The Stifle Joint

This joint (Articulatio genu), which corresponds to the knee-joint of man, is the largest and most elaborate of all the articulations. Taken as a whole, it may be classed as a ginglymus, although it is not a typical example of the group. In reality it consists of two joints—the femoro-patellar and the femoro-tibial.

The femoro-patellar articulation (Articulatio femoro-patellaris) is formed between the trochlea of the femur and the articular surface of the patella.

Articular Surfaces.—The trochlea consists of two slightly oblique ridges, with a wide and deep groove between them. The inner ridge is much the larger of the two, especially at its upper part, which is wide and rounded. The outer ridge is much narrower, and is more regularly curved; its upper part lies about an inch behind a frontal plane tangent to the inner ridge. The articular surface of the patella is much smaller than that of the trochlea. It is completed internally by a supplementary plate of fibro-cartilage (Fibrocartilago patellæ), which curves over the internal surface of the inner lip of the trochlea. A narrow strip of cartilage is found along the outer border also. The articular cartilage on the trochlea completely covers both surfaces of the inner ridge, but only a narrow marginal area on the external surface of the outer ridge.

Joint Capsule.—This is thin and is very capacious. On the patella it is attached around the margin of the articular surface, but on the femur the line of attachment is at a varying distance from the articular surface. On the inner side it is an inch or more from the articular cartilage; on the outer side and above, about half an inch. It pouches upward under the quadriceps femoris for a distance of two or three inches, a pad of fat separating the capsule from the muscle. Below the patella it is separated from the straight ligaments by a thick pad of fat, but inferiorly it is in contact with the femoro-patellar capsules. The joint cavity is the most extensive in the body. It usually communicates with the inner femoro-tibial joint cavity by a slit-like opening situated at the lowest part of the inner ridge of the trochlea. A similar, but smaller, communication with the outer femoro-patellar capsule is often found at the lowest part of the outer ridge.

The inner communication appears to be constant in adult horses, but is liable to be overlooked on account of the fact that it is covered by a valvular fold of the synovial membrane. It is about half an inch wide, and lies under the narrow articular area which connects the trochlea and internal condyle. The outer communication occurs in 18 to 25 per cent. of cases, according to Baum. It is instructive to distend this capsule and thus obtain an idea of its potential capacity and relations ([Fig. ]).

Ligaments.—The lateral femoro-patellar ligaments, external and internal (Ligamentum femoro-patellare fibulare, tibiale), are two thin bands which reinforce the capsule on either side. The external ligament is fairly distinct; it arises from the external epicondyle of the femur just above the lateral femoro-tibial ligament, and ends on the external border of the patella. The internal ligament is thinner and is not distinct from the capsule; it arises above the internal epicondyle, and ends on the patellar fibro-cartilage.

The patellar ligaments (Ligamenta patellæ), also called the straight ligaments of the patella, are three very strong bands which attach the patella to the tuberosity of the tibia. The external patellar ligament is attached above to the outer part of the anterior surface of the patella, and below to the outer part of the tuberosity. It receives a strong tendon from the biceps femoris muscle. The middle patellar ligament extends from the front of the apex of the patella to the lower part of the groove on the tuberosity of the tibia, a bursa being interposed between the ligament and the upper part of the groove. The internal patellar ligament is attached above to the patellar fibro-cartilage, and ends on the tuberosity of the tibia, internally to the groove. It is joined by the common aponeurosis of the gracilis and sartorius. These so-called ligaments are, in reality, the tendons of insertion of the quadriceps femoris muscle, and transmit the action of the latter to the tibia; they also function similarly for the other muscles attached to them as noted above.

It will be noticed that the upper attachments are further apart than the lower ones, so that the ligaments converge below. The inner ligament is especially oblique. The middle ligament is more deeply placed than the others, and therefore cannot usually be felt distinctly in the living animal.

The femoro-tibial articulation (Articulatio femoro-tibialis) is formed between the condyles of the femur, the proximal end of the tibia, and the interposed semilunar cartilages.

Articular Surfaces.—The condyles of the femur are slightly oblique in direction. The articular surface of the outer one is more strongly curved than that of the inner one; the latter is confluent below with the inner ridge of the trochlea, while the narrow ridge which connects the external condyle with the trochlea is usually non-articular. The saddle-shaped surfaces of the condyles of the tibia are not adapted to the femoral condyles, and are in contact with only a small part of them.

The semilunar cartilages (Meniscus lateralis, medialis) are two C-shaped or crescentic discs of fibro-cartilage which produce congruence in the articular surfaces. Each has an upper concave surface adapted to the condyle of the femur, and a lower surface which fits the corresponding condyle of the tibia. The external cartilage does not cover the outer and posterior part of the condyle, over which the tendon of origin of the popliteus muscle plays. The peripheral border is thick and convex, the central one very thin and concave. The fibrous ends or cornua are attached to the tibia in front of and behind the spine. The external cartilage has a third attachment by means of an oblique band (Ligamentum femorale menisci lateralis) which passes from the posterior cornu to the posterior part of the intercondyloid fossa of the femur.

The cornua of the internal cartilage (Ligamenta tibiæ anterius et posterius menisci medialis) are attached in front of and behind the inner eminence of the spine. The anterior cornu of the external cartilage (Ligamentum tibiæ anterius menisci lateralis) is attached in front of the outer eminence of the spine. The posterior cornu bifurcates; the lower branch (Ligamentum tibiæ posterius menisci lateralis) is inserted at the popliteal notch, the upper (Ligamentum femorale menisci lateralis) in a small fossa in the extreme posterior part of the intercondyloid fossa.

The joint capsule is attached to the margin of the tibial articular surface, but on the femur the line of attachment is for the greater part about half an inch from the articular margin. It is also attached to the convex borders of the semilunar cartilages and to the crucial ligaments. It is strong posteriorly, but in front it practically consists only of the synovial layer. There are two synovial sacs, corresponding to the double nature of the articular surfaces; they do not usually communicate, and each is partially divided into an upper and a lower compartment by the semilunar cartilage. The inner sac pouches upward about half an inch over the condyle of the femur. The external sac invests the tendon of origin of the popliteus muscle, and also pouches downward about three or four inches (ca. 8 to 10 cm.) beneath the peroneus tertius and long extensor muscles (Fig. ). As stated above, the outer sac sometimes communicates with the femoro-patellar joint cavity, and the inner sac usually, if not always, does so in the adult.

Ligaments.—There are four of these—two lateral and two crucial.

The internal lateral ligament (Ligamentum collaterale tibiale) is attached above to the prominent internal epicondyle of the femur, and below to a rough area below the margin of the internal condyle of the tibia.

The external lateral ligament (Ligamentum collaterale fibulare) is somewhat thicker; it arises from the upper depression on the external epicondyle, and ends on the head of the fibula. It covers the tendon of the origin of the popliteus muscle, and a bursa is interposed between the lower part of the ligament and the margin of the external condyle of the tibia.

The crucial ligaments are two strong rounded bands situated mainly in the intercondyloid fossa of the femur, between the two synovial sacs. They cross each other somewhat in the form of an X, and are named according to their tibial attachments. The anterior crucial ligament (Ligamentum cruciatum anterius) arises in the central fossa on the tibial spine, extends upward and backward, and ends on the upper part of the inner surface of the external condyle of the femur. The posterior crucial ligament (Ligamentum cruciatum posterius) is internal to the preceding, and is somewhat larger. It is attached to an eminence at the popliteal notch of the tibia, is directed upward and forward, and ends in the anterior part of the intercondyloid fossa of the femur.

It may be added that these ligaments do not lie in a sagittal plane, but are somewhat twisted across each other; outward rotation of the leg untwists and slackens them.

Movements.—The principal movements of the stifle joint as a whole are flexion and extension. In the ordinary standing position the articular angle (behind) is about 140° to 150°. Flexion is limited only by contact of the leg with the thigh if the hock is also flexed. Extension is incomplete, i. e., the femur and tibia cannot be brought into the same straight line. Rotation is limited, and is freest during semiflexion. The patella glides on the femoral trochlea upward in extension, downward in flexion.

Extension is checked mainly by tension of the crucial and lateral ligaments. In extreme extension, which is accompanied by slight outward rotation of the leg, the patella can be pushed upward and inward so that its fibro-cartilage hooks over the upper end of the inner ridge of the trochlea, but it will not remain there unless held in position. When pressure is removed, the base of the patella tips forward and the cartilage lies upon the most prominent part of the trochlear ridge. During flexion, which is accompanied by slight inward rotation of the leg, the condyles of the femur and the semilunar cartilages glide backward on the tibia; the movement of the external condyle and cartilage is greater than that of the inner one. In extreme flexion the patellar and posterior crucial ligaments are tense; the other ligaments are relaxed. The movement of the patella is gliding with coaptation, i. e., different parts of the opposing articular surfaces come into contact successively. Only a narrow transverse strip (ca. 1.5 to 2 cm. wide) of the patella is in contact with the trochlea at a time.