and the transverse ligaments, and the ligamentum teres or round ligament; the cotyloid fibro-cartilage is also generally, though improperly, spoken of as a ligament.

The capsular ligament is at once the strongest, and yet one of the weakest, ligaments in the body. Besides completely covering the articular portions of the bones, it also encloses the ligamentum teres and the cotyloid cartilage, while it partially springs from the outer surface of the transverse ligament. It is large and somewhat loose, so that in every position of the limb some portion of it is relaxed. At the pelvis, it is attached near to, but at a slightly varying distance from, the edge of the acetabulum. Thus superiorly it reaches as high as the base of the anterior inferior iliac spine, thence it curves backwards and becomes blended with the deep surface of the long tendon of the rectus femoris muscle. Posteriorly it is only a few lines from the acetabular rim, and is firmly fixed to the bodies of the ilium and ischium. Inferiorly it is attached to the upper lip of the groove between the acetabulum and tuberosity of the ischium, in which the posterior or lower edge of the belly of the obturator externus muscle is compressed during extension of the limb. Thus it reaches the transverse ligament, to the outer surface of which it is firmly blended, and frequently several long stout fibres are prolonged over the notch to the obturator fascia to which they are firmly attached. Anteriorly it is attached to the pubis near the notch, to the pectineal eminence, and from this backwards along the pubis to the base of the inferior iliac spine. From the superficial aspect of the capsule on the posterior part, a thin but strong stratum extends beneath the gluteus minimus and small rotators, to be attached above to the dorsum of the ilium higher than the long tendon of the rectus, and behind to the ilium and ischium, nearly as far back as the sciatic notch. As this expansion passes over the long tendon of the rectus, part of the origin of the muscle may correctly be described as being within the substance or between the layers of the capsule. 

Plate XXVI

Quote pp. 328-333

The ligamentum teres, or round ligament, is an inter-articular flat band, which extends from the acetabular notch to the dimple in the head of the femur. At the acetabulum it has two bony attachments, one on each side of the notch, while intermediate fibres spring from the under surface of the transverse ligament; indeed, some lowermost fibres of the transverse ligament consist of these intermediate fibres of the round ligament. It is usually about one and a half to one inch and three-quarters long. To the acetabulum, on the pubic side of the notch, it is fixed to the acetabular surface, immediately below the articular cartilage. On the ischial side it is also fixed close to the notch, immediately below the articular facet, but several of the fibres arise outside the cavity, below and in connexion with the origin of the transverse ligament, where it is also continuous with the capsular ligament and periosteum of the ischium. The posterior or ischial portion is much stronger than the anterior or pubic, but it is not strictly correct to say that the origin is bifid, as between the posterior and anterior bands there are the fibres connected with the under edge of the transverse ligament. To the femur the ligament is attached at the anterior part (i.e., the pit) of the dimple in the head, as well as to the cartilage which forms the margin of this part of the dimple. Its axis of insertion corresponds to the base of the triangularshaped dimple; the ischial fibres pass chiefly into the upper angle, the pubic fasciculus into the anterior and lower angle.

In connexion with the ligamentum teres the fatty tissue at the bottom of the rough recess in the acetabulum requires a word of notice. It forms quite a thick quadrangular pad or cushion, which occupies all the non-articular portion of the cavity, and projects outwards, beneath the transverse ligament, through the acetabular notch. Into it pass the articular nerves and arteries, which, as they enter the cavity to run along the round ligament to the head of the femur, lie between the bony origins of the ligamentum teres, and beneath its connexion with the transverse ligament. The synovial membrane which covers the fatty cushion is of unusual thickness; from the cushion, as well as from the lower edge of the transverse ligament, the synovial membrane is reflected along the round ligament to the head of the femur. The part of the membrane reflected from the cushion does not cleave closely to the round ligament, but forms a triangular fold, the apex of which is at the dimple in the head of the femur; one side is continuous with the round ligament, and the other, free, looks towards the back of the acetabulum; while the flat surfaces (in the erect posture) face towards and from the lower part of the femoral head. The ligamentum teres presents the appearance of two triangular planes at right angles to each other, one formed by the broad fibrous ligament, and the other by the reflected synovial membrane as described above. The ligamentum teres is shut out from the synovial cavity of the joint by the reflected membrane, as the lungs are by the pleura, and the abdominal viscera by the peritoneum. 

The use of the ligamentum teres is to check rotation outwards during flexion, and adduction during flexion. As a ligament can only be in use when it is tight, and as there have been various and very different opinions published as to the positions which the joint is in when the round ligament is tight, I shall give the results of different modes of examination. 

When examined after division of the entire circumference of the capsule, the round ligament is on stretch during extension, and adduction in the nearly extended position. During simple extension, the ischial band is alone tense; during extension with adduction, the rest becomes tense also.

After trephining the acetabulum, removing the fat and synovial membrane corresponding to the excised bone, and dividing the fibres of the ilio-femoral ligament through part of its thickness, then adduction in the nearly extended position brings the ligament tight, though perhaps not so tight as rotation outwards with flexion. But if the ilio-femoral ligament be left untouched, so that it offers its full resistance in extension and adduction, there is no tension on the ligamentum teres in the extended or nearly extended positions; but the ligament is still very tight during flexion combined with outward rotation. In this position the ligament is quite flat, and rests in the posterior portion of the dimple (i.e., the groove) of the head of the femur. In flexion with adduction it is also tight; the fibres are almost flat, but twisted a little on themselves near the dimple of the femur. During adduction, as the limb passes from flexion into extension, the round ligament gets less and less tight until it becomes quite lax. After flexion with adduction, it is as tight in flexion with rotation inwards as in any other position. It is at its loosest in abduction with flexion, in which position the two ends of the ligament are close together, and opposite to one another. It is very loose in abduction with extension. It is also loose in abduction combined with flexion and outward rotation.

The tension of the ligament was tested by threading a piece of whipcord round it and pulling on the cord in the various positions. In this mode of examination, the results are very unmistakable-viz., the ligament is tightest in flexion combined with adduction and rotation outwards, and almost as tight in flexion with external rotation alone; and in adduction combined with flexion. Its most lax state is in abduction.

Plate XXVIII

As this method of examination requires the removal from the floor of the cavity of a piece of the synovial membrane near where it is reflected along the round ligament, and as this reflected synovial membrane, together with the fibrous ligament itself, forms a broad triangular structure, it was deemed well to test the results thus obtained by opening the joint at a spot where the division of the synovial membrane could not possibly have any effect upon the round ligament. The capsule was accordingly opened by removing the thin portion over which the ilio-psoas plays and the corresponding portion of the rim of the acetabulum was gouged away; but the results obtained were in no way different from those seen through the trephinehole in the floor of the acetabulum.

The transverse ligament supports the cotyloid fibro-cartilage, and is intimately connected with the ligamentum teres. It is composed of decussating fibres, those which arise from the pubis being more superficial than those arising from the ischium. Attached to the pubis, at some distance above the acetabular notch, some of the superficial fibres soon reach the upper border of the ligament, and then pass over the notch to their ischial insertion on the deep aspect of the ligament; others arise from the pubis nearer the notch, and then pass obliquely across below the former to blend with the ischial portion of the ligament on its outer surface. Some of the deep fibres arise near the margin of the acetabulum at the ischial side of the notch, and pass obliquely across to form the upper border of the ligament near the pubis; while others, attached lower down and farther from the notch, form the lower and deep portion of the pubic side of the ligament.

This ligament converts the notch in the acetabulum into a foramen through which nerves, arteries, and fat enter the acetabulum, and out through which the fatty tissue is compressed in certain positions of the joint. The use of the ligament is to complete the rim of the acetabulum and to furnish a basis of support to the cotyloid cartilage.

The cotyloid fibro-cartilage is a yellowish white structure, which deepens the acetabulum by surmounting its margin. It varies in depth and thickness, and is altogether stronger at its iliac and ischial portions than over the pubis and transverse ligament. Nowhere, however, is it more than a quarter of an inch from its attached to its free edge. It is broader at its attachment than elsewhere, and becomes very thin along its free border. It is somewhat lunated on section, having its outer surface convex and its articular face concave, and very smooth in adaptation to the head of the bone which it tightly embraces a little beyond its greatest circumference. It some what contracts the aperture of the acetabulum, and retains the head of the femur within its grasp after the capsule and all muscles have been completely divided. It is firmly fixed to the bony rim, as well as to the articular cartilage on the inner, and the periosteum on the outer side of it, while at the notch it is inseparably blended with the transverse ligament, if indeed it can be said to exist at all as a distinct structure. It is covered on both aspects by the synovial membrane, which is reflected over its free edge from the capsule to the articular cartilage of the acetabulum.

The articular cartilage lines a large part of the acetabulum, and covers the smooth portion of the head of the femur. In the acetabulum the width and thickness of the cartilage are great in those parts which have to bear most pressure, and greatest on the ilium behind a vertical line from the anterior inferior spinous process. To the head of the femur the cartilage gives much the appearance of a white billiard-ball; to the dimple for the round ligament it gives the raised margin and triangular shape seen in the recent state, for as soon as the cartilage is removed the appearance of the dimple is much altered. Into it at the dimple (especially at the upper margin) the round ligament is inserted, and a large scale is often torn away with the ligament from off the femur in dislocation of the thigh. It is much thicker over the upper than the lower part, and is thicker near the dimple than towards the circumference. At its thickest part, just above the dimple, it is about one-twelfth of an inch deep, while at the under part of the head it is so thin that the bone can be seen through it. The extent of the cartilage corresponds with the smooth part of the head of the dried bone, and its limit with the sinuous outline of the head.

The SYNOVIAL MEMBRANE lines the capsule, and passes over the border of the acetabulum to reach the fatty cushion and the round ligament. By the latter it is conducted, in the manner already described, to the head and neck of the femur, and thus to the femoral attachment of the capsule.

ARTERIES. Blood is supplied to the hip-joint from the deep femoral and the internal iliac arteries.

(1) From the deep femoral, the transverse branch of the internal circumflex as it winds above the small trochanter gives off, when opposite the joint, an articular branch which enters at the cotyloid notch, supplies the fatty tissue, synovial membrane, and round ligament, and, like the following, sometimes reaches the head of the femur.

(2) The transverse branch of the external circumflex, as it passes outwards beneath the vastus externus, gives a branch of considerable size to the joint. It enters through a well-marked and constant aperture in the ilio-femoral band a little above the middle of its femoral attachment.

A second branch, from the same source, sometimes enters the joint through the ligament lower down.

(3) From the internal iliac, blood is derived through the obturator, gluteal, and sciatic branches. The external, lower, and posterior branch of the obturator gives an articular twig, which enters beneath the transverse ligament, ramifies in the fatty cushion of the acetabulum, and runs along the round ligament to the head of the femur.

(4) The inferior division of the deep portion of the gluteal sends small branches to the hip, which pierce the gluteus minimus and penetrate the capsule.

(5) The sciatic artery gives off directly some branches to the back of the capsule of the joint; and the branch from it to the quadratus femoris, after passing beneath the gemelli and internal obturator, sends twigs to the hip-joint before it terminates in the muscle.

NERVES are derived from the lumbar and sacral plexuses. From the lumbar plexus (1) the anterior crural furnishes one or more branches to the front part of the capsule, as the nerve is passing over the joint, and just after it has escaped from beneath Poupart's ligament. (2) The anterior portion of the obturator sends articular branches to the hip-joint when near the thyroid membrane, one of which enters at the acetabular notch, and reaches the ligamentum teres, another supplies the anterior, while a third goes to the lower part of the capsule. (3) The accessory obturator, when present, gives off, behind the pectineus muscle, an articular branch, which sometimes enters the hip-joint with the branch of the obturator artery, and at others perforates the capsule.

From the sacral plexus (1) the nerve to the quadratus femoris furnishes a small branch to the back of the joint, while it is lying between the external rotators and the capsule. (2) Several branches, derived either from the upper part of the great sciatic nerve, or from the lower part of the sacral plexus itself, or from both sources, enter the joint by perforating the back of the capsule. 

Plate XXIX

Quote p. 341

Extension is limited by the ilio-femoral ligament. Abduction and outward rotation can be performed freely in every position of flexion and extension. Abduction is limited by the pectineo-femoral ligament; outward rotation, by the ilio-femoral ligament; by the inner part of it, especially, during extension, but by the outer part of it, as well as by the ligamentum teres, during flexion.

Adduction and inward rotation are very limited in the extended thigh; the former, because of the contact with the opposite limb; the latter, because all the muscles of inward rotation, the tensor vaginæ femoris excepted, are also extensors, whereas most of the other extensors are also outward rotators; so that each set requires to be relaxed by flexion before inward rotation can be perfected.

In the nearly extended position, adduction is more free, and is limited by the outer fibres of the ilio-femoral ligament, and by the thick superior part of the capsule. In flexion, the range of adduction is still greater and is limited by the ischio-femoral ligament; the ligamentum teres is also rendered nearly tight.

In the nearly extended position, inward rotation is limited by the ilio-femoral ligament; and in flexion, by the ischio-femoral ligament, and the part of the capsule between it and the ilio-femoral ligament. 

External links

Morris H. The anatomy of the joints of man. London: J. & A. Churchill, 1879. [archive.org]

Morris H. The anatomy of the joints of man. Philadelphia: Lindsay & Blakiston, 1879. [books.google]

Authors & Affiliations

Henry Morris (1844-1926) was a British medical doctor and surgeon. [wikipedia.org] 

Sir Henry Morris (before 1915)
 Author Anton Mansch, published by A. Eckstein, Berlin; 
original in the wikimedia.org collection (CC0 – Public Domain, no changes).

Keywords

ligamentum capitis femoris, ligamentum teres, ligament of head of femur, anatomy, role, significance, experiment

                                                                     

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