778 



NORMAL ANATOMY OF THE HIP-JOINT. 



free, and bounds a foramen for the passage of 

 vessels. The internal layer of the transverse 

 ligament is attached below to the inferior cornu, 

 and above to the superior, where it appears to 

 blend with the cotyloid ligament. By its exter- 

 nal surface it is in apposition with the external 

 layer of the transverse ligament, and its inter- 

 nal surface is directed towards the obturator 

 ligament and external obturator muscle. Some 

 fibres pass from its upper margin to the obtu- 

 rator ligament ; but in greatest part this mar- 

 gin contributes to form the foramen already 

 described for the passage of vessels. Its infe- 

 rior margin affords attachment to the capsular 

 ligament. 



Round ligament. (Ligamentum teres capitis 

 femoris sen ligamentum inter-articulare.) 

 This ligament, which was first described by 

 Vesalius, has very improperly received the 

 epithet round, inasmuch as in point of fact it is a 

 triangular fasciculus, about an inch and a half in 

 length, having its base attached to the aceta- 

 bulum and its apex to the depression on the 

 head of the femur. It is most advantageously 

 placed for escaping injury in the various 

 motions of the joint, as, independently of its 

 corresponding to the soft cushion contained in 

 the excavation of the acetabulum, its direction 

 and attachments completely remove it from all 

 danger on this score. It is attached by the 

 superior portion of its base to the upper cornu 

 of the notch, and to the external layer of the 

 tranverse ligament; and by the inferior and 

 larger portion of its base to the lower cornu, as 

 well as to the external layer of the tranverse 

 ligament; from these points of attachment its 

 direction in the quiescent state of the limb, 

 i. e. the femur being placed vertically under 

 the pelvis, is upwards, outwards, and back- 

 wards, to its insertion into the head of the 

 femur.* 



When the joint is cut into in the recent state, 

 there are processes seen extending from this 

 ligament towards the circumference of the exca- 

 vation ; these should not be mistaken for por- 

 tions or attachments of the ligamentum teres ; 

 they are folds of the synovia! membrane pro- 

 ceeding from that ligament over the surface of 

 the acetabulum. Situated in the rough exca- 

 vation of the acetabulum, and forming a cushion 

 for the ligamentum teres in the several motions 

 and positions of the head of the femur, is the 

 soft pulpy mass of fatty cellular tissue, covered 

 by synovial membrane, already alluded to as the 

 glands of Havers, first described and figured by 

 that anatomist in his Osteologia Nova. 



Capsular ligament. The hip-joint is com- 

 pleted by a strong fibrous investment, termed 

 capsular ligament (capsula fibrosa ossis fe- 

 moris). This is by far the strongest and 

 largest capsular ligament in the body. How- 

 ever it is by no means uniform in its strength 

 and thickness, these being greatly increased by 



* [Weber states that, in the erect posture, the 

 direction of the ligamentum teres is vertical. See 

 Mechanik der Menschlichen Gehwerkzeuzc, p. 143. 

 and pi. ii. fig. l.ED.J 



super-imposed fibres in those situations upon 

 which a considerable force is exercised in 

 certain motions of the joint. It not only em- 

 braces the articulation, but also includes the 

 neck of the femur, to the base of which it 

 extends from the os innominatum. Its fibres 

 are variously directed from the os innomi- 

 natum, to which they are firmly attached 

 from the margin of the acetabulum to a 

 considerable distance on the dorsum of that 

 bone. Superiorly and externally they may be 

 traced as far as the inferior anterior spinous 

 process of the ilium in front, whilst posteriorly 

 the great sciatic notch marks their boundary, 

 and an arched line drawn from the inferior 

 anterior spine of the ilium to the spine of the 

 ischium denotes with tolerable exactness their 

 attachment in this direction. Inferiorly and 

 externally they are attached to that portion of 

 the ischium situated between the cotyloid cavity 

 and the external lip of the tuber ischii, and to 

 this latter itself by very strong dense fibres. 

 Superiorly and internally they arise from that 

 portion of the ilium situated between its an- 

 terior inferior spine and the ilio-pectineal 

 eminence, and from the pubis as far as the 

 superior cornu of the acetabulum. Inferiorly 

 and internally the capsule is attached to the 

 transverse ligament of the cotyloid cavity. 



By this description we perceive that the cap- 

 sular ligament is firmly attached to the os inno- 

 minatum ; that with the exception of the portion 

 arising from the transverse ligament its origins at 

 all points are from an inch to nearly two inches 

 in extent. Passing in various directions, ac- 

 cording to their several situations, the fibres 

 run to be inserted into the base of the neck 

 of the femur, anteriorly into the anterior inter- 

 trochanteric line, superiorly and externally into 

 the surface of the bone close to the digital 

 fossa at the root of the great trochanter, inferi- 

 orly and internally to the line leading from the 

 lesser trochanter to the anterior inter-trochan- 

 teric line, and posteriorly it is partly reflected 

 upwards, so as to become continuous with the 

 periosteum of the posterior part of the neck of 

 the bone ; this reflection taking place along the 

 posterior inter-trochanteric lime, and partly in- 

 serted into that line, especially at its internal and 

 external extremities. The reflected portion is 

 derived from the deep fibres of the capsule, 

 which in passing upwards to be inserted into 

 the bone at the circumference of the head, con- 

 tribute to form those bands of fibrous mem- 

 brane, which are manifest on the posterior aspect 

 of the neck of the femur on opening the cap- 

 sule, being covered only by synovial membrane. 

 These bands are sometimes of considerable 

 strength, and they are well described and 

 figured by Weitbrecht,* by whom they were 

 designated retinacula. 



We have already observed that the capsular 

 ligament is not uniform in thickness at all 

 points. At the outer part of its anterior sur- 

 face its thickness is very considerable, being 

 strengthened and increased by a band of fibres 



* Syndesmologia, Petrop. 1742. 1 



