THE LOWER LIMB 605 



studied, and the threefold insertion of the semimembranosus is to be displayed. 

 The arteries entering into the geniculate arterial rete are to be studied as fully 

 as possible. All the external Ugaments of the joint are now to be dissected, 

 namely, (i) the hgamentum patellse ; (2) the lateral patellar Ugaments; 

 (3) the internal lateral ligament, with the inferior internal articular artery 

 passing beneath it, and the medn division of the tendon of the semimem- 

 branosus overlapped by it posteriorly ; (4) the long and short external lateral 

 ligaments, with the inferior external articular arten,- passing beneath the 

 long ligament ; (5) the posterior hgament, with its thickened part, known as 

 the hgamentum posticum Winslowii ; and (6) the capsular ligament. In con- 

 nection with the hgamentum patellze, the bursa between it and the upper 

 part of the tubercle of the tibia should be shown. The exact origin of the 

 tendon of the pophteus is to be displayed, and its relation to the joint and the 

 long external lateral hgament noted. The expansion of the sj-novial mem- 

 brane of the joint upwards above the patella and beneath the suprapatellar 

 tendon is to be again studied. The zirticulation is now to be open«i from 

 before by cutting transversely down through the sjTio\ial membrane just 

 above the patella. This bone, along with the hgamentum patellae, having 

 been turned downwards, underneath them will be seen a collection of fat 

 covered by the synovial membrane, and representing the Haversian gland 

 of the joint. In connection with this portion of the sj-novial membrane, the 

 following so-called Ugaments are to be studied, namelj% the hgamentum 

 mucosum and the hgamenta alairia. The crucial Ugaments are next to be 

 examined in situ, as well as the semilunar fibro-cartilages. 



The sjTiovial membrane is to be examined, and thereafter the following 

 external Ugaments, are to be cut, namely, the capsular and the posterior, 

 thus leaving only the two lateral Ugaments intact. The joint is now to be 

 placed in different positions — e.g., flexion, extension, internal rotation, and 

 external rotation — and the conditions of the crucial and lateral Ugaments, 

 as weU as of the semilunar fibro-cartilages, are to be carefuUy attended to. 



The lateral Ugaments are then to be cut, when the femur wiU be boimd to the 

 tibia only by the crucial Ugaments, which should be completely mastered. The 

 femur should be firmly grasped and the tibia rotated inwards in order to see 

 the effect of this upon the anterior crucial Ugament. The tibia should next 

 be rotated outwards, and it wiU then be made to describe hglf a circle, neither 

 crucial Ugament interfering with this movement. In connection with the 

 posterior comu of the external semilunar fibro-cartilage, the posterior acces- 

 sory- bundle is to be observed, and thereafter the crucial Ugaments are to be 

 divided. The upper surface of the head of the tibia being now fuUy exposed, 

 the semilunar fibro-cartilages are to be studied, and in connection with their 

 anterior aspects the transverse Ugament is to be examined. Lastly, the bony 

 articular surfaces are to be examined. 



Sole of the Foot. — The skin is to be removed from the sole and plantar aspects 

 of the toes by making the foUowing incisions : a median incision from the 

 heel to the roots of the toes, a transverse incision across the roots of the toes, 

 a median incision along the plantar aspect of each toe, and a transverse 

 incision across the tip of each toe. Within the skin of the webs of the toes 

 a bundle of transverse fibres, called the superficiad transverse Ugament, is 

 to be dissected. The superficiad faiscia should be examined, and the calcaneal 

 and plantar di\isions of the calcaneo-plantar branch of the posterior tibial 

 nerve are to be followed out to their distribution. 



The superficial fascia is now to be removed so as to expose the dense deep 

 fascia, known as the plantar fascia. In dissecting the three di\isions of this 

 important fascia, care is to be taken to display the foUowing structures : (i) 

 cutaneous branches of the internal plantar a^ter^- and ner\'e, which appear in 

 the groove between the inner and middle di\isions'; and (2) cutaneous branches 

 of the external plantar artery- and nerve, which appear in the groove between 

 the middle and outer di\isions. The three divisions of the fascia are 

 then to be carefuUy studied, and the grooves between them, indicating 

 intermuscular septa, are to be noted. In the outer groove, near the base of 

 the fifth metatarsal bone, the external plantar arterv should be exposed. 



