joint, the interior of the articulation is occa- 
‘sionally injured ; that the crucial ligaments are 
stretched ; and that some of their fibres give 
way occasionally, breaking in their centres, or 
detached by their extremities from the bone. 
We lately had an example of a severe injury 
‘of the knee-joint, in which the anterior crucial 
ligament must have suffered great violence. 
‘The fibres of this structure did not give way, 
bat the portion of the tibia to which they were 
urally connected was torn up with the cru- 
ligament. We are not aware that such an 
cident as this has been before noticed, al- 
though it is probable that all complete luxa- 
jons of the knee-joint must be preceded by- 
such a lesion. 
_ A young man, aged 25, was admitted into 
‘the Richmond Hospital under the care of Dr. 
tton, on the 11th of December, 1837, with 
njury of the left knee-joint, which occurred 
hen wrestling. Being intoxicated at the time 
is account of the manner in which the acci- 
t occurred could not be depended upon. 
joint was much swollen, very tense, and 
inful; no fracture, and no other deformity 
that occasioned by the general swelling of 
the joint could be detected. The limb was 
jaintained in the semiflexed position and on 
ie outside. Inflammation and symptomatic 
r ran very high, and the pain was excessive, 
ecially on the least motion of the joint. 
in the eleventh day the pain and swelling had 
diminished. He could then raise the limb 
fiom the bed, but could not increase the 
‘amount of flexion. On the seventeenth day 
symptoms of diffuse inflammation set in; these 
_Tapidly increased, and on the twenty-fourth 
‘day from the receipt of the injury he died. 
The knee-joint was found to contain eight 
ounces of purulent matter, in which flakes of 
lymph floated ; the synovial membrane was 
soft, pulpy, and vascular ; the circumference of 
the cartilages covering the condyles of the femur 
was in a slight degree absorbed. On flexing 
the joint, the spine and central portion of the 
head of the tibia, with a considerable portion 
_ of its left articulating surface, were found torn 
| up from the rest of the bone in one piece, 
(fig. 10,) and remained attached to the ante- 
nor crucial ligament. 
Rupture of the quadriceps extensor tendon 
_ from its attachment to the superior border of 
the patella—The muscles and tendons around 
the knee-joint are very seldom the subject of 
accident. We have never heard of any acci- 
dental rupture of the tendons of the hamstring 
muscles ; we have, however, known some in- 
stances of rupture from the upper edge of the 
patella of the muscular and tendinous structure 
attached to the superior edge of this bone, con- 
sisting of the combined muscular and tendinous 
attachments, of the rectus, crureus, and vasti 
muscles. A person who has met with this 
_ accident cannot rise from the ground, nor can 
} he stand when raised without being sustained 
by two persons; when he attempts to lean his 
weight on the affected limb, it yields and 
_ bends forwards. On examining the knee we 
_ observe between the superior border of the 
roe eee a 
ABNORMAL CONDITIONS OF THE KNEE-JOINT. 
77 
Fig. 10. 
patella and broken tendon a separation of one 
inch, which is diminished when we extend the 
leg, and increased much when we flex it. If 
we introduce our fingers into the bottom of 
this depression, we feel plainly the trochlea of 
the femur. In this case, as may be expected 
in all analogous accidents, there is much effu- 
sion of synovial fluid, which distends the inte- 
rior of the joint; and it is probable that the 
synovial membrane does not escape laceration. 
Patrick Dignam, xt. 69, was admitted into 
the Richmond Surgical Hospital on the 15th 
of December, 1839, for a rupture of the tendon 
of the rectus cruris. He»stated that about a 
week previously, while carrying on his back a 
load of about two hundred weight, he slipped 
and fell backwards, and in making a violent 
muscular effort to recover himself, he felt some- 
thing snap about his knee. He fell backwards, 
and was unable to rise without assistance. 
When placed on his sound limb, he found he 
could not elevate the affected one; he could 
only flex it. Whenever he attempted to put 
the limb under him, it quite failed. him, his 
knee giving way and becoming instantly flexed 
against his will. It was found that consider- 
able effusion had taken place into the knee- 
joint: the patella was raised up and seemed to 
float as it were on the synovial fluid and was 
very moveable; its entire outline could be 
easily ascertained ; and when the leg was fully 
flexed, the patella was still quite moveable in 
the lateral directions. Above the margin of 
the patella a considerable depression existed 
