KNEE JOINT 403 



through the lateral intermuscular septum, and between the 

 biceps femoris and the bone, into the substance of the vastus 

 intermedius. 



As the inferior genicular vessels and nerves are followed care 

 must be taken to avoid injury to the collateral ligaments of the 

 knee joint. Cut through the biceps femoris at the level of the 

 proximal part of the lateral condyle of the femur, pull the distal 

 part downwards, and clean the fibular collateral ligament, which 

 descends from the lateral epicondyle of the femur through the 

 tendon of the biceps to the head of the fibula (Fig. 178). Then 

 follow the inferior lateral genicular artery and nerve forward, 

 between the fibuiar collateral ligament and the fibrous capsule 

 to the front of the knee. Next throw the tendons of the sartorius, 

 gracilis, and semitendinosus forwards ; clean the broad tibial 

 collateral ligament, which descends from the medial epicondyle 

 of the femur to the medial condyle and the medial surface of the 

 tibia ; then follow the inferior genicular artery and the accom- 

 panying nerve along the proximal border of the popliteus to the 

 point where they disappear under cover of the tibial collateral 

 ligament below the medial condyle of the tibia. Turn now to 

 the anterior border of the tibial collateral ligament, and secure 

 the inferior medial genicular artery as it issues from under cover 

 of the tibial collateral ligament, and, if possible, display its 

 anastomoses with the adjacent arteries. 



Now turn to the recurrent branches of the anterior tibial 

 artery. The posterior tibial recurrent artery springs from the 

 anterior tibial artery at the back of the leg and ascends to the 

 knee anterior to the popliteus; therefore that muscle must be 

 reflected. Cut through the narrow part of the muscle, immedi- 

 ately medial to the proximal tibio-fibular joint, and turn the 

 medial part to the medial side ; then follow the artery to its 

 termination and at the same time note the termination of the 

 nerve to the popliteus ; it enters the anterior surface of the 

 muscle. 



The anterior tibial recurrent artery and the accompanying 

 branch of the common peroneal nerve were displayed during 

 the dissection of the anterior and lateral regions of the leg. 

 Follow them now through the proximal part of the origin of the 

 tibialis anterior to their terminations. 



Anastomosis around the Knee Joint. The most important 

 of the anastomoses around the knee joint are placed on the 

 anterior aspect of the articulation, and take the form of 

 three transverse arches. The most proximal of these arterial 

 arcades passes through the superficial fibres of the quadriceps 

 extensor, close to the proximal border of the patella, and is 

 formed by the union of a branch from the superior lateral 

 genicular artery with a twig from the articular branch of the 

 arteria genu suprema. The middle and the distal transverse 

 arches are both placed under cover of the ligamentum patellae. 

 The middle arch runs across in the fatty tissue close to the 

 distal end of the patella. It is formed by the inferior lateral 

 i 26 a 



