JOINTS
OF
THE LOWER LIMB
03. 03. 2014
Kaan Yücel
M.D., Ph.D.
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Dr.Kaan Yücel
yeditepeanatomyfhs122.wordpress.com
Joints of the lower limb
The joints of the lower limb include the articulations of the pelvic girdle—lumbosacral joints, sacroiliac joints,
and pubic symphysis. The remaining joints of the lower limb are the hip joints, knee joints, tibiofibular joints, ankle
joints, and foot joints.
The hip joint forms the connection between the lower limb and the pelvic girdle. It is a strong and stable joint.
Synovial joint type Multiaxial ball and socket type of synovial joint
Articular surfaces: The head of the femur is the ball, and the acetabulum is the socket. The round head of the
femur articulates with the cup-like acetabulum of the hip bone.
Knee joint is the largest and most superficial joint. Synovial joint type hinge type; allowing flexion and
extension; however, the hinge movements are combined with gliding and rolling and with rotation about a vertical
axis. Articular surfaces The articular surfaces of the knee joint are characterized by their large size and their
complicated and incongruent shapes.
The tibia and fibula are connected by two joints: the tibiofibular joint and the tibiofibular syndesmosis
(inferior tibiofibular) joint. In addition, an interosseous membrane joins the shafts of the two bones.
The ankle joint (talocrural articulation) is located between the distal ends of the tibia and the fibula and the
superior part of the talus. The trochlea (L., pulley) is the rounded superior articular surface of the talus. The medial
surface of the lateral malleolus articulates with the lateral surface of the talus.Hinge-type
The many joints of the foot involve the tarsals, metatarsals, and phalanges. The important intertarsal joints are
the subtalar (talocalcaneal) joint and the transverse tarsal joint (calcaneocuboid and talonavicular joints). Inversion
and eversion of the foot are the main movements involving these joints. The other intertarsal joints (e.g.,
intercuneiform joints) and the tarsometatarsal and intermetatarsal joints are relatively small and are so tightly joined
by ligaments that only slight movement occurs between them.
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Dr.Kaan Yücel
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Joints of the lower limb
The joints of the lower limb include the articulations of the pelvic girdle—lumbosacral joints,
sacroiliac joints, and pubic symphysis. The remaining joints of the lower limb are the hip joints, knee joints,
tibiofibular joints, ankle joints, and foot joints.
1. HIP JOINT
1. Articulation between Acetabulum & Femur
2. Distinct feature of the joint Forms the connection between the lower limb and the pelvic girdle. It is a
strong and stable joint.
3. Synovial joint type Multiaxial ball and socket type of synovial joint
4. Articular surfaces The head of the femur is the ball, and the acetabulum is the socket. The round head of
the femur articulates with the cup-like acetabulum of the hip bone.
The head of the femur forms approximately two thirds of a sphere. Except for the pit or fovea for the
ligament of the femoral head, all of the head is covered with articular cartilage, which is thickest over
weight-bearing areas.
The acetabulum is formed by the fusion of three bony parts. The lip-shaped acetabular labrum (L.
labrum, lip) is a fibrocartilaginous rim attached to the margin of the acetabulum, increasing the acetabular
articular area by nearly 10%.
5. Ligaments of the hip joint
Iliofemoral ligament [body's strongest ligament]
Ischiofemoral ligament
Ligament of the head of the femur
Pubofemoral ligament
6. Movements of the hip joint
The hip joint is designed for stability over a wide range of movement. Next to the glenohumeral (shoulder)
joint, it is the most movable of all joints. During standing, the entire weight of the upper body is transmitted
through the hip bones to the heads and necks of the femurs. Hip movements are flexion-extension,
abduction-adduction, medial-lateral rotation, and circumduction.
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Joints of the lower limb
Figure 1. Hip joint-anterior view
http://3dsciencepics.com/the-anterior-view-of-hip-joint
2. KNEE JOINT
1. Articulation between Femur and tibia, femur and patella
2. Distinct feature of the joint Largest and most superficial joint
3. Synovial joint type hinge type; allowing flexion and extension; however, the hinge movements are
combined with gliding and rolling and with rotation about a vertical axis
4. Articular surfaces The articular surfaces of the knee joint are characterized by their large size and their
complicated and incongruent shapes. The knee joint consists of three articulations:
Two femorotibial articulations (lateral and medial) between the lateral and the medial femoral and tibial
condyles.
One intermediate femoropatellar articulation between the patella and the femur.
The fibula is not involved in the knee joint.
6. Ligaments of the knee joint
Extracapsular (external) ligaments of the knee joint
The joint capsule is strengthened by five extracapsular or capsular (intrinsic) ligaments: patellar ligament,
fibular collateral ligament, tibial collateral ligament, oblique popliteal ligament, and arcuate popliteal
ligament. They are sometimes called external ligaments to differentiate them from internal ligaments, such
as the cruciate ligaments.
1. Patellar ligament is a thick fibrous band which is the distal part of the quadriceps tendon. It passes
passes from the apex and adjoining margins of the patella to the tibial tuberosity. It is the anterior ligament
of the knee joint.
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Joints of the lower limb
Collateral ligaments of the knee one on each side of the joint, stabilize the hinge-like motion of the knee.
They are tense when the knee is fully extended, contributing to stability while standing. As flexion proceeds,
they become increasingly loose, permitting and limiting (serving as check ligaments for) rotation at the knee.
2. Fibular collateral ligament (FCL; lateral collateral ligament) is a strong cord-like extracapsular ligament.
3. Tibial collateral ligament (TCL; medial collateral ligament) is a strong, flat band weaker than the FCL, and
is more often damaged. As a result, the TCL and medial meniscus are commonly torn during contact sports
such as football.
4. Oblique popliteal ligament
5. Arcuate popliteal ligament .
Intracapsular (internal) ligaments of the knee joint
The intra-articular ligaments within the knee joint consist of the cruciate ligaments and menisci.
1. Cruciate ligaments (L. crux, a cross) are located in the center of the joint and cross each other obliquely,
like the letter X.
1.1. Anterior cruciate ligament (ACL) is the weaker of the two cruciate ligaments.
It arises from the anterior intercondylar area of the tibia, just posterior to the attachment of the medial
meniscus. The ACL attaches to the medial side of the lateral condyle of the femur. It hyperextension of the
knee joint.
1.2. Posterior cruciate ligament (PCL) is the stronger of the two cruciate ligaments.
It arises from the posterior intercondylar area of the tibia. It attaches to the lateral surface of the medial
condyle of the femur. The PCL limits anterior rolling of the femur on the tibial plateau during extension.
2. Menisci of the knee joint (G. meniskos, crescent) are crescentic plates of fibrocartilage on the articular
surface of the tibia that deepen the surface and play a role in shock absorption. Wedge shaped in transverse
section, the menisci are firmly attached at their ends to the intercondylar area of the tibia. Their external
margins attach to the joint capsule of the knee.
2.1. Medial meniscus is C shaped, broader posteriorly than anteriorly. Because of its widespread
attachments laterally to the tibial intercondylar area and medially to the TCL, the medial meniscus is less
mobile on the tibial plateau than is the lateral meniscus.
2.2. Lateral meniscus is nearly circular, smaller, and more freely movable than the medial meniscus.
7. Movements of the knee joint
Flexion and extension are the main knee movements; some rotation occurs when the knee is flexed.
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When the knee is fully extended with the foot on the ground, the knee passively “locks” because of medial
rotation of the femoral condyles on the tibial plateau (the “screw-home mechanism”). This position makes
the lower limb a solid column and more adapted for weight-bearing.
8. Bursae around the knee joint There are at least 12 bursae around the knee joint because most tendons
run parallel to the bones and pull lengthwise across the joint during knee movements. The subcutaneous
prepatellar and infrapatellar bursae are located at the convex surface of the joint, allowing the skin to be
able to move freely during movements of the knee. The large suprapatellar bursa is especially important
because an infection in it may spread to the knee joint cavity.
STABILITY OF KNEE JOINT
The knee joint is relatively weak mechanically because of the incongruence of its articular surfaces, which
has been compared to two balls sitting on a warped tabletop.
The stability of the knee joint depends on:
(1) the strength and actions of the surrounding muscles and their tendons
(2) the ligaments that connect the femur and tibia.
Of these supports, the muscles are most important; therefore, many sport injuries are preventable through
appropriate conditioning and training.
Figure 3. Knee joint
http://www.kneejointsreplacement.com/anatomy-of-the-knee-joint
3. TIBIOFIBULAR JOINTS
The tibia and fibula are connected by two joints: the tibiofibular joint and the tibiofibular syndesmosis
(inferior tibiofibular) joint. The interosseous membrane not only links the tibia and fibula together, but also
provides an increased surface area for muscle attachment.
Tibiofibular joint (Superior tibiofibular joint)
1. Articulation between tibia and fibula superiorly
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Joints of the lower limb
2. Articular surfaces Flat facet on the fibular head and a similar articular facet located posterolaterally on
the lateral tibial condyle
3. Ligaments of the (superior) tibiofibular joint
The joint capsule is strengthened by anterior and posterior ligaments of the fibular head.
4. Movements of the knee joint
Slight movement of the joint occurs during dorsiflexion of the foot as a result of wedging of the trochlea of
the talus between the malleoli.
Tibiofibular syndesmosis (Inferior tibiofibular joint)
1. Articulation between tibia and fibula, inferiorly
2. Distinct feature of the joint The integrity of the inferior tibiofibular joint is essential for the stability of the
ankle joint because it keeps the lateral malleolus firmly against the lateral surface of the talus.
3. Joint type compound fibrous joint. It is the fibrous union of the tibia and fibula by means of the
interosseous membrane (uniting the shafts) and the anterior, interosseous, and posterior tibiofibular
ligaments (the latter making up the inferior tibiofibular joint, uniting the distal ends of the bones).
4. Articular surfaces The rough, triangular articular area on the medial surface of the inferior end of the
fibula articulates with a facet on the inferior end of the tibia.
5. Movements of the tibiofibular syndesmosis
Slight movement of the joint occurs to accommodate wedging of the wide portion of the trochlea of the
talus between the malleoli during dorsiflexion of the foot.
Figure 4. Superior tibiofibular joint
Figure 5. Inferior tibiofibular joint
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Joints of the lower limb
4. ANKLE JOINT
Talocrural articulation
1. Articulation between distal ends of tibia and fibula with talus
2. Distinct feature one of the most vulnerable joints of the body
3. Joint type Hinge-type
4. Articular surfaces It is located between the distal ends of the tibia and the fibula and the superior part of
the talus. The trochlea (L., pulley) is the rounded superior articular surface of the talus. The medial surface
of the lateral malleolus articulates with the lateral surface of the talus.
6. Ligaments of the ankle joint
The ankle joint is reinforced laterally by the lateral ligament of the ankle. The lateral ligament of the ankle
is composed of three separate ligaments, the anterior talofibular ligament, the posterior talofibular
ligament, and the calcaneofibular ligament.
The medial (deltoid) ligament is large, strong and triangular in shape. Its apex is attached above to the
medial malleolus and its broad base is attached below to a line that extends from the tuberosity of the
navicular bone in front to the medial tubercle of the talus behind.
The medial ligament stabilizes the ankle joint during eversion and prevents subluxation (partial dislocation)
of the joint.
7. Movements of the ankle joint
The main movements of the ankle joint are dorsiflexion and plantarflexion of the foot, which occur around a
transverse axis passing through the talus.
Figure 6. Ankle joint
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Joints of the lower limb
5. FOOT JOINTS
The many joints of the foot involve the tarsals, metatarsals, and phalanges. The important intertarsal
joints are the subtalar (talocalcaneal) joint and the transverse tarsal joint (calcaneocuboid and
talonavicular joints). Inversion and eversion of the foot are the main movements involving these joints. The
other intertarsal joints (e.g., intercuneiform joints) and the tarsometatarsal and intermetatarsal joints are
relatively small and are so tightly joined by ligaments that only slight movement occurs between them.
Intertarsal joints between the cuneiforms and between the cuneiforms and the navicular allow only limited
movement.
MAJOR LIGAMENTS OF THE FOOT
The major ligaments of the plantar aspect of the foot are the:
Plantar calcaneonavicular ligament (spring ligament)
Long plantar ligament.
Plantar calcaneocuboid ligament (short plantar ligament)
The plantar calcaneonavicular ligament (spring ligament) is a broad thick ligament that spans the space
between the sustentaculum tali behind and the navicular bone in front. It supports the head of the talus,
takes part in the talocalcaneonavicular joint, and resists depression of the medial arch of the foot.
The plantar calcaneocuboid ligament (short plantar ligament) is short, wide, and very strong, and connects
the calcaneal tubercle to the inferior surface of the cuboid. It not only supports the calcaneocuboid joint, but
also assists the long plantar ligament in resisting depression of the lateral arch of the foot.
The long plantar ligament is the longest ligament in the sole of the foot and lies inferior to the plantar
calcaneocuboid ligament.
More superficial fibers of the long plantar ligament extend to the bases of the metatarsal bones.
The long plantar ligament supports the calcaneocuboid joint and is the strongest ligament, resisting
depression of the lateral arch of the foot.
6. ARCHES OF THE FOOT
The arches distribute weight over the foot, acting not only as shock absorbers but also as
springboards for propelling it during walking, running, and jumping. The resilient arches add to the foot's
ability to adapt to changes in surface contour. The weight of the body is transmitted to the talus from the
tibia. Then it is transmitted posteriorly to the calcaneus and anteriorly to the “ball of the foot” (the
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Joints of the lower limb
sesamoids of the 1st metatarsal and the head of the 2nd metatarsal), and that weight/pressure is shared
laterally with the heads of the 3rd-5th metatarsals as necessary for balance and comfort.
Between these weight-bearing points are the relatively elastic arches of the foot, which become
slightly flattened by body weight during standing. They normally resume their curvature when body weight
is removed. The longitudinal arch of the foot is composed of medial and lateral parts. Functionally, both
parts act as a unit with the transverse arch of the foot, spreading the weight in all directions.
The medial longitudinal arch is higher and more important than the lateral longitudinal arch.The talar head
is the keystone of the medial longitudinal arch. The lateral longitudinal arch is much flatter than the medial
part of the arch and rests on the ground during standing. The transverse arch of the foot runs from side to
side. The medial and lateral parts of the longitudinal arch serve as pillars for the transverse arch. The
integrity of the bony arches of the foot is maintained by both passive factors and dynamic supports.
Figure 7. Arches of the foot
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