The article is devoted to studying the function of the ligamentum capitis femoris (LCF) in an experiment. The author believes it is in limiting and checking combined flexion, adduction, and outward rotation, that the LCF has its use; and, in a doing, it assists the outer half of the ilio-femoral, band of the capsule. This combined movement is a frequent one in man, and occurs during walking, running, climbing. Mr. J.F. Knott (Dublin) remarked that the results of his observations gave him the idea that the combined positions of flexion, adduction, and rotation inwards made the ligament most uniformally tense.
THE LIGAMENTUM TERES, AND ITS USES IN MAN AND
ANIMALS.
Read in the Section of Anatomy and Physiology
at the Annual Meeting of the British Medical Association in Worcester, August
1882.
BY HENRY MORRIS, M.A., F.R.C.S.,
Surgeon to, and Lecturer on Surgery at, the
Middlesex Hospital.
THE
ligamentum teres is still an imperfectly understood structure, and anatomists
are not agreed as to its uses. I propose to say a few words on what appears to
me to be its purpose in man and other animals. To ascertain the tension of the
ligament in different positions of the limb, I have employed a mode of
examination of which no mention is made, so far as I am aware, except in my
work on the Anatomy of the Joints; and which does not seem to have been
resorted to by other anatomists. It consists in opening the joint by chiselling
away that portion: of the pubic rim of the acetabulum over which the psoas and iliacus
pass. Thus, the structures in the floor of the acetabulum, to which the
synovial covering of the round ligament is attached, are not disturbed, as they
necessarily are by the method of trephining the floor of the acetabulum;
moreover, the capsular ligament is interfered with only where it is so thin as
to be little more than synovial membrane, and therefore at a part which can
have no restraining influence over the movements of the joint. In this way, the
round ligament is sufficiently exposed to see what degree of tension it assumes
during the extended position of the limb, as well as in many others; whilst, in
the positions in which the ligament is not altogether visible, its condition cam
be easily ascertained by traction upon a string looped beneath it. In this
manner, then, positive proof is obtained that (1) the ligamentum teres is quite
relaxed during extension of the thigh, and that, too, whether the body lies on
its back or is raised into the standing posture; (2) when adduction: is combined
with extension of the thigh there is no tension on the round ligament; (3) the
ligament is at its tightest when the limb is simultaneously flexed, adducted,
and rotated outwards, very nearly as tight when the limb is-fully flexed and
rotated outwards without being adducted, or fully flexed and adducted without
being rotated outwards.*
Much the
same results have been repeatedly ascertained by trephining the floor of the
acetabulum, without in the least interfering with the capsule of the joint; so
that these two methods of examination correct and corroborate one another.
It is
clear, therefore, (1) that it is not the prime function of the round ligament
to assist in supporting the weight of the body in the erect position, either
when we stand on one leg or on both; in other words, that the pelvis is not
slung upon the heads of the femora by means of the round ligaments in the
standing attitude; (2) that the round ligament does not check adduction in the
extended or nearly extended position, as when standing at ease.
Nor can I
suppose that the primary function of the ligamentum teres is to convey blood to
the head of the femur; and that the cotyloid notch is to provide a transit free
from pressure to the nutrient artery. If it were so, a small bony foramen would
serve the purpose better than a notch large enough in man for the iliac artery,
and in the horse for the aorta itself. Besides, a process of synovial membrane,
instead of a bundle of strong ligamentous fibres, could conduct a little vessel
to the head of the femur; and there would be no need of the large and
peculiarly shaped dimple in the head of the bone. Again, in the young subject,
before the epiphyses are joined to the diaphyses, the head of the humerus and
the extremities of other long bones receive their blood supply without the
requirement of a round ligament. Why, then, is this specially required for the
nutrition of the head of the femur? In the adult certainly the number of
vessels entering the neck of the femur are quite enough to supply the head of
the bone also.
It is in
limiting and checking combined flexion, adduction, and outward rotation, that
the ligamentum teres has its use; and, in a doing it assists the outer half of
the ilio-femoral, band of the capsule. This combined movement is a frequent one
in man, and occurs during walking, running, climbing, and under many other
conditions; it often occurs rapidly, and with great force, and is repeated, quick
accession. It therefore stands in need of some controlling agency. In man,
under ordinary circumstances, the restraint exercised by the iliofemoral band
is sufficient; but, in some of the lower animals, in which this combination of
movement at the hip is even more rapid, or more powerful, extra provision is
made against its being carried to excess, by increased strength of the
ligamentum teres, or by the direct continuation of a part of the ligament with
one of that group of muscles which at the same time flex, adduct, and rotate
outwards, Thus in the horse the round ligament passes out of the acetabulum, at
the cotyloid notch, and, under the name of the «pubo-femoral ligament», is attached
to the body and symphysis of the os pubis.** From this ligament, the pectineus
muscle (as well as some of the muscles of the abdomen) arises. The fossa in the
head of the femur of the horse is very deep and long — so that the ligament can
as securely lock the bone as the biceps humeri of man can the arm at the
shoulder.
Again, in
the ostrich, whose rapidity of movement is faster even than the horse’s, the
ligamentum teres is actually continuous with the tendon of a muscle arising
from that portion of the bird’s pelvis which corresponds to the site of origin
of the pectineus in man; and this muscle Professor Owen has named pectineus.
By the
action of the pectineus, the ligamentum teres in these animals is, therefore,
made tense — just as the great sacro-sciatic ligament and the vertebral
aponeurosis in man are, as I have shown elsewhere, made tense by the action of the
hamstring muscles.
In the
great ruminants, in which more considerable outward rotation during flexion is
possible than in the Solidipedes (e.g., the horse), the ligamentum teres has no
pubic fasciculus, and the fossa in the head of the femur is not nearly so deep
; but, though these animals occasionally exhibit a great range of this combined
movement, as shown in what is commonly called the «cow kick», it is only
exceptional, and then always deliberate and intentional, and not a part of any
ordinary act, such as walking, running, or roosting.
In the
elephant, in whom outward rotation, with flexion and adduction, is but
slightly, if at all, effected, and in the seal, in which the conformation of
the hind legs renders such movement impossible, there is, as anatomists well
knew, no ligamentum teres.
Mr. Sutton,
who has lately devoted a good deal of attention to the comparative anatomy of
this ligament, has come to the conclusion that, in birds, it is really the
tendon of the ambiens. muscle. If so, we have, I think, another proof that the
primary object of the ligamentum teres is to retain in place, steady, fand
control, the head of the femur during the action of those muscles which flex,
adduct, and at the same time rotate outwards, the lower limb.
That, in
man, the ligamentum teres is not necessary to the perfection of the hip-joint,
is proved, not only by its perfect mobility and security in persons who have
been congenitally devoid of the ligament, but also after reduction in those who
have dislocated their hip, whereby the ligament is always either torn asunder,
or torn away from the dimple in the head of the femur. The fact that the round
ligament, when quite tense, can be divided without causing the slightest jerk
or change of position of the limb, so long as the ilio femoral band is intact,
points also to the secondary importance of the ligament as a controlling structure
over the movements of the joint in man. The ligament, however, is of much
interest in him, from being the representative of a structure which, in other
animals, sets a definite limit to the action of a muscle, with which it is
anatomically continuous, and of which it may fairly be considered the tendon.
Professor
Humphry thanked Mr. Morris for his paper, and said he would like to hear
whether Mr. Morris had ever read his work, on the Skeleton, as he had there
expressed opinions on the ligamentum teres almost, if not quite, identical with
those just put forth by Mr. Morris, and he had employed the same methods for examining
its state of tension. The fact that the posterior angle was larger and deeper
than the others (in the dimple on the femur) must indicate the position of the
ligament during tension; and, therefore the function must be to render the
parts tense when the thigh was adducted, flexed and slightly rotated outwards.
Webers’s observation on this subject were certainly wrong. In the horse and cow,
where the thigh was slightly adducted, the ligamentum teres was present, but in
the elephant and seal it was absent. It was resent in the chimpanzee but absent
in the orang, which was very difficult to, explain, for the animals were much
alike in configuration. He thought it helped to prevent the joint from becoming
dislocated, because dislocation never occurred without breaking the ligament,
On the whole, it appeared rather a homologue than an useful structure, ‘and
thus much resembled plantaris muscle.
Mr. Shuter
(London) considered that one great function of the ligamentum teres was, that
it conveyed blood-vessels to the head of the femur, while it remained separate from
the shaft, as it was the only portion of separate bone in the body which was so
far removed from the ordinary opportunities of receiving blood.
Mr. J.F. Knott
(Dublin) remarked that it did not seem to have been noticed that the vessels
which passed into the ligamentum teres from without, viz., one from the
obturator artery, and the other from the internal circumflex, had been shown by
Professor Hyrtl to turn back in loops, and not enter the substance of the head
of the at all. The results of his (Mr. Knott’s) observations gave him the idea that
the combined positions of flexion, adduction, and rotation inwards made the
ligament most uniformally tense.
Mr. Henry Morris, in reply, said that he was very well acquainted with Professor Humphry’s work, and that, had the results of his own experiments sufficiently agreed with those of Professor Humphry, he would have alluded to them as. simply corroborating Professor Humphry’s. But, as a, matter of fact, Mr. Morris’s views though they were like in some respects to, did not entirely accord with those of either Meyer, Struthers, or Humphry; his conclusion being that it was during combined flexion, adduction, and outward, rotation (not flexion combined with adduction; nor flexion and rotation outwards without adduction), the ligamentum teres was tightest. The association of the ligamentum teres and the muscles which flex, adduct, and rotate outwards, as well as the mode of examining the ligament described above had not been pointed out previously by any writer. As to, the varying strength of the ligamentum teres, there could, be no dispute; but, however strong, it was always possible, without much difficulty, to rupture it-during abduction by a sudden jerk. By means of injections, other anatomists than Hyrtl had found that the vessels of the ligamentum teres were prolonged a short way into the substance of the head of the femur. The relations between the ligamentum teres and the pectineus muscle in the horse, and the tendon of the ambiens in, the ostrich, were very important in considering the functions of the ligament. The continuation of the fibres of the ligamentum teres with the fibres of the ambiens tendon of the ostrich, had been well seen, in a dissection by Mr. Sutton, on making a vertical section through the acetabulum.
* During
adduction with flexion beyond a right angle, the round ligament doubtless
assists the ischio-femoral portion of the capsule and the rim of the acetabulum
in, keeping the head of the femur in its place. Possibly, in persons who often assume
this attitude, the round ligament becomes thickened from constant use. It has occasionally
been noticed in the dissecting-room that a very thick ischio-femoral band was associated
with an unusually thick ligamentum teres, the result probably of hypertrophy
from frequent action.
The range
of adduction during extension has been incorrectly estimated by the brothers Weber,
who sought to illustrate its limits by asserting that we cannot press the knees
together without bending the hips. This inability exists only in certain individuals,
and isa departure from the normal state in the direction of bandy legs. In present
who have straight legs, adduction during complete extension can be carried far
enough to produce sufficient pressure by the inner condyles of the femur to
prevent even a sheet of writing-paper from being withdrawn from between them.
** In man, many of the fibres of the ligament arise from the ischium, quite outside the acetabulum.
External links
Morris H. The ligamentum teres and his uses in man and animals. Brit. med. journ., 1882;2(Nov. 25)1036-1037. [archive.org]
Authors & Affiliations
Henry Morris (1844-1926) was a British medical doctor and surgeon. [wikipedia.org]
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| Sir Henry Morris (before 1915) Author Anton Mansch, published by A. Eckstein, Berlin; original in the wikimedia.org collection (CC0 – Public Domain, no changes). |
John Freeman Knott (1853–1921) was an Irish surgeon and medical writer. [dib.ie]
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| John Freeman Knott Unknown date and author; image from Royal College of Surgeons in Ireland website rcsi.access.preservica.com (CC0 – Public Domain, no changes) |
Keywords
ligamentum capitis femoris, ligamentum teres, ligament of head of femur, role, experiment, function, walking, running
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