Henry Gray (18251861). Anatomy of the Human Body. 1918.
groove rests on the articular margin in front of the lateral process of the tibial intercondyloid eminence. Into the groove on the medial condyle is fitted the anterior part of the medial meniscus, while the anterior cruciate ligament and the articular margin in front of the medial process of the tibial intercondyloid eminence are received into the forepart of the intercondyloid fossa of the femur. This third phase by which all these parts are brought into accurate apposition is known as the screwing home, or locking movement of the joint.
The complete movement of flexion is the converse of that described above, and is therefore preceded by an external rotation of the femur which unlocks the extended joint.
The axes around which the movements of flexion and extension take place are not precisely at right angles to either bone; in flexion, the femur and tibia are in the same plane, but in extension the one bone forms an angle, opening lateralward with the other.
In addition to the rotatory movements associated with the completion of extension and the initiation of flexion, rotation inward or outward can be effected when the joint is partially flexed; these movements take place mainly between the tibia and the menisci, and are freest when the leg is bent at right angles with the thigh.
Movements of Patella.The articular surface of the patella is indistinctly divided into seven facetsupper, middle, and lower horizontal pairs, and a medial perpendicular facet (Fig. 353). When the knee is forcibly flexed, the medial perpendicular facet is in contact with the semilunar surface on the lateral part of the medial condyle; this semilunar surface is a prolongation backward of the medial part of the patellar surface. As the leg is carried from the flexed to the extended position, first the highest pair, then the middle pair, and lastly the lowest pair of horizontal facets is successively brought into contact with the patellar surface of the femur. In the extended position, when the Quadriceps femoris is relaxed, the patella lies loosely on the front of the lower end of the femur.
During flexion, the ligamentum patellæ is put upon the stretch, and in extreme flexion the posterior cruciate ligament, the oblique popliteal, and collateral ligaments, and, to a slight extent, the anterior cruciate ligament, are relaxed. Flexion is checked during life by the contact of the leg with the thigh. When the knee-joint is fully extended the oblique popliteal and collateral ligaments, the anterior cruciate ligament, and the posterior cruciate ligament, are rendered tense; in the act of extending the knee, the ligamentum patellæ is tightened by the Quadriceps femoris, but in full extension with the heel supported it is relaxed. Rotation inward is checked by the anterior cruciate ligament; rotation outward tends to uncross and relax the cruciate ligaments, but is checked by the tibial collateral ligament. The main function of the cruciate ligament is to act as a direct bond between the tibia and femur and to prevent the former bone from being carried too far backward or forward. They also assist the collateral ligaments in resisting any bending of the joint to either side. The menisci are intended, as it seems, to adapt the surfaces of the tibia to the shape of the femoral condyles to a certain extent, so as to fill up the intervals which would otherwise be left in the varying positions of the joint, and to obviate the jars which would be so frequently transmitted up the limb in jumping or by falls on the feet; also to permit of the two varieties of motion, flexion and extension, and rotation, as explained above. The patella is a great defence to the front of the knee-joint, and distributes upon a large and tolerably even surface, during kneeling, the pressure which would otherwise fall upon the prominent ridges of the condyles; it also affords leverage to the Quadriceps femoris.
FIG. 353 Posterior surface of the right patella, showing diagrammatically the areas of contact with the femur in different positions of the knee. (See enlarged image)
When standing erect in the attitude of attention, the weight of the body falls in front of a line carried across the centers of the knee-joints, and therefore tends to produce overextension of the articulations; this, however, is prevented by the tension of the anterior cruciate, oblique popliteal, and collateral ligaments.
Extension of the leg on the thigh is performed by the Quadriceps femoris; flexion by the Biceps femoris, Semitendinosus, and Semimembranosus, assisted by the Gracilis, Sartorius, Gastrocnemius, Popliteus, and Plantaris. Rotation outward is effected by the Biceps femoris, and rotation inward by the Popliteus, Semitendinosus, and, to a slight extent, the Semimembranosus, the Sartorius, and the Gracilis. The Popliteus comes into action especially at the commencement of the movement of flexion of the knee; by its contraction the leg is rotated inward, or, if the tibia be fixed, the thigh is rotated outward, and the knee-joint is unlocked.
7c. Articulations between the Tibia and Fibula
The articulations between the tibia and fibula are effected by ligaments which connect the extremities and bodies of the bones. The ligaments may consequently