76 
to form an obstuse angle internally, and it is 
not improbable, that by the sprain the internal 
lateral ligament or other structures in the in- 
terior of the joint were injured. The sprain 
was followed by swelling, &c., and it was six 
weeks before he recovered so as to be able 
to walk. Mr. L. remained well for eight 
months, when, in crossing over a ditch, the 
sudden derangement recurred. The moment 
the displacement of some part of the interior 
of the joint occurred, he dropped suddenly to 
the ground. Another day, while practising 
some gymnastic exercise, it occurred. Again, 
it happened while in bed, the bed-clothes em- 
barrassing the motion of the foot while he was 
turning his body round. On the last oceasion 
on which the displacement happened, he was 
on horseback ; he had just mounted, and was, 
while his knee was flexed, seeking with the in- 
verted foot for the off-stirrup, when the dis- 
a area happened. On all these occasions 
e has without loss of time sought to replace 
the deranged parts, and sometimes has suc- 
ceeded instantaneously, and sometimes weeks 
have passed without the adjustment of the 
arts in the interior of the joint occurring. 
he restoration of the use of the joint has al- 
ways been as sudden as the derangement, and 
the replacement has invariably been accom- 
panied by a sudden snap, as if something at 
that moment changed its place, and this to him 
was always the signal of recovery of the uses 
of the joint. When the extension and flexion 
of the limb in the manner recommended by 
Hey has been the means of restoration, he has 
on some occasions not only felt the sudden 
movement of what he considers the dislocated 
ae in the interior of the joint, but he thinks 
e could distinctly hear the crack the part 
gave in resuming its ordinary place. The writer 
of this has lately seen a examined Mr. 
L.’s knee-joint, and compared it with the 
opposite one, and cannot perceive the slightest 
difference on a simple inspection of both arti- 
culations either before or behind. The patella 
and the ligament which connects it to the tibia 
are just as firmly applied in front of the joint 
as usual, and there is now no effusion into the 
joint of any unnatural quantity of synovial 
fluid. He habitually wears a laced knee-cap, 
and finds only a difficulty in flexing as fully 
the affected knee-joint as the other, and he has 
an habitual fear of any movement of the leg in 
which this is at the same time flexed, and the 
foot inverted. This is a well-marked example 
of the internal derangement of the knee de- 
scribed by Hey; but what are the true ana- 
tomical characters of the accident, or what 
really is the structure, whether normal or ab- 
normal, which slips in and out with a noise? 
Nothing positive, in our opinion, has been added 
to the knowledge of the nature of the accident 
given to us by Hey, who has the merit not only 
of first describing the injury, but of also 
pointing out a simple and generally successful 
remedy. 
Many surgeons have considered that the in- 
ternal derangement of the knee described hy 
Hey, and considered by Sir A. Cooper as a 
ABNORMAL CONDITIONS OF THE KNEE-JOINT. 
“ partial luxation of the femur from the semi- 
lunar cartilages,” is a dislocation of these fibr 
cartilages. Malgaigne justly criticises the vaga 
ness of the lan used by authors relative t 
this matter. M. Velpeau, according to Ma 
gaigne, in one place treats of this luxation as 
luxation of the semilunar fibro-cartilages, and | 
another work he seems so uncertain of the mi 
ture of the accident as to demand wheth 
the phenomena may not be owing to th 
istence, in the interior of the joint, of some ¢ 
those cartilages which we call foreign bodie 
Malgaigne himself seems to fall into the op 
nion of Sir A. Cooper upon this subject, a 
though he does not use the pei in 
considers the accident to be a simple par 
tial luxation of the femur from the tibia, the 
consequence of the relaxation of all the liga 
ments, but adduces no anatomical evidence ol 
the truth of his hypothesis. He iders the 
accident, “ Une simple luxation incomplete d 
femur sur le tibia, produite par un relachement 
de tous les ligamens, et tout-d-fait analog 
aux deplacemens occasionés par la méme 
dans les autres articulations.” Sir A. 
is of opinion that Mr. Hey’s plan is gene’ 
but not invariably successful, and adduces the 
case of a lieutenant in the army who sufferer 
this accident repeatedly, and the limb was 
often reduced by the above-mentioned means 
but at length, turning in bed, from the pre 
sure of the bed-clothes on his foot, the acciden! 
recurred. He came to London, but bendin 
the limb had now no effect in enabling him t 
extend the joint. Sir A. Cooper, therefore, ac 
vised him to visit Mr. Hey, but he learnec 
that in this case the dislocation was never | 
duced. In an obstinate case of this internal 
derangement of the knee-joint, which resistes 
all the ordinary means of surgical treatmen 
the writer succeeded (in Jervis-street Hospit 
by using the pulleys. Under exactly simi 
te cveutiiatshbels is lamented friend, Dr. 
M‘Dowel, subsequently succeeded by having 
recourse to the pulleys when all other me 
had failed. 
The knee-joint is seldom affected by sprains 
When, however, there is an undue inclinatior 
of the knee inwards, the internal lateral liga 
ment is occasionally, by an accidental fals 
step or twist, sprained, and sudden lamenes 
comes on followed by swelling, and more ot 
less inflammation of the synovial membrane 
the articulation. It has not been ascertain 
whether in such cases the fibres of the inter 
lateral ligament have given way, or whethe 
they are detached from the bone or not; but 
is not improbable that some such lesion hi 
occurred as that we have already noticed unde 
the head of Sprains in another articulatio 
(see ANKLE.) When sprains of the knee tak 
lace, it is almost invariably the inner side of the 
Joint to which the patient refers as the prin 
i seat of tenderness and pain. The join 
admitting of motion unaccompanied by any 
ps meses (although the act may be painfull 
ily distinguishes a sprain from any frat 
ture of the bones of the articulation. It 
not improbable that in sprains of the 
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