Anatomy Tables - Joints of the Lower Limb

Osteology
Bone Structure Description
os coxae (pelvic or innominate bone) three fused bones: ischium, ilium & pubis
acetabulum socket for head of femur (Latin, acetabulum = a shallow wide-mouthed vessel or cup)
acetabular notch notch in the inferior margin of the acetabulum
lunate surface of acetabulum smooth articular surface within the acetabulum
obturator foramen large foramen surrounded by the superior and inferior pubic rami, the ischial ramus and the acetabulum; obturator means to occlude or stop up, a reference to the fact that the obturator membrane closes the obturator foramen almost completely; a site of attachment for the obturator externus m. and the obturator internus m.
femur (Latin, femur = thigh)
body long cylindrical central part of femur; also known as: shaft
head smooth, rounded proximal end; articulates with acetabulum
fovea capitis femoris pit in the femoral head; attachment site of ligamentum capitis femoris (Latin, fovea = a pit + capitis = head)
neck constricted area distal to head
intertrochanteric line on anterior surface; ridge coursing between greater and lesser trochanters
intertrochanteric crest on posterior surface; heavy ridge coursing between greater and lesser trochanters
medial condyle located at distal end; articulates with medial condyle of tibia (Greek, kondyle = the knob formed by the knuckle of any joint)
lateral condyle located at distal end; articulates with lateral condyle of tibia (Greek, kondyle = the knob formed by the knuckle of any joint)
intercondylar fossa between the condyles at distal end; accommodates cruciate ligaments
patellar surface the smooth anterior surface at the inferior end of the femur; it articulates with the posterior surface the patella
patella a sesamoid bone in the quadriceps femoris tendon; articulates with anterior surface of inferior femur
tibia
medial condyle at proximal end; articulates with medial condyle of femur; larger than lateral condyle (Greek, kondyle = the knob formed by the knuckle of any joint)
lateral condyle at proximal end; articulates with lateral condyle of femur; smaller than medial condyle (Greek, kondyle = the knob formed by the knuckle of any joint)
intercondylar eminence projection between condyles; attachment site of cruciate ligaments & medial & lateral meninsci (Greek, kondyle = the knob formed by the knuckle of any joint)

Joints - Hip
Joint Description Significance
acetabular labrum fibrocartilage fibrocartilage forming rim of acetabulum; deepens the acetabulum (Latin, acetabulum = a shallow wide-mouthed vessel or cup + labrum = lip)
transverse acetabular ligament bridges the acetabular notch; forms a bridge over the artery in the ligament of the femoral head (ligamentum capitis femoris) (Latin, acetabulum = a shallow vessel or cup)
ligamentum capitis femoris intracapsular ligament connecting transverse acetabular ligament with fovea capitis femoris; also known as: ligament of the femoral head (Latin, capitis = head)
zona orbicularis fibrous capsular fibers fromthe hip bone to the intertrochanteric line, forming a collar to help hold the femoral head in place
pubofemoral ligament capsular ligament of hip joint connecting superior pubic ramus to medial surface of femoral neck
iliofemoral ligament capsular ligament of the hip joint connecting anterior inferior iliac spine to intertrochanteric line
ischiofemoral ligament capsular ligament of the hip joint connecting body of ischium to posterior femoral neck (Latin, ischion = hip joint)
hip joint synovial acetabulum of os coxae articulates with femoral head; reinforced by capsular ligaments (iliofemoral, pubofemoral, ischiofemoral, zona orbicularis) and containing acetabular labrum & ligamentum capitis femoris
iliopectineal bursa bursa lies deep to the iliopsoas tendon as it crosses the neck of the femur and the capsule of the hip joint

Joints - Knee
Joint Description Significance
infrapatellar synovial fat pads synovial masses of loose fatty tissue on both sides of the patellar ligament
knee joint synovial femoral condyles articulate with tibial condyles; reinforced by intracapsular ligaments (anterior cruciate & posterior cruciate), a capsular ligament (tibial collateral ligament), and an extracapsular ligament (fibular collateral ligament); contains medial & lateral menisci
patellar ligament tendon connects quadriceps femoris muscle group to the tibial tuberosity; patella is a sesamoid bone within the quadriceps tendon
tibial collateral ligament capsular ligament of the knee joint connecting medial epicondyle of femur with medial surface of medial tibial condyle; its attachment to the medial meniscus is clinically relevant
fibular collateral ligament extracapsular ligament, not part of the fibrous capsule of the knee; connects lateral epicondyle of femur with fibular head
anterior cruciate ligament intracapsular ligament connecting anterior aspect of intercondylar eminence of tibia with medial surface of lateral femoral condyle
posterior cruciate ligament intracapsular ligament connecting posterior aspect of intercondylar eminence of tibia with lateral surface of medial femoral condyle
medial meniscus fibrocartilage C-shaped intra-articular disc within knee joint between medial femoral condyle & medial tibial condyle; attached to tibial collateral ligament, coronary ligament, & intercondylar eminence (Greek, meniskos = crescent)
lateral meniscus fibrocartilage C-shaped intra-articular disc within knee joint between lateral femoral condyle & lateral tibial condyle; attached to coronary ligament & intercondylar eminence (Greek, meniskos = crescent)
posterior meniscofemoral ligament intracapsular ligament connects posterior part of lateral meniscus with lateral surface of medial femoral condyle
suprapatellar bursa bursa superior extension of the synovial membrane of the knee joint; passes deep to the quadriceps tendon
prepatellar bursa bursa subcutaneous bursa overlying patella
infrapatellar bursa, superficial bursa subcutaneous bursa overlying patellar tendon
infrapatellar bursa, deep bursa bursa lying between patellar tendon & tibia

Joints - Ankle
Joint Description Significance
interosseous membrane of the leg syndesmosis the membrane that connects the interosseous borders of the shafts of the tibia and fibula
distal tibiofibular joint syndesmosis tibia and fibula are bound together by anterior, posterior, and transverse tibiofibular ligaments
ankle joint synovial, hinge articulation between distal end of tibia, medial malleolus, lateral malleolus and talus; reinforced by deltoid ligament (anterior tibiotalar, tibionavicular, tibiocalcaneal, posterior tibiotalar), anterior talofibular, calcaneofibular & posterior talofibular ligaments
anterior tibiofibular ligament connects distal ends of tibia & fibula anteriorly
posterior tibiofibular ligament connects distal ends of tibia & fibula posteriorly
transverse inferior tibiofibular ligament forms a strong connection between the distal ends of the tibia and fibula
deltoid ligament connects medial malleolus with talus, navicular & calcaneus; its four parts arranged from anterior to posterior: anterior tibiotalar, tibionavicular, tibiocalcaneal, posterior tibiotalar; also known as: medial ligament of ankle
anterior tibiotalar ligament part of deltoid ligament connecting medial malleolus with talus
posterior tibiotalar ligament part of deltoid ligament connecting medial malleolus with talus posteriorly
tibiocalcaneal ligament part of deltoid ligament connecting medial malleolus with sustentaculum tali
tibionavicular ligament part of deltoid ligament connecting medial malleolus with navicular
anterior talofibular ligament connects lateral malleolus with talus anterolaterally
posterior talofibular ligament connects lateral malleolus with talus posterolaterally
calcaneofibular ligament connects lateral malleolus with calcaneus

Joints - Foot
Joint Description Significance
plantar calcaneonavicular ligament syndesmosis connects sustentaculum tali with inferior surface of navicular; also known as: spring ligament
subtalar joint synovial articulation between talus and calcaneous, strengthened by the interosseous talocalcaneal ligament
interosseous talocalcaneal ligament syndesmosis connects the neck of the talus with calcaneus, filling the tarsal sinus
transverse tarsal joint synovial two joints in line, talonavicular and calcaneocuboid, allow most inversion/eversion to happen through this joint
plantar calcaneocuboid (short plantar) ligament syndesmosis connects calcaneus & cuboid inferiorly
long plantar ligament syndesmosis connects calcaneus with cuboid & bases of lateral 3 metatarsals
interosseous talocalcaneal ligament fibrous suppots fibrous capsule of subtalar joint (Latin, inter = between + os = bone)
tarsometatarsal joints synovial reinforced by dorsal & plantar ligaments
metatarsophalangeal joints (5) synovial chondyloid joint connecting head of metatarsal with proximal phalanx; reinforced by collateral ligaments
longitudinal arch of the foot combination of synovial joints & syndesmoses passes from calcaneus to talus to navicular to cuneiforms to metatarsals; supported by plantar calcaneonavicular ligament & many other ligaments; supported by tendons of tibialis anterior & tibialis posterior mm.
transverse arch of the foot combination of synovial joints & syndesmoses passes through distal row of tarsal bones; supported by shape of bones and many ligaments; supported by tendons of fibularis longus & tibialis anterior & tibialis posterior mm.

Muscles
Muscle Origin Insertion Action Innervation Blood Supply Notes
obturator externus the external surface of the obturator membrane and the superior and inferior pubic rami trochanteric fossa of the femur laterally rotates the thigh obturator nerve obturator a. the tendon of the obturator externus m. passes inferior to the neck of the femur to reach its insertion site

Arteries
Artery Source Branches Supply to Notes
obturator internal iliac a., anterior division pubic br., acetabular br., anterior br., posterior br. medial thigh and hip anterior and posterior brs. pass on the anterior and posterior sides of the adductor brevis m.; aberrant obturator a. arises from the inferior epigastric a. in 30% of cases

Clinical Terms
Term Definition
popliteal/Baker's cyst a synovial cyst or pouch that occurs in the synovial lining of the knee. Presents in the popliteal fossa (area behind the knee). Synovial fluid escapes from the knee joint and into the cyst in individuals who suffer from degenerative and other joint disease. Typically these cysts are not painful unless swelling is extensive. Aspiration of the cyst is therapeutic only temporarily since recurrence is common. Most disappear spontaneously after several years. Larger cysts can be removed surgically. Rupture of a Baker's cyst can present with pain and swelling to the calf.
terrible triad injury to the knee joint including: a torn anterior cruciate ligament, a torn tibial collateral ligament, and a torn medial meniscus.
drawer sign rupture of the anterior cruciate ligament (common in skiing injuries) allows the tibia to slide anteriorly from the femur-called the anterior drawer sign. Rupture of the posterior cruciate ligament (harder, but happens in head-on collisions with no seatbelt and the tibia strikes the dashboard) allows the tibia to slide posteriorly from the femur-the posterior drawer sign.
Pott's fracture dislocation of the ankle that occurs when the foot is forcibly everted. This pulls hard on the medial ligament (very strong) and often tears off the medial malleolus. The talus then moves laterally, shearing off the lateral malleolus or more commonly breaking the fibula superior to the inferior tibiofibular joint. If the tibia is carried anteriorly the posterior margin of the distal end of the tibia is also sheared off by the talus, producing a trimalleolar fracture.
knee prosthesis replacement for a knee joint
genu valgus/varus lateral angulation of the leg in relation to the thigh (exaggeration of the knee angle) is called genu valgum (knock-knee). Medial angulation of the leg in relation to thigh is a deformity called genu varum (bowleg). A valgus stress at the knee pushes it to create a knock-knee, testing the medial collateral ligament. A varus stress pushes the knee into bow-leg position, to test lateral collateral ligament.

The material presented in these tables is contained in the book:
MedCharts Anatomy by Thomas R. Gest & Jaye Schlesinger
Published by ILOC, Inc., New York
Copyright © 1995, unauthorized use prohibited.
 The excellent editorial assistance of
Dr. Pat Tank, UAMS
is gratefully acknowledged.