LCF Mechanics

 

Ligamentum Capitis Femoris Mechanics 

Announcement:

• A new scientific direction «Ligamentum Capitis Femoris Mechanics» has been formed. 

Definition:

• A section of physiology that develops issues of applying the doctrine of the ligamentum capitis femoris (LCF), its movements and forces to solving medical and biological problems. 

Synonyms:

• LCF Mechanics
• Ligamentum Capitis Femoris Mechanics
• Ligament of the Head of Femur Mechanics
• Ligamentum Teres Femoris Mechanics
• Round Ligament of Femur Mechanics 

Postulates of LCF biomechanics:

• Strong, flexible, and non-stretchable with specific attachment points.
• Limits adduction, rotation, and cranial displacement of the femur.
• Shunts load on the femoral head and the abductor muscle group of the hip joint.
• Ensures rhythmicity, symmetry, and energy efficiency of walking.

 

The foundation of Ligamentum Capitis Femoris Mechanics is laid by the work of physicians, physicists, anatomists, and physiologists over the past 3,600 years. Key quotes and links to seminal publications are provided below: 

Arkhipov Sergey Vasilyevich (born 1966) – Russian physician, surgeon, traumatologist-orthopedist, and candidate of medical sciences.

• «1. The ligament of head of femur is an important functional connection of the hip joint, capable of locking it in a relaxed single-support position, and transforming it into an analogue of a second-class lever and stabilizing the pelvis. 2. Tension of the ligament of head of femur in vertical poses and during walking redistributes part of the load from the upper to the lower sectors of the articular surfaces and reduces the load on the abductor muscle group.» (2012АрхиповСВ:15).
• «... the effect of spontaneous rotation of the pelvis in the horizontal plane when the hip joint is locked in the frontal plane in a single-support orthostatic position with a stretched ligament of head of femur has been experimentally proven. Due to the tension of the ligament of head of femur in a single-support orthostatic position, autostabilization of the pelvis occurs...»  (2005Архипов-БалтийскийСВ:39).
• LCF «…ensures a reduction in the energy consumption of a single-support orthostatic position and walking, determines its rhythm and cyclicity.» (2005Архипов-БалтийскийСВ:3).
• «The main role of the ligament of head of femur is mechanical. Its most important functions include: the function of connecting the femur and pelvic bones, limiting the adduction of the femur, lateral and cranial displacement of the femoral head, and the function of support.» (2004Архипов-БалтийскийСВ:419).
• LCF «…being a functional connection in the hip joint, it participates in determining the magnitude, direction and acceleration of angular movements of adjacent biokinematic links…» (1997АрхиповСВ).

 

Rudolf Armin Fick (1866-1939) was a German anatomist, pathologist and university professor at the universities of Prague, Innsbruck, Berlin.

• «... the internal ligament is actually an inhibitory ligament. However, as discussed in more detail in Volume II, only for one small range of motion, namely extreme adduction and external rotation of the hip, which is strongly lifted forward [flexed at the joint].» (1904FickR:335).

 

Gilis Jean-Louis-Paul-Marie Antoine (1857-1929) was a French anatomist, professor of anatomy at the Faculty of Medicine in Montpellier University. 

• «1. The round ligament limits the movements of flexion and addiction, of flexion and rotation outwards; 2. It becomes clearly suspensory of the trunk in flexion with lateral inclination of the pelvis when the weight of the trunk bears almost entirely on one of the femurs. Thus, the tension of the round ligament of the right coxo-femoral articulation becomes extreme, if, the left lower limb being flexed and thrown back, the pelvis flexes forward, while tilting laterally on the left side;» (1892GilisP:565).

 

Charles Basile Morel (1822-1884) was a French anatomist, prosector, later professor of anatomy at the Faculty of Medicine in Strasbourg, and University in Nancy.

Mathias Duval (1867-1870) was a French anatomist, prosector at the Faculty of Medicine in Strasbourg, Member of the Faculty of Medicine of Paris.

• «This peculiarity is therefore due to the arrangement of the round ligament; in fact, in the adduction of the thigh, the head of the femur slides from bottom to top in the acetabulum, so as to move the two insertions (femoral and acetabulum) of the round ligament away from each other; now, as in the upright position this ligament, suspending the weight of the body to the head of the femur, is very tense, it opposes any further separation of its insertions, or, in other words, adduction;» (1883MorelC_DuvalM:266).

 

Henry Morris (1844-1926) was a British medical doctor and surgeon. 

• «…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.» (1879MorrisH:330).

 

Christian Wilhelm Braune (1831-1892) was a German anatomist, professor of topographical anatomy at the University of Leipzig.

• «Based on these observations, I must explain the ligamentum teres as an inhibitory ligament for outward rolling and adduction of the femur or corresponding movement of the pelvis during strong flexion of the hip joint.» (1875BrauneW:22).

 

William Scovell Savory (1826-1895), F.R.S., Surgeon and Lecturer on Surgery, St Bartholomew's Hospital, late Professor of Comp. Anat & Physiol., R.G.S.E. 

• «But when resting upon one leg, inasmuch as the pelvis is then raised on that side, which of course affects the ligament in the same way as adduction of the femur would do, then the ligament becomes extremely tense. In other words, it becomes tightest when the hip-joint has to sustain the greatest weight. When therefore the pelvis is borne down upon the femur, or when the femur is forced upwards — that is, when the pressure would be greatest between the upper part of the acetabulum and the opposite surface of the head of the femur — it is put directly on the stretch. More precisely, its great purpose is to prevent undue pressure between the upper portion of the acetabulum, just within the margin, and the corresponding part of the head of the femur. … When the person is erect the body partly hangs upon the Ligamentum Teres.» (1874SavoryWS:292-293).

 

Georg Hermann von Meyer (1815-1892) was Germany anatomist and physiologist; a lecturer in physiology and histology in Tübingen, and later a prosector at the Institute of Anatomy at the University of Zurich. 

• «…tension always occurs simultaneously in both the ligamentum teres and the ligamentum ileo-femorale, and hence it is evident that these two ligaments constitute a restraining pair of forces for the specified class of positions, acting on both sides of the axis…» (1873MeyerGH:344).

 

John Struthers (1823-1899) M.D., F.R.C.S., between 1845 and 1847 was Handyside’s Assistant Demonstrator, Lecturer on Anatomy of Extra-mural School in Edinburgh since 1847, Professor of Anatomy in the University of Aberdeen (1863–1889), President of the Royal College of Surgeons of Edinburgh (1895–1897).

• «But by flexion the front of the capsule is relaxed, allowing the outward rotation to go farther, until it is checked by the round ligament and by the outer part of the ilio femoral band. The limb is in this position when it is lifted and advanced in walking, or in stepping up with the toes everted, in sitting with the knees apart, or with one leg laid across the other knee, or in the tailor posture, or on horseback. In all these and similar positions the hip joint is flexed and rotated outwards, and the ligament is called into play to prevent the ball starting forward from the socket.» (1863StruthersJ:174).

 

Nikolay Ivanovich Pirogov (1810-1881) was a Russian scientist, medical doctor, pedagogue, professor of surgery at the Imperial Academy of Military Medicine in Saint Petersburg.

• «Just as the wickerwork of our carts is suspended on round steel bases, so the pelvis, supported by ligamentum teres, rests on the thigh bones.» (1859PirogoffN:51).

 

George Murray Humphry (1820–1896) was an English surgeon, gerontologist and medical writer, professor of physiology and anatomy at the University of Cambridge.

• «The inclination downwards in the erect, and slightly bent, positions of the joint (which corresponds with adduction of the thigh) is limited by the anterior fibres of the superior accessory ligament; and by the hinder fibres of the same ligament, as well as by the ligamentum teres, when the joint is more bent.» (1858HumphryGM:522).

 

John Struthers (1823-1899) M.D., F.R.C.S., between 1845 and 1847 was Handyside’s Assistant Demonstrator, Lecturer on Anatomy of Extra-mural School in Edinburgh since 1847, Professor of Anatomy in the University of Aberdeen (1863–1889), President of the Royal College of Surgeons of Edinburgh (1895–1897).

• «But by flexion, the front of the capsule is relaxed, allowing the outward rotation to go farther, until it is checked by the round ligament, and by the outer part of the ilio-femoral band. The limb is in this position when it is lifted and advanced in walking, or in stepping up, with the toes everted; in sitting with the knees apart, or with one leg laid across the other knee; or in the tailor position, or on horseback. In all these, and other allied positions, the hip joint is flexed and rotated outwards, and the round ligament is called into play to prevent the ball starting forward from the socket.» (1858StruthersJ:266).

 

William Turner (1832–1916), was a demonstrator of anatomy and Professor of Anatomy at the University of Edinburgh, the Principal of the University of Edinburgh from 1903 to 1916.

• «In the interior of the joint is a strong band of fibres called the interarticular or suspensory ligament (d.) This is connected by its upper end to a depression a little above the centre of the head of the thigh bone, by its lower end to the lower margin of the great hollow (acetabulum) in the haunch bone, which receives that head. When a person is standing erect, or with the body slightly bent, a portion of the weight of the trunk is borne directly by the heads of both thigh bones, or of one thigh bone, according as he stands upon one or both legs, owing to the direct pressure of the acetabula upon the heads of those bones. Now, as the end of this ligament that is connected to the lower margin of the acetabulum is much lower than the end connected to the thigh bone, it of necessity suspends that portion of the weight of the body which is thrown upon it. The effect of this is, to distribute over the head of the thigh bone that weight which, supposing the suspensory ligament had not been present, would have been sustained by that portion merely which is in direct contact with the upper part of the acetabulum.» (1857TurnerW:42-43).

 

Georg Hermann von Meyer (1815-1892) was Germany anatomist and physiologist; a lecturer in physiology and histology in Tübingen, and later a prosector at the Institute of Anatomy at the University of Zurich. 

• «Therefore, the significance of the ligamentum teres lies in providing fixation of the femur in the transverse direction when standing and stabilizing the torso during walking when resting on one leg in a position with hip flexion, preventing it from falling downward due to its own weight. Thus, in the transverse direction when resting on one leg, it has the same effect as the lig. ileo-femorale in the anterior-posterior direction when standing upright.» (1856MeyerGH:125).

 

Richard Partridge F.R.S., F.R.C.S. (1805-1873) was a British surgeon, professor of descriptive and surgical anatomy at King's College (1836-1840), professor of anatomy at the Royal Academy (from 1853).

• «Prof. Partridge in his lectures on anatomy at King's College was accustomed to compare the Ligamentum Teres, in its function, to the leathern straps by which the body of a carriage is suspended on springs…» (1874SavoryWS:291).

 

Wilhelm Eduard Weber (1804-1891) was a German physicist, professor at the University of Göttingen.

Eduard Friedrich Weber (1806-1871) was a German anatomist and physiologist, professor at the University of Leipzig. 

• «The limitation of thigh adduction or lateral flexion of the hip joint, caused by the ligamentum teres and the ligamentum superius, is important for walking, as the center of gravity of the body, which is located between the two femoral heads, is supported alternately by one and then by the other head, and then partially supports the body load only; the unsupported part of the body load will rotate the trunk inward and downward around the femoral head, and therefore fall if these ligaments do not prevent this rotation by their tension.» (1836WeberW_WeberE:145-146).

 

Pierre Nicolas Gerdy (1797-1856) was a French surgeon, anatomist, pathologist and physiologist, professor with the Faculty of Medicine in Paris.

• «Then, by directing the femur into adduction, you will see how the intra-articular ligament involuntarily separates the head of the bone from the surface of its cavity from top to bottom…» ; «The femur, brought out of the acetabulum, the interarticular ligaments and the upper part of the hip joint capsule are forced to support the weight of the body without the almighty support of the upper edge of the acetabulum…» (1833GerdyPN:552-553).
• «…the intra-articular ligament tends to spiral around the femoral head during strong adduction and pulls the bone outwards.» (1823GerdyPN:95).

 

John Bell (1763-1820) was a Scottish anatomist and surgeon. 

• LCF «… which prevents the head from starting out of the socket, or being at all luxated till this ligament is burst; and indeed it would seem as if the weight of the body were in some degree supported by this strong ligament, though the weight is chiefly balanced upon the head of the thigh bone.» (1801BellJ:574).

 

Augustin Friedrich Walther (1688-1746) was a German anatomist, botanist and physician, a professor of anatomy, pathology and therapy at the University of Leipzig.

• LCF «… performs two important actions: either supports the body on one leg, while holding the pelvis, and varies its inclinations; or, when the leg is raised, allows him to move more freely; no matter how it occurs, the round ligament, with the exception of abduction only, is the best at limiting these large and heavy movements and forces. Therefore, when the head of the femur collides with the upper part of the acetabulum of the hip joint, this shorter and stronger than the external [ligament], as if the central support, softens the impacts and reliably protects the joint from them.» (1728WaltherAF:23).

 

Nicolas Andry de Bois-Regard (1658-1742) was a French physician and writer, professor at the French College. 

• «…this head is held by two opposing forces, one, which is the ligament that our Author calls round, prevents the point of the bony ball where it attaches from rising; the other, which is the ligamentous capsule, which attaches to the neck of the femur, prevents this point to which it attaches from descending beyond a certain degree;» (1725AndryN:78).

 

William Cowper (1666-1709) was an English surgeon and anatomist.

• «The Round Ligament of the Os Femoris which is Fasten’d to the Inferior Part or Margin of the Acetabulum; whereby the Great Atrition of the Superior Part of the Acetabulum, with the Head of the Os Femoris, is prevented in Walking, Running, and the like Actions.» (1698CowperW:T.74).

 

Bernardino Genga (1620-1690) was a scholar of Classical medical texts, anatomist and surgeon in Rome.

• «… this ligament is the strongest, supporting not only the femur but the entire body,» (1672GengaB:145). 

Archangelo Piccolomini (1525-1586) was an Italian physician and anatomist at the University of Bordeaux. 

• «Why among walking animals do some move upright and others obliquely? This difference arises from the tension of a round and strong ligament inserted from the head of the thigh bone into the acetabulum.» (1586PiccolominiA:379).

 

Galen (Κλαύδιος Γαληνός, Aelius Galenus, Claudius Galenus, Γαληνός ὁ Περγαμηός, Galenus Pergamenus, Galen of Pergamon; 129–210/217) was a Roman and Greek physician, surgeon, anatomist, and philosopher.

• «There is a socket of large size in each of the ischia, attached by a very stout ligament to the head of the femur.» (162-166Galen. On bones, for beginners).
• «In the femoral joint nature created a ligament, which is round, very strong, extending from the femoral head and connecting in the middle with the acetabulum,» (163-176Galen. On the use of the parts of the human body).
• «In this joint, the ligament is extremely strong, rounded and hidden in it, connecting the top of the femoral head with the deepest inner part of the acetabulum.» (177-180bGalen. Commentary on Hippocrates’ On Joints, IV).

 

Hippocrates (Hippocrates of Kos, Ἱπποκράτης ὁ Κῷος, Hippocrates II; 460 – ca. 370 BC) was a Greek physician, philosopher. (480-413bcHippocrates)

• «... the femur itself bends outwards and forwards; its head is a round epiphysis which gives origin to the ligament inserted in the acetabulum of the hip-joint.» (Hippocrates. Instruments of Reductions; 1886AdamsF:162).

 

The Book of Bereshit (ca. 1600 BC) – author unknown, presumably an ancient Egyptian or Levantine physician and surgeon, active in 1650-1550 BC, whom we conditionally called Imhotep the Younger (1650-1550bcImhotep the Younger).

• «…and there wrestled a man with him until the breaking of the day. And when he saw that he could not pre vail against him, he struck against the hollow of his thigh and the hollow of Jacob's thigh was put out of joint, as he was wrestling with him.» (Book of Genesis 32:25-26; 1922LeeserI).
• «And the sun rose unto him as he passed by Penuёl, and he halted upon his thigh. … because he struck against the hollow of Jacob's thigh on the sinew that shrank.» (Book of Genesis 32:32-33; 1922LeeserI).

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