45O The Thigh 



so also are the hollows at the sides of the ligamentum patella. This 

 ligament is inserted into the lower part of the tubercle of the tibia. 

 The prominent part of this tubercle corresponds with the level of the 

 head of the fibula. 



On the outer side of the knee, a little above the joint, are two 

 thick fibrous bands, one anterior to the other : the larger and posterior 

 is the tendon of the biceps, descending to the head of the fibula ; the 

 anterior is the ilio-tibial band of the fascia lata descending to the outer 

 tuberosity of the tibia (p. 448). Between these bands is a shallow groove 

 through which abscess in popliteal space is best attacked. The 

 external popliteal nerve (p. 381) may often be made out close to the 

 inner side of the biceps tendon ; it pierces the peroneus longus, at the 

 neck of the fibula, and ultimately divides into the musctilo-cutaneous 

 and anterior tibial trunks. 



Tenotomy of biceps is often needed when a stiff knea is being 

 straightened. The strong and narrow blade must be introduced close 

 on the inner side of the tendon, feeling its way down, as it were, between 

 the tendon and the external popliteal nerve. Section of the tendon 

 is then accomplished by a sawing motion in the outward direction. 

 If the tendon were divided from without inwards there would be 

 considerable risk of the knife passing ' with a run ' through the last 

 bundles of fibres, and thus wounding the nerve. 



When the joint is slightly bent, the fascia lata at the back of the 

 thigh and knee is relaxed, and the fingers can explore the popliteal 

 space, and also the slackened hamstring tendons. On* the outer 

 side is the biceps, and below and internal to it is a head of thegastro- 

 cnemius. On the inner side is the semi-membranosus, and a little 

 to the fibular side of that tendon is the slender tendon of the semi- 

 tendinosus. The tendon of the gracilis is more towards the front, and 

 is not always very readily made out, especially in a fat subject. Still 

 more to the inner side and to the front is the flat musculo-aponeurotic 

 sartorius ; its position is not marked by a tendon, but one can tell 

 where it is by following its course from the groove between the vastus 

 and the adductors, and noting, perhaps, a soft prominence caused 

 by the muscle as it passes over the side of the inner condyle. On the 

 fibular side of the inner hamstrings is the inner head of the gastro- 

 cnemius. 



The superficial fascia consists of a fatty layer continuous with 

 that of abdomen and buttock, and with the dartos, and of a deeper 

 layer which is thin and membranous. The latter is beneath the 

 saphenous vein and the lymphatic glands of the groin ; it blocks up 

 the saphenous opening ; but at that situation it has so many perfora- 

 tions for blood-vessels and lymphatics that it is called cribriforui. It 

 is one of the coverings of femoral hernia. 



The Internal saphenous vein begins in an arch with the external 

 or short saphenous on the dorsum of foot, and passes up in front 



