5 o LANDMARKS MEDICAL AND SURGICAL. 



outer side of the head of the tibia ; and the head of the fibula 

 are the chief bony landmarks of the knee. 



Observe that the head of the fibula lies at the outer and 

 back part of the tibia, and that it is pretty nearly on a level 

 with the tubercle for the attachment of the ligamentum 

 patellae. 



We can also feel the adductor tubercle or spur-like pro- 

 jection of bone above the internal condyle which gives 

 attachment to the tendon of the adductor magnus. This 

 spur-like projection corresponds with the level of the epi- 

 physis of the lower end of the femur, and also with the 

 level of the highest part of the trochlea for the patella : facts 

 worth notice in performing excision of the knee. 



' In reducing a dislocation of the hip, it is important to 

 bear in mind that the inner aspect of the internal condyle in 

 every position of the limb faces nearly in the direction of the 

 head of the femur.' (100) 



The tubercle on the outer side of the head of the tibia 

 gives attachment to the broad and strong aponeurosis 

 (tendon of the tensor fasciae), which, acting like a brace for 

 the support of the pelvis, is well seen in emaciated persons 

 down the outer side of the thigh. This tubercle indicates 

 the level to which the condyles of the femur descend, and 

 the lower level of the synovial membrane. 



The patella, in extension of the knee, is nearly all above 

 the condyles ; in flexion, it lies in the inter-condyloid fossa 

 (more on the external condyle), and thus protects the joint 

 in kneeling. Its inner border is thicker and more prominent 

 than the outer, which slopes down towards its condyle. 



1 08. Ligamentum patellae. The line of the ligamentum 

 patellae is vertical. Hence any deviation from this line, one 

 way or the other, indicates more or less dislocation of the 

 tibia. There is a pellet of fat under the ligament, which 

 answers a ' packing ' purpose sinking in when the knee is 

 bent ; rising when the knee is extended, and bulging on 

 either side of the tendon, almost enough to give the feel of 

 fluctuation. 



In a well-formed leg the ligamentum patellae, the tubercle 



