1882ReevesHA

Fragments from the book Reeves HA. Human Morphology: A Treatise on Practical and Applied Anatomy. Vol. 1. (1882). The author describes the anatomy of the ligamentum capitis femoris (LCF) and its role.

Quote pp. 451-452

By arrangement with the dissector of the abdomen, who will be interested in the observation, the student should carefully trephine or chisel out a small piece from the roof of the acetabulum in order to observe what has already been stated with regard to the capsule, and also to note how the ligamentum teres is affected with regard to its tension or laxity in the various movements of the joint. He may also try to inject into the joint some warm tallow so as to note if there be any hernial protrusions or projections of the synovial membrane between the layers of the capsule, or whether the synovial membrane of the joint communicates with any of the neighbouring bursæ, more especially with the psoas bursa.

FIG 336. RIGHT HIP JOINT OPENED.
The femur is pulled out of the acetabulum.

FIG. 337. PELVIC LIGAMENTS. ANTERIOR VIEW, ONE-FOURTH.
The right hip-joint is opened and the femur rotated out.
1. Four lumbar vertebra. 2. Ilium. 2'. Ant. sup. spine. 2". Ant. inf. spine. 3. Ischium. 4. Pubes. 5. Femur. 5'. Head of femur. 5". Femoral neck. 6. Ilio-lumbar lig. 7. Ant. sacro-iliac. 8. Great sciatic. 9. Lesser sciatic. 10. Ant. common lig. 11. Ant. sacro-coccygeal. 12. Subpubic lig. 13. Obturator lig. 14. Symphysis pubis. 15. Ilio-femoral. 16. Pubc-femoral. 17. Capsular. 18. Cotyloid. 19. Lig. teres. 20. Great sacro sciatic foramen. 2'''. Ilio-pectincal line.

FIG. 338. LEFT HIP JOINT OPENED THROUGH THE ROOF OF THE ACETABULUM.

FIG. 339. VERTICAL TRANSVERSE SECTION THROUGH RIGHT HIP JOINT.
A. Internal iliac fossa cut.

Quote pp. 454-457

Dissection. Divide the capsular ligament about half an inch from the acetabulum. Displace the head of the femur, then the cotyloid ligament and the ligamentum teres will become evident. Remove the synovial and areolar tissue, and expose the bifurcated attachment of the ligamentum teres. Clean the transverse ligament which passes over the notch.

The Ligamentum teres, or interarticular, or round ligament, is a triangular band of fibres about an inch in length, and is attached by its apex, which is roundish, to a depression slightly behind and below the centre of the femoral head. Its broad base is flattened, and divides into two bands. of fibres which are attached thus: the upper or anterior piece, called the pubic portion of the ligament, blends with the transverse ligament and is fixed to the pubic edge of the notch; the posterior lower piece, the ischial portion, is inserted behind the transverse ligament into the ischial portion of the cotyloid notch. The strength and thickness of this ligament are variable. It is surrounded by a tubular process of the synovial membrane; this may exist even when the ligament is absent. The round ligament checks external rotation and adduction in the flexed position. It consequently tends to prevent dislocation forwards and outwards. Mr. Savory, in the Lancet of May 23, 1874, says that the ligamentum teres is always tense when standing upright, and is further tightened in standing on one leg, and consequently is of opinion that its main function is to support and distribute the body weight over the whole surface of the acetabulum and head of the femur. Some anatomists say that the ligament is lax when the limb is extended, as then the innominate and femoral attachments are near each other. If the femur be adducted the ischial portion becomes tense because the femoral head is raised. If the joint be flexed the ligament becomes tense, as then the femoral insertion is removed from the acetabular; and the ligament will be most stretched if, in the flexed condition, the femur be adducted or rotated out.

Dissection. Divide the ligamentum teres so that the cavity of the acetabulum and the cotyloid and transverse ligaments may be studied.

The Cotyloid ligament is a narrow fibro-cartilaginous band, which is attached by its base to the acetabular margin, the inequalities of which it fills up, and is prolonged across the notch on its inner and lower side (the ischio-pubic notch), and forms the superficial part of the transverse ligament. It is thinner at its free margin or apex, where it embraces the head of the femur. Its outer surface is in contact with the capsular ligament, and its inner surface is inclined inwards and narrows and deepens the acetabulum.

It is much thicker above than behind, and below than in front, and its fibres are close and compact, and interlace in various directions. The inner part of the capsular ligament often blends with the outer part of the cotyloid.

The Transverse ligament is a strongish narrow band of fibres which crosses the notch at the lower part of the acetabulum (ischio-pubic), and converts it into a foramen. It is continuous at the margins of the notch with the cotyloid, and its superficial part, which is mostly distinct, is a continuation of the cotyloid over the notch. The deeper fibres are special to the ligament. Beneath it the nutrient vessels of the joint pass in and out. The fatty tissue in the joint communicates beneath this ligament with the areolar tissue outside the joint, so that pus formed within the joint may pass down and inwards to the thigh and vice versa.

The Joint Surfaces. It will now be clear that the hip joint is an enarthrodial, or ball-and-socket joint, being the largest and most perfect of its kind in the human body. It is formed by the head of the femur fitting into the cavity of the acetabulum.

The Acetabulum is coated with cartilage over the greater part of its surface excepting where the interarticular mass of fat is lodged (the socalled gland of Havers), and opposite the ischio-pubic notch. The articular surface of the acetabulum is deep above, but narrows towards the notch. The head of the femur, or rather the cartilage covering its head, is in contact with the acetabular cartilage and the interarticular adipose mass. A depression a little behind and below its centre will be noticed on the head of the femur, to this the round ligament is attached; on that part of the acetabulum uncovered by cartilage is a mass of vascular fatty tissue which is thicker near the margin of the cartilage than near the transverse ligament, and which acts as a buffer preventing concussion of the head of the femur against the thin roof of the acetabulum. This is the so-called gland of Havers.

Synovial Membrane. The synovial membrane of this joint is extensive, and like all serous membranes is a closed sac. It lines the capsular ligament and invests the others. If we commence at the margin of the acetabulum it will be seen to be reflected on the inner surfaces of the capsular, and reflected along the neck and over the head of the femur, along the ligamentum teres to the bottom of the acetabulum, and then along the inner side of the cotyloid ligament, over its outer side to the margin of the acetabulum again.

FIG. 340. TRANSVERSE VERTICAL SECTION THROUGH LEFT HIP JOINT.

FIG. 341. VERTICAL TRANSVERSE SECTION THROUGH LEFT HIP.

External links

Reeves HA. Human Morphology: A Treatise on Practical and Applied Anatomy. Vol. 1. London: Smith, Elder, & Company, 1882. [books.google , wellcomecollection.org]

Authors & Affiliations

Henry Albert Reeves (1841?-1914) was a surgeon to the Royal Orthopaedic Hospital, M.R.C.S., F.R.C.S.Ed. [wellcomecollection.org , ncbi.nlm.nih.gov]

Keywords

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

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