We are publishing a chapter from the fifth edition of «Morris's Human
Anatomy» (1914). A significant portion of it is dedicated to the ligamentum
capitis femoris (LCF). The original text has been edited by Wood Jones.
Particularly notable are the illustrations depicting the LCF. Some of them are
improved drawings by the first author (1879MorrisH).
Quote pp. 276-284
1. THE HIP-JOINT
Class. — Diarthrosis.
Subdivision. — Enarthrodia.
The hip is the most typical example of a ball-and-socket joint in the
body, the round head of the femur being received into the cup-shaped cavity of
the acetabulum. Both articular surfaces are coated with cartilage, that
covering the head of the femur being thicker above where it has to bear the
weight of the body, and thinning out to a mere edge below; the pit for the
ligamentum teres is the only part uncoated, but the cartilage is somewhat
heaped up around its margin. Covering the acetabulum, the cartilage is
horseshoe-shaped, and thicker above than below, being deficient over the
depression at the bottom of the acetabulum, where a mass of fatty tissue — the
so-called synovial or Haversian gland — is lodged.
The ligaments of the joint are:
Articular capsule.
Ligamentum teres.
Transverse.
Glenoid lip.
The articular capsule is one of the strongest ligaments in the body. It is large and somewhat loose, so that in every position of the body some portion of it is relaxed. At the pelvis it is attached, superiorly, to the base of the anterior inferior iliac spine; curving backward, it becomes blended with the deep surface of the reflected tendon of the rectus femoris; posteriorly, it is attached a few millimetres from the acetabular rim; and below, to the upper edge of the groove between the acetabulum and tuberosity of the ischium. Thus it reaches the transverse ligament, being firmly blended with its outer surface, and frequently sends fibres beyond the notch to blend with the obturator membrane. Anteriorly it is attached to the pubis near the obturator notch, to the ilio-pectineal eminence and thence backward to the base of the inferior iliac spine.
 |
| Fig. 306. — Anterior View of the Articular Capsule op the Hip-joint. |
A thin strong stratum is given off from its superficial aspect behind;
this extends beneath the gluteus minimus and small rotators, to be attached
above to the dorsum of the ilium higher than the reflected tendon of the
rectus, and posteriorly to the ilium and ischium nearly as far as the sciatic
notch. As this expansion passes over the long tendon of the rectus, the tendon may
be described as being in part contained within the substance of the capsule.
At the femur, the capsule is fixed to the anterior portion of the upper
border of the great trochanter and to the cervical tubercle. Thence it runs
down, the intertrochanteric line as far as the medial border of the femur, where
it is on a level with the lower part of the lesser trochanter. It then runs upward
and backward along an oblique line about 1.6 cm. (2/3 in.) in front of the
lesser trochanter, and continues its ascent along the back of the neck nearly
parallel to the intertrochanteric crest, and from 12 to 16 mm. (1/2 to 2/3 in.)
above it; finally, it passes along the medial side of the trochanteric fossa to
reach the anterior superior angle of the great trochanter.
On laying open the capsule, some of the deeper fibres are seen reflected
upward along the neck of the femur, to be attached much nearer the head: these
are the retinacula. One corresponds to the upper, and another to the lower,
part of the intertrochanteric line; a third is seen at the upper and back part
of the neck. They form flat bands, which lie on the femoral neck.
Superadded to the capsule, and considerably strengthening it, are three
auxiliary bands, whose fibres are intimately blended with, and in fact form
part of, the capsule, viz., the ilio-femoral, ischio-capsular, and
pubo-capsular ligaments.
The ilio-femoral ligament (fig. 306) is the longest, widest, and strongest of the bands. It is of triangular shape, with the apex attached above to a curved line on the ilium immediately below and behind the anterior inferior spine, and its base below to the anterior edge of the greater trochanter and to the spiral line as far as the medial border of the shaft. The highest or most lateral fibres are coarse, almost straight, and shorter than the rest; the most medial fibres are also thick and strong, but oblique. This varying obliquity of the fibres, and their accumulation at the borders, explain why this band has been described as the Y-shaped ligament; but it should be noted that the Y is inverted. About the centre of its base, near the femoral attachment, is an aperture transmitting an articular twig from the ascending branch of the external circumflex artery.
 |
| Fig. 307. — Upper Extremity of the Femur (Anterior View), to snow the Relation of the Articular Capsule op the Hip-joint (in red) to the Epiphysial Lines. |
The ischio-capsular ligament (fig. 308) is formed of very strong fibres attached all along the upper border of the groove for the external obturator, and to the ischial margin of the acetabulum above the groove. The highest of these incline a little upward as they pass laterally to be fixed to the greater trochanter in front of the insertion of the piriformis tendon, while the other fibres curve more and more upward as they pass laterally to their insertion at the inner side of the trochanteric fossa, blending with the insertion of the external rotator tendons. When the joint is in flexion, these fibres pass in nearly straight lines to their femoral attachment, and spread out uniformly over the head of the femur; but in extension they wind over the back of the femur in a zonular manner [zona orbicularis], embracing the posterior aspect of the neck of the femur.
The pubo-capsular (pectineo-femoral) band (fig. 306) is a distinct but
narrow set of fibres which are individually less marked than the fibres of the
other two bands; they are fixed above to the obturator crest and to the
anterior border of the ilio-pectineal eminence, reaching as far down as the
pubic end of the acetabular notch. Below, they reach the neck of the femur, and
are fixed above and behind the lowermost fibres of the ilio-femoral band, with
which they blend.
In thickness and strength the capsule varies greatly; thus, if two lines be drawn, one from the anterior inferior spine to the medial border of the femur near the lesser trochanter, and the other from the anterior part of the groove for the external obturator to the trochanteric fossa, all the ligament between these lines on the lateral and upper aspects of the joint is very thick and strong, while that below and to the medial side, except at the narrow pubo-capsular ligament, is thin and weak, so that the head of the bone can be seen through it. The capsule is thickest in the course of the ilio-femoral ligament, toward the lateral part of which it measures over 6 mm. (1/4 in.). Between the ilio-femoral and ischio-capsular ligaments the capsule is very strong, and with it here, near the acetabulum, is incorporated the reflected tendon of the rectus, and here also a triangular band of fibres runs downward and forward to be attached by a narrow insertion to the ridge on the front border of the greater trochanter near the gluteus minimus (the ilio-trochanteric band) (fig. 308).
 |
| Fig. 308. — Posterior View of the Articular Capsule of the Hip-joint. |
 |
| Fig. 309. — Section through the Hip-joint, showing the Glenoid Lip, Ligamentum Teres, and Retinacula. |
The capsule is strengthened also at this point by a strong band from the under surface of the gluteus minimus, and by the tendino-trochanteric band which passes down from the reflected tendon of the rectus to the vastus lateralis (externus) (fig. 306). This is closely blended with the capsule near the lateral edge of the ilio-femoral ligament.
The thinnest part of the capsule is between the pubo-capsular and ilio-femoral ligaments; this is sometimes perforated, allowing the bursa under the psoas to communicate with the joint. The capsule is also very thin at its attachment to the back of the femoral neck, and again opposite the acetabular notch.
 |
| Pig. 310. — Hip-joint after Dividing the Articular Capsule and Disarticulating the Femur. |
The ligamentum teres (figs. 309 and 310) is an interarticular flat band
which extends from the acetabular fossa to the head of the femur, and is
usually about 3.7 cm. (1 1/2 in.) long. It has two bony attachments, one on either
side of the acetabular notch immediately below the articular cartilage, while
intermediate fibres spring from the lower surface of the transverse ligament.
The ischial portion is the stronger, and has several of its fibres arising
outside the cavity, below and in connection with the origin of the transverse
ligament, where it is also continuous with the capsule and periosteum of the
ischium. At the femur it is fixed to the front part of the depression on the
head, and to the cartilage round the margin of the depression.
It is covered by a prolongation of synovial membrane, which also covers
the cushion of fat in the recess of the acetabulum; the portion of the membrane
reflected over the fatty tissue does not cling closely to the round ligament,
but forms a triangular fold, the apex of which is at the femur.
The transverse ligament (fig. 311) passes across the acetabular notch and converts it into a foramen; it supports part of the glenoid fibro-cartilage, and is connected with the ligamentum teres and the capsule. It is composed of decussating fibres, which arise from the margin of the acetabulum on either side of the notch, those coming from the pubis being more superficial, and passing to form the deep part of the ligament at the ischium, while those superficial at the ischium are deep at the pubis. It thus completes the rim of the acetabulum.
 |
| Fig. 311. — Portion of Ischium and Pubis, showing the Acetabular Notch and the ligamentum teres attached outside the Acetabulum. |
The glenoid lip (cotyloid fibro-cartilage) (figs. 309 and 310) is a yellowish-white structure, which deepens the acetabulum by surmounting its margin. It varies in strength and thickness, but is stronger at its iliac and ischial portions than elsewhere. Its base is broad and fixed to the bony rim as well as to the articular cartilage of the acetabulum on the inner, and the periosteum on the outer, side of it, and blends inseparably with the transverse ligament which supports it over the acetabular notch.
 |
| Fig. 312. — The Upper Extremity op the Femur (Posterior View), to show the Relation of the Articular Capsule op the Hip-joint (in red) to the Epiphysial Lines. |
Its free margin is thin; on section it is somewhat lunated, 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 somewhat contracts the aperture of the acetabulum, and retains the head of the femur within its grasp after division of the muscles and capsular ligament. It is covered on both aspects by synovial membrane.
The synovial membrane lines the capsule and both surfaces of the glenoid
lip, and passes over the border of the acetabulum to reach and cover the fatty cushion
it contains. The part covering the fatty cushion is unusually thick, and is
attached round the edges of the rough bony surface on which the cushion rests. The
membrane is loosely reflected off this on to the ligamentum teres, along which
it is prolonged to the head of the femur; thus the fibres of the round ligament
are shut out from the joint cavity. From the capsule the synovial membrane is
also reflected below on to the neck of the femur, whence it passes over the
retinacula to the margin of the articular cartilage. A fold of synovial membrane
on the under aspect of the neck often conveys to the head of the femur a branch
of an artery — generally a branch of the medial circumflex.
The arterial supply comes from — (a) the transverse branches of the
medial and lateral circumflex arteries; (b) the lateral branch of the obturator
sends a branch through the acetabular notch beneath the transverse ligament,
which ramifies in the fat at the bottom of the acetabulum, and travels down the
round ligament to the head of the femur; (c) the inferior branch of the deep
division of the superior gluteal; and (d) the inferior gluteal (sciatic)
arteries. The branch from the obturator to the ligamentum teres is sometimes
very large when the branch from the medial circumflex does not also supply the ligament.
The superior and inferior gluteal send several branches through the innominate attachment of the articular capsule: these anastomose freely beneath the capsule around the outer aspect of the acetabulum, and supply some branches to enter the bone, and others which enter the substance of the glenoid lip. There is quite an arterial crescent upon the posterior and posterosuperior portions of the acetabulum; but no vessels are to be seen on the inner aspect of the glenoid lip.
 |
| Fig. 313. — Ligamentum Teres, lax in Flexion. |
The nerve-supply comes from—(a) femoral (anterior crural), (b) anterior division of the obturator, (c) the accessory obturator, and (d) the sacral plexus, by a twig from the nerve to the quadratus femoris, or from the upper part of the great sciatic, or from the lower part of the sacral plexus.
Relations. — In front and in contact with the capsule are the psoas
bursa, the tendinous part of the psoas magnus, and the iliacus. Still more
anteriorly and not in contact are the femoral artery, the femoral (anterior
crural) nerve, the rectus femoris, the sartorius, and the tensor fasciae latae.
Above and in close relation with the capsule are the piriformis, the
obturator internus and the gemelli, and the reflected head of the rectus femoris,
whilst more superficially lie the gluteus minimus and medius.
Behind and in close relation with the capsule are the obturator
externus, the gemelli and obturator internus, and the piriformis. More superficially
he the quadratus femoris, the sciatic nerves, and the gluteus maximus.
Below the obturator externus, the pectineus, and the medial circumflex
artery are in close relation with the capsule.
The movements. — The hip-joint, like the shoulder, is a ball-and-socket
joint, but with a much more complete socket and a corresponding limitation of
movement. Each variety of movement is permitted, viz., flexion, extension,
abduction, adduction, circumduction, and rotation; and any two or more of these
movements not being antagonistic can be combined, i. e., flexion or extension
associated with abduction or adduction can be combined with rotation in or out.
It results from the obliquity of the neck of the femur that the
movements of the head in the acetabulum are always more or less of a rotatory
character. This is more especially the case during flexion and extension, and
two results follow from it. First, the bearing surfaces of the femur and
acetabulum preserve their apposition to each other, so that the amount of
articular surface of the head in the acetabulum does not sensibly diminish pari
passu with the transit of the joint from the extended to the flexed position,
as would necessarily be the case if the movement of the femoral head, like that
of the thigh itself, was simply angular, instead of rotatory and angular.
Secondly, as rotation of the head can continue until the ligaments are tight
without being checked by contact of the neck of the thigh bone with the rim of
the acetabulum, flexion of the thigh so far as the joint is concerned is
practically unlimited. Flexion is the most important, most frequent, and most
extensive movement, and in the dissected limb, before the ligaments are
disturbed, can be carried to 160°, and is then checked by the lower fibres of
the ischio-capsular ligament. In the living subject simple flexion can continue
until checked by the contact of the soft parts at the groin, if the knee be
bent; if the knee be straight, flexion of the hip is checked in most persons by
the hamstring muscles at nearly a right angle. This is very evident on trying
to touch the ground with the fingers without bending the knees, the chief
strain being felt at the popliteal space. This is due to the shortness of the]
hamstrings. Extension is limited by the ilio-femoral ligament.
 |
| Fig. 314. — Ligamentum Teres, very lax in Complete Extension. |
Adduction is very limited in the extended thigh on account of the contact with the opposite limb. In the slightly flexed position adduction is more free than in extension, and is then limited by the lateral fibres of the ilio-femoral band and the superior portion of the capsule. In flexion the range is still greater, and limited by the ischio-capsular ligament, the ligamentum teres being also rendered nearly tight. Medial rotation in the extended position is limited by the lower fibres of the ilio-femoral ligament; and in flexion by the ischio-capsular ligament and the portion of the capsule between it and the ilio-femoral band.
The ilio-femoral band also prevents the tendency of the trunk to roll backward
on the thigh bones in the erect posture, and so does away with the necessity
for muscular power for this purpose; it is put on stretch in the stand-at-ease
position.
The ligamentum teres is of little use in resisting violence or in imparting
strength to the joint. It assists in checking lateral rotation, and adduction
during flexion. A ligament can only be of use when it is tight, and it was
found by trephining the bottom of the acetabulum, removing the fat, and
threading a piece of whipcord round the ligament, that the ligament was slack
in simple flexion, and very loose in complete extension, but that its most
slack condition was in abduction. It is tightest in flexion combined with
adduction and lateral rotation and almost as tight in flexion with lateral
rotation alone, and in flexion with adduction alone (figs. 313-315).
Muscles which act upon the hip-joint. — Flexors. — The psoas and iliacus, the rectus femoris, the pectineus, the adductors, the sartorius, the tensor fasciae latae, and the gluteus medius.
 |
| Fig. 315. — Ligamentum Teres, drawn Tight in Flexion Combined with Lateral Rotation and Adduction. |
Extensors. — The gluteus maximus, the posterior fibres of the glutei medius and minimus, the biceps, the semitendinosus, the semimembranosus, and the ischial fibres of the adductor magnus; also (slightly) the piriformis, obturator internus and gemelli. Abductors. — Gluteus maximus (upper fibres), tensor fasciae latae, gluteus medius, gluteus minimus, and, when the joint is flexed, the piriformis, obturator internus, the gemelli, and the sartorius also become abductors. Adductors. —Adductores magnus, longus, brevis, and minimus, semitendinosus, biceps, the gracilis, the pectineus, the quadratus femoris, and the lower fibres of the gluteus maxunus. Medial rotators. — Psoas (slightly), adductor magnus, semimembranosus, the anterior fibres of the gluteus medius and minimus, and the tensor fascise latae. Lateral rotators. — Gluteus maximus, posterior fibres of gluteus medius and minimus, the adductors, obturator externus, quadratus femoris, obturator internus, the gemelli, and the piriformis when the joint is extended.
Note
Revised for the fifth edition by Frederic Wood Jones, D.Sc, M.B., B.S. (Lond.), M.R.C.S., L.R.C.P., Head of the Department of Anatomy and Lecturer in the London School of Medicine for Women. Originally written by Sir Henry Morris, A.M., M.B.
External links
Jones FW, Morris H. Section III. The Articulacion. In Jackson CM (Ed). Morris's Human Anatomy: A Complete Systematic Treatise by English and American Authors. Philadelphia: P. Blakiston's Son & Co, 1914. [archive.org]
Authors & Affiliations
Frederic Wood Jones (1879-1954), was a British observational naturalist, embryologist, anatomist and anthropologist, was elected President of the Anatomical Society of Great Britain and Ireland. [wikipedia.org]
 |
| Frederic Wood Jones Source: Clark WLG. Frederic Wood Jones: An Appreciation. Journal of Anatomy. 1955;89(Pt.2)255-267. [ncbi.nlm.nih.gov] (Creative Commons 1.0, no changes) |
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
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
EXPERIMENTS AND OBSERVATIONS
Comments
Post a Comment