ANATOMY- DR ASHWANI KUMAR

HIP JOINT
Classification:
Ball and socket, multi axial type of synovial joint

Articular structures
The head of femur forms more than half of a sphere. It is covered by the articular hyaline
cartilage except for a small fovea capitis for ligamentum teres.
The acetabulum presents three features: a horseshoe-shaped lunate surface, acetabular notch,
and acetabular fossa.

Capsule attachment:
Superiorly It is attached superiorly 5 to 6 mm the acetabular margin of hip bone
Inferiorly Anteriorly: On the intertrochanteric line
Posteriorly: One cm medial to intertrochanteric crest

Types of fibres in capsule:

• The outer fibres are longitudinal and are best developed anterosuperiorly to form
retinacula. The blood vessels supplying head and neck travel along these retinacula
• The inner fibres are circular and are called zona orbicularis

Synovial membrane:
• The inner surface of fibrous capsule, intracapsular portion of neck of femur
• Both surface of acetabular labrum
• Transverse ligament
• Fat in the acetabular fossa

Acetabular labrum (fibrocartilaginous)

• Deepens the acetabular cavity
• Maintains the bony contacts
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LIGAMENTS
Iliofemoral ligament -It is Y shaped, strongest ligament in the body extends from the
(ligament of Bigelow) anterior inferior iliac spine to the intertrochanteric line
-It prevents backwards falling
Pubofemoral ligament Extends from iliopubic eminence, obturator crest and obturator
membrane to inferior part of capsule
Ischiofemoral ligament It is weak and extends from posterior inferior surface of acetabular
margin to posterior part of neck of femur and is continues with
zone orbicularis
Ligament of head of -It is flat and triangular ligament
femur (ligamentum -Its apex is attached to the depression present on the head of
teres or round femur called fovea centralis & base is attached to:
ligament) I. Transverse acetabular ligament and
II. Margins of acetabular notch
Transverse ligament Is a part of acetabulum and it bridges the notch
of the acetabulum

Relations:
Anterior Posterior Superior Inferior
Pectineus Tendon of obturator externus Reflected head of Pectineus
Iliopsoas Tendon of obturator internus rectus femoris Obturator muscle
Rectus femoris Gemelli
Femoral vein Piriformis Gluteus minimus
Femoral artery
Femoral nerve
Blood supply:
1. Obturator artery, a branch of posterior division of internal iliac artery
2. Medial circumflex femoral, a branch of profunda femoris
3. Lateral circumflex femoral, a branch of profunda femoris
Nerve supply:
A. Accessory obturator nerve
B. Sciatic nerve
C. Nerve to rectus femoris
D. Nerve to quadratus femoris
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E. Obturator nerve
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Movements:
Action Muscle
Flexion Psoas major, iliacus
Extension Gluteus maximus (main)
Adductor magnus
Biceps femoris
Semimembranosus
Semitendinosus
Adduction Adductor magnus
Adductor longus
Adductor brevis

Abduction Gluteus medius and

Gluteus minimus
Medial rotation Tensor fascia lata
Lateral rotation Gluteus maximus
Obturator internus and
externus
Superior and inferior gemelli
Piriformis
Quadratus femoris

Applied anatomy:
A. Congenital dislocation is more common in hip than in any other joint
B. Dislocation may be posterior which is (more common) and anterior is (less
common), central is very (rare)
C. Disease of hip may cause referred pain to knee joint.
D. The position of the hip joint is weak in flexion and lateral rotation of femur
hence posterior dislocation (dash board injuries) is more common.
E. Perthes’ disease (pseudocoxalgia): It is a clinical condition characterized by
destruction and flattening of the head of femur with an increased joint space in
the radiograph.
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KNEE JOINT COMPLEX

Complex: Joint is divided into two compartments by a meniscus
Condylar: Medial and lateral condyles of femur and tibia, are taking part
Saddle shaped: Between femur and patella
Modified hinge joint: The movements permitted are flexion, extension hence hinge joint. But
there is a certain amount of axial rotation so it is called modified hinge joint.

Capsule of knee joint

To femur: It is attached to the peripheral margin of articular surface of lower end of femur
excluding articulating area for patella and including for popliteus tendon
To tibia: It is attached 1 cm distal to articular margin
a. Anteriorly it descends along the margin of tibial tuberosity where it is deficient.
b. Posteriorly it is attached to the intercondylar ridge
c. Posterolaterally it leaves a gap for popliteal tendon

Cruciate ligament
Anterior cruciate ligament Posterior cruciate ligament
Extent From anterior part of upper From posterior part of upper surface of tibia
surface of tibia to the lateral to the medial condyle of femur
condyle of femur *The posterior cruciate ligament is stronger,
shorter and less oblique
Function Prevents sliding of the femur Prevents femur from sliding forward
backwards on tibia

Meniscus
• Are semilunar, fibrocartilaginous ring, triangular in cross section, covers the articular
surface of the condyles of tibia
• Each meniscus has anterior and posterior horns. Both the horn of both the menisci are
attached to the anterior and posterior intercondylar area respectively
• The medial margin of the medial meniscus is attached to the tibial collateral ligament
A. The posterior horn of the lateral meniscus provided attachment to
a. The meniscofemoral ligament and
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b. Fibers of the popliteus

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Menisco-femoral ligament
• Arise from posterior horn of lateral meniscus to medial condyle of the femur
• Regulate the forward movement of the lateral meniscus during extension of the knee

Oblique popliteal ligament

Is an expansion of semimembranosus muscle and forms the floor of popliteal fossa.
It is pierced by
1. Middle genicular vessels and nerves
2. Genicular branch of posterior division of obturator nerve

Transverse ligament
It connects anterior horn of medial meniscus to anterior margin of lateral meniscus.
It is present in 40% of individuals

Coronary ligament
It is a part of fibrous capsule and provides attachment to peripheral margin of medial and
lateral meniscus

Arcuate ligament
• The stem of the arcuate ligament is fixed to styloid process of fibula
• The anterior band is attached to lateral condyle of femur
• The posterior band is attached to lateral condyle of tibia

Collateral ligament
Medial collateral ligament Lateral collateral ligament
Attachment From medial femoral epicondyle From lateral femoral epicondyle to the
to shaft to tibia styloid process of the head of fibula
Shape It is broad and fan shaped It is strong, narrow and cord like
Functions It prevents excessive abduction It prevents excessive adduction
Phylogenetically It represents ischial fibres of It represents peroneus longus
adductor magnus
Attachment to It is attached to meniscus It is not attached to meniscus
meniscus
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Bursae of knee joint

Relations of knee joints

Anterior: Quadriceps femoris
Posterior:
a. Popliteal vessels
b. Tibial nerve and
c. Lateral and medial head of gastrocnemius
Medially:
a. Medial patellar retinaculum
b. Sartorius, Gracilis
c. Semimembranosus and
d. Semitendinosus
Laterally
a. Common peroneal nerve
b. Lateral patellar retinaculum and
c. Tendon of biceps femoris

Movements of knee joint and muscles

Movement Muscle Accessory muscles
Flexion A. Hamstring muscles Gastrocnemius plantaris
a. Semimembranosus
b. Semitendinosus
c. Biceps femoris
B. Sartorius
C. Gracilis
Extension Quadriceps femoris, tensor fascia lata Articularis genu
Locking Quadriceps femoris -------
(Medial rotation of the
femur on fixed tibia)
Unlocking Popliteus -------
(Lateral rotation of
femur on fixed tibia)
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Applied anatomy:
1. Osteoarthritis: Being a weight-bearing joint, the knee joint is commonly involved in
osteoarthritis (degenerative wear and tear of articular cartilages).
2. The medial meniscus is more prone for injury as it is more firmly attached to the
capsule and tibial collateral ligament
3. The anterior cruciate ligament is more commonly damaged than the posterior ligament.
The anterior cruciate ligament is injured in the anterior dislocation of the tibia
4. Unhappy triad of the knee joint: A combination of injury of the (a) tibial collateral
ligament, (b) medial meniscus, and (c) anterior cruciate ligament is called “unhappy
triad” of the knee joint.

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