1460 



SURFACE AND SURGICAL ANATOMY. 



hip-joint. One of the commonest situations to meet with an abscess in' hip-joint disease is in 

 the cellular tissue and fat under the tensor fasciae latae ; or the pus may pass below and to the 

 medial side of the neck of the femur, and thence along the course of the medial circumflex artery 

 of the thigh to the back of the thigh. To tap or explore the hip-joint, the puncture should be 

 made in the interval between the sartorius and the tensor fasciae latae, 2 to 3 in. distal to the 

 anterior superior iliac spine ; if the instrument is then pushed upwards, medially and posteriorly 

 beneath the tendon of the rectus femoris, it will pass through the capsule a little above the inter- 

 trochanteric line. Regarded from the point of view of dislocation, the regions of the acetabular 

 notch and of the inferior part of the capsule are the weak points in the joint ; it follows, 

 therefore, that abduction favours dislocation by bringing the head of the femur into relation 

 with these two weak areas. 



THE KNEE. 



With the knee extended and the quadriceps -relaxed, the patella can be readily 

 outlined and moved from side to side upon the femoral condyles. When the 



quadriceps is contracted its tendon 

 springs forwards and is felt as a 

 tense band above the patella ; while 

 the lig. patellae, which has become 

 tense and prominent, may be traced 

 to the distal part of the tuberosity 

 of the tibia. In front of the distal 

 part of the patella and of the proxi- 

 mal part of the lig. patellae is the 

 pre-patellar bursa, into which effusion 

 takes place in the condition known 

 as housemaid's knee. Deep to and 

 on each side of the ligamentum 

 patellae is a well-circumscribed pad 

 of fat, palpation of which gives rise 

 to a feeling closely resembling true 

 fluctuation. In extension, only the 

 distal pair of articular facets of 

 the patella are in contact with the 

 trochlear surface of the femur. In 

 semiflexion the middle pair of facets 

 tibia rests upon the trochlea ; in this posi- 



tion the medial margin of the medial 

 condyle, the proximal border of the 

 medial condyle of the tibia, and the 

 distal part of the patella are all 

 distinctly visible, and together bound 

 a triangular depression, which over- 

 lies the line of the joint and con- 

 tains the anterior part of the medial 

 meniscus ; it is in -this triangle that 

 the surgeon searches for a displaced 

 or thickened medial meniscus, for a 

 loose body, and for " lipping " of the 

 edge of the articular cartilage in 

 chronic osteo- arthritis. A similar, 

 but less well-defined, triangle may 

 be felt immediately lateral to the 

 distal edge of the patella. When 

 the quadriceps is thrown into sud- 

 den or violent contraction, as in 



preventing oneself from falling backwards, the patella may be transversely fractured 

 at the moment of partial flexion. In full flexion almost the whole of the trochlear 

 surface of the condyles is exposed to palpation, covered, however, by the stretched 

 quadriceps tendon. 



racilis 



Rectus femoris 

 rtorius 



Vastus lateralis 

 Vastus medialis 



Quadriceps extensor 



tendon 



Proximal border of 



patella 



Patella 



Ilio-tibial tract 

 Medial epicondyle 

 Medial meniscus 

 Ligamentum patellae 



Pad of fat 

 Medial condyle of 



Head of fibula 



Tuberosity of tibia 



Medial margin of 



tibia 



Anterior crest of 



tibia 



astrocnemius 



~-Soleus 



FIG. 1121. ANTERIOR ASPECT OF KNEE. 



