Joints of Lower Limbs

- The sacro-iliac joints link the axial skeleton and the inferior appendicular skeleton

Sacroiliac Joint

- Type: anterior synovial and posterior syndesmosis

- Articulation:

1. Between the auricular surfaces of sacrum and ilium

2. Between the tuberosities of sacrum and ilium

- Ligaments:

1. Anterior sacroiliac ligaments – anterior part of the fibrous capsule of the synovial
part of the joint

2. Interosseous sacroiliac ligaments – between the tuberosities of the sacrum and

ilium

3. Posterior sacroiliac ligaments – posterior external continuation of the same

mass of fibrous tissue.

- Because the fibers of the interosseous and posterior sacro-iliac ligaments run
obliquely upward and outward from the sacrum, the axial weight pushing down on the
sacrum actually pulls the ilia inward (medially) so that they compress the sacrum
between them, locking the irregular but congruent surfaces of the sacro-iliac joints
together. The iliolumbar ligaments are accessory ligaments to this mechanism.

4. Iliolumbar ligaments

5. Sacrotuberous ligaments – passes from the posterior ilium and lateral sacrum
and coccyx to the ischial tuberosity, transforming the sciatic notch of the hip
bone into a large sciatic foramen
 6. Sacrospinous ligaments – passes from lateral sacrum and coccyx to the ischial
spine, further subdividing the foramen into greater and lesser sciatic foramina

- Movements: Limited

Pubic Symphysis

- Type: symphysis, secondary cartilaginous

- Articular Disc: fibrocartilaginous interpubic disc

- Articulation: between the symphyseal surfaces of the pubic bones

- Ligaments:

1. Superior pubic ligament – connects the superior aspects of the pubic bodies
and the interpubic disc.

2. Inferior pubic ligament – connects the inferior aspects of the joint, rounding off
the pubic angle, forming the apex of the pubic arch.

- Movements: –

Lumbosacral Joint

- Type: symphysis (anterior IV joint) and plane (2 posterior zygapophyseal joints)

- Articulation:

1. Between the IV disc of L5 and S1

2. Between the articular process of L5 and S1

- Ligaments:

1. Iliolumbar ligament – fan like, radiating from the transverse processes of L5 to

the ilia

- Movements: slight movement

Sacrococcygeal Joint

- Type: symphysis

- Articulation: between the apex of the sacrum and the base of the coccyx

- Ligaments:

1. Anterior sacrococcygeal ligaments

2. Posterior sacrococcygeal ligaments

- Movements: –

Hip Joint

- Type: ball and socket

- Articulation: between the round head of the femur and the cup-like acetabulum of the
hip bone

● The entire femoral head is covered with articular cartilage, except for the
fovea for the ligament of the femoral head

● The acetabular rim consists of a lunate surface covered with articular

cartilage

- Ligaments:

1. Iliofemoral ligament – y-shaped, which attaches to the AIIS and the acetabular
rim proximally and the intertrochanteric line distally

The body’s strongest ligament

Prevents hyperextension of the hip joint

2. Pubofemoral ligament – arises from the obturator crest of the pubic bone and
passes laterally and inferiorly to merge with the fibrous layer of the joint capsule
 Blends with the medial part of the iliofemoral ligament, and tightens during both
extension and abduction of the hip joint
Prevents overabduction of the hip joint

3. Ischiofemoral ligament – arises from the ischial part of the acetabular rim.
The weakest of the three ligaments, it spirals superolaterally to the femoral
neck, medial to the base of the greater trochanter

4. Ligament of the head of the femur – attaches to the margins of the acetabular
notch and the transverse acetabular ligament; its narrow end attaches to the
fovea for the ligament of the head.

- Bursae:

1. Obturator externus bursa) – for obturator externus tendon; a synovial protrusion

beyond the free margin of the joint capsule onto the posterior aspect of the
femoral neck

2. Obturator internus bursa – for obturator internus tendon

- Movements: wide range; flexion-extension, adduction-abduction, medial–lateral

rotation, and circumduction

Knee Joint

- Type: Hinge

● Largest and most superficial joint

- Articulation:

The fibula is not involved in the knee joint

1. 2 femorotibial between the lateral and the medial femoral and tibial condyles

2. 1 intermediate femoropatellar between the patella and the femur

- Ligaments:
Extracapsular

1. Patellar ligament – anterior, passes from the apex and adjoining margins of the
patella to the tibial tuberosity

2. Collateral ligaments of the knee

● Fibular collateral ligament (FCL; lateral collateral ligament) – cord-like

strong, extends from the lateral epicondyle of the femur to the lateral
surface of the fibular head

● Tibial collateral ligament (TCL; medial collateral ligament) – flat, extends

from the medial epicondyle of the femur to the medial condyle and the
superior part of the medial surface of the tibia

3. Oblique popliteal ligament – arises posterior to the medial tibial condyle and
passes superolaterally toward the lateral femoral condyle

4. Arcuate popliteal ligament – posterior aspect of the fibular head, passes

superomedially over the tendon of the popliteus, and spreads over the posterior
surface of the knee joint

Intraarticular

1. Cruciate ligaments – crisscross within the joint capsule of the joint but outside
the synovial cavity the center of the joint and cross each other obliquely, like the
letter X.

● Anterior cruciate ligament (ACL) – weaker, from the anterior intercondylar

area of the tibia

Limits posterior rolling of the femoral condyles on the tibial plateau during
flexion, converting it to spin.

Prevents posterior displacement of the femur on the tibia and

hyperextension of the knee joint.
 ● Posterior cruciate ligament (PCL) –stronger, from the posterior
intercondylar area of the tibia
Limits anterior rolling of the femur on the tibial plateau during extension,
converting it to spin.

Prevents anterior displacement of the femur on the tibia or posterior

displacement of the tibia on the femur and helps prevent hyperflexion of
the knee joint.

Main stabilizing factor for the femur

2. The menisci of the knee joint – crescentic plates of fibrocartilage

● Medial meniscus – C shaped, anterior and posterior ends are attached to

the anterior and posterior intercondylar areas of the tibia, respectively.

● Lateral meniscus – more freely movable

3. Meniscofemoral ligament – joins the lateral meniscus to the PCL and the medial
femoral condyle

4. Coronary ligaments – between the margins of the menisci and most of the
periphery of the tibial condyles

5. Transverse ligament of the knee – joins the anterior edges of the menisci,
crossing the anterior intercondylar area and tethering the menisci to each other
during knee movements.

- Bursae:

Subcutaneous prepatellar and infrapatellar bursae are located at the convex surface
of the joint, allowing the skin to move freely during movements of the knee

Four bursae communicate with the synovial cavity of the knee joint: suprapatellar
bursa, popliteus bursa, anserine bursa, and gastrocnemius bursa.

Semimembranosus and deep infrapatellar bursae

 - Movements: Flexion and extension, some rotation

- Infrapatellar fat pad, so that they are excluded from the articular cavity. This creates a
median infrapatellar synovial fold, a vertical fold of synovial membrane that
approaches the posterior aspect of the patella, occupying all but the most anterior part
of the intercondylar region. Thus, it almost subdivides the articular cavity into right and
left femorotibial articular cavities; indeed, this is how arthroscopic surgeons consider
the articular cavity. Fat-filled lateral and medial alar folds cover the inner surface of fat
pads that occupy the space on each side of the patellar ligament internal to the
fibrous layer. Superior to the patella, the knee joint cavity extends deep to the vastus
intermedius as the suprapatellar bursa.

Tibiofibular Joint

- Type: plane

- Articulation: between the fibular head and the lateral tibial condyle

- Ligaments:

1. Anterior ligaments of fibular head

2. Posterior ligaments of fibular head

- Bursae: popliteus bursa – a pouch of synovial membrane from the knee joint that
passes between the tendon of the popliteus and the lateral condyle of the tibia

- Movements: Slight movement during dorsiflexion

Tibiofibular Syndesmosis

- Type: fibrous

- Articulation: between the medial surface of the inferior end of the fibula and the
inferior end of the tibia

- Ligaments:
 1. Interosseous tibiofibular ligament – continuous superiorly with the interosseous
membrane

2. Anterior tibiofibular ligaments

3. Posterior tibiofibular ligaments

4. Inferior transverse (tibiofibular) ligament – between the distal ends of the tibia
(medial malleolus) and the fibula (lateral malleolus)

- Bursae: popliteus bursa – a pouch of synovial membrane from the knee joint that
passes between the tendon of the popliteus and the lateral condyle of the tibia

- Movements: slight movement

Ankle Joint

- Type: hinge

- Articulation: between the distal end of tibia and fibula and the superior part of talus,
forming a malleolar mortise in which the trochlea of the talus fits into it.

● Fibula and talus:

1. The medial surface of the lateral malleolus articulates with the lateral
surface of the talus.

● Tibia and talus:

1. Tibia’s inferior surface forms the roof of the malleolar mortise, transferring
the body’s weight to the talus.
2. The medial malleolus articulates with the medial surface of the talus.

- Ligaments:

● Lateralerally, lateral ligament of the ankle

1. Anterior talofibular ligament – flat, weak band, extends anteromedially

from the lateral malleolus to the neck of the talus
 2. Posterior talofibular ligament – thick, strong band, extends medially and
slightly posteriorly from the malleolar fossa to the lateral tubercle of the
talus.
3. Calcaneofibular ligament – round cord, extends postero-inferiorly from the
tip of the lateral malleolus to the lateral surface of the calcaneus

● Medially, medial ligament of the ankle (deltoid ligament) – attaches proximally to

the medial malleolus

- Movements:

1. Dorsiflexion of the ankle

2. Plantarflexion of the ankle

Subtalar Joint

- Type: plane – intertarsal ; (talocalcaneal)

- Articulation: inferior surface of body of talus with superior surface of calcaneus

- Ligaments:

1. Medial talocalcaneal ligaments – support capsule

2. Lateral talocalcaneal ligaments – support capsule

3. Posterior talocalcaneal ligaments – support capsule

4. Interosseous talocalcaneal ligament – binds bones together

- Movements: inversion and eversion of foot

Talocalcaneonavicular Joint

- Type: synovial – intertarsal ; transverse tarsal

- Parts: talocalcaneal + talonavicular (ball and socket)

 - Articulation: head of talus with calcaneus and navicular bones

- Ligaments:
1. Plantar calcaneonavicular (spring) ligament – supports head of talus

- Movements: gliding and rotary

Calcaneocuboid Joint

- Type: plane

- Articulation: anterior end of calcaneus with posterior surface of cuboid

- Ligaments:

1. Dorsal calcaneocuboid ligament

2. Plantar calcaneocuboid ligament

3. Long plantar ligaments – support joint capsule

- Movements: inversion and eversion of foot; circumduction

Cuneonavicular Joint

- Type:

- Articulation: anterior navicular with posterior surfaces of cuneiforms

- Ligaments:

1. Dorsal cuneonavicular ligaments

2. Plantar cuneonavicular ligaments

- Movements: little movement

Tarsometatarsal Joint
 - Type:

- Articulation: anterior tarsal bones with bases of metatarsal bones

- Ligaments:

1. Dorsal tarsometatarsal ligaments – bind bones together

2. Plantar tarsometatarsal ligaments – bind bones together

3. Interosseous tarsometatarsal ligaments – bind bones together

- Movements: gliding or sliding

Intermetatarsal Joint

- Type: plane

- Articulation: between bases of adjacent metatarsal bones

- Ligaments:

1. Dorsal intermetatarsal ligaments – bind lateral four metatarsal bones together

2. Plantar intermetatarsal ligaments – bind lateral four metatarsal bones together

3. Interosseous intermetatarsal ligaments – bind lateral four metatarsal bones

together

- Movements: little individual movement

Metatarsophalangeal Joint

- Type: condyloid

- Articulation: heads of metatarsal bones with bases of proximal phalanges

- Ligaments:

1. Collateral ligaments – support capsule on each side

 2. Plantar ligament – supports plantar part of capsule

- Movements: Flexion-extension, abduction-adduction, and circumduction

Interphalangeal Joint

- Type: hinge

- Articulation: head of one phalanx with base of one distal to it

- Ligaments:

1. Collateral ligaments – support joints

2. Plantar ligament – support joints

- Movements: flexion and extension