436 



SURGICAL APPLIED ANATOMY. [Chap. xxi. 



The synomal membrane of the knee-joint extends 

 upwards as a large cul-de-sac above the patella and 

 beneath the extensor tendon. This cul-de-sac reaches 

 a point an inch or more above the upper margin of the 

 trochlear surface on the femur, and is rendered very 



Fig. 45. Vertical Section of Normal Knee-joint (Braune). 



a, Quadi'iceps ; 6, semiraembranosus ; c, gastrocnemius ; d, posterior crucial 

 ligament ; e, liganientum patellse ; /, bursa between quadriceps and femur. 



distinct when the joint is distended with fluid (Fig. 

 46). When the knee is bent, the cul-de-sac is drawn 

 down, and therefore this position of the limb is 

 advised when operations are about to be performed 

 upon the lower end of the femur. Above the sy no vial 

 pouch is a bursa that separates the quadriceps tendon 

 from the femur, and is usually over an inch in its 

 vertical measurement (Fig. 45). From the exami- 

 nation of two hundred and sixty knee-joints in both 

 infants and adults Schwartz found that this bursa 



