Assignment 2

Ligaments of hip joint and lower limb

With clinical relevance

Name: M Talha Khan

Sap: 53107
Semester: 2nd
Department: Biomedical engineering
 Ligaments of hip joint and lower limb ~

Ligaments of hip joints:

The ligaments of the hip joint are crucial for maintaining stability and can be categorized into
intracapsular and extracapsular groups:

1) Intracapsular Ligament
Ligament of Head of Femur (Ligamentum Teres):

Location: It extends from the acetabular fossa (a deep socket in the pelvis) to the fovea capitis (a small
depression on the head of the femur).

Structure: This ligament is relatively small and flat.

Function: It mainly serves to carry a small blood vessel, the artery to the head of the femur, which is
a branch of the obturator artery. Although it provides some mechanical stability, its role in this regard is
minimal compared to the extracapsular ligaments.

2) Extracapsular Ligaments

a) Iliofemoral Ligament:

Origin: Anterior inferior iliac spine of the pelvis.

Insertion: Intertrochanteric line of the femur.

Appearance: This ligament has a Y-shape, making it easily distinguishable.

Function: It is the strongest ligament in the body and provides a significant reinforcement to the hip
joint, preventing hyperextension when standing or during activities. This contributes to maintaining an
upright posture without excessive muscular effort.

b) Pubofemoral Ligament:

Origin: Superior pubic ramus.

Insertion: Intertrochanteric line of the femur, blending with the iliofemoral ligament.

Appearance: Triangular shape.

Function: This ligament prevents excessive abduction and extension of the hip joint. It reinforces the
anterior and inferior parts of the joint capsule, adding stability particularly when the hip is extended and
abducted.

c) Ischiofemoral Ligament:

Origin: Body of the ischium (part of the pelvis).

Insertion: Greater trochanter of the femur.

Appearance: Has a spiral orientation which allows it to wind around the femoral neck.

Function: It prevents hyperextension and helps stabilize the femoral head within the acetabulum. This
ligament is the primary reinforcement on the posterior side of the hip joint, aiding in the control of
internal rotation and adduction.

Clinical Relevance:
The ligaments of the hip joint are vital for maintaining stability and function. Here’s a look at their
clinical relevance:

1. Hip Dislocations
Mechanism: Hip dislocations typically occur due to high-energy impacts, such as those from car accidents
or falls. When the hip dislocates, the surrounding ligaments can be torn or severely stretched.

Types:

Anterior Dislocation: Less common and usually involves tears in the iliofemoral and pubofemoral
ligaments.

Posterior Dislocation: More common and often involves the ischiofemoral ligament.
Symptoms: Severe pain, inability to move the leg, and visible deformity of the hip.

2. Ligament Tears and Strains

Causes: Often due to sports injuries, falls, or accidents. Overuse can also lead to ligament strains,
particularly in athletes.

Symptoms: Pain, swelling, reduced range of motion, and instability of the joint.

Diagnosis: MRI or ultrasound is used to assess the extent of the damage.

3. Hip Instability

Description: A condition where the hip joint feels loose or unstable, often due to damaged ligaments.
Causes: Can be congenital (like developmental dysplasia of the hip), due to trauma, or from repetitive
strain.

Treatment: Physical therapy to strengthen surrounding muscles, or surgery in severe cases to repair the
ligaments.

4. Arthroscopic Surgery
Purpose: A minimally invasive procedure to repair damaged ligaments or address other issues inside
the hip joint, like labral tears.

Benefits: Faster recovery and less pain compared to open surgery.

Indications: Used when pain, instability, or other symptoms persist despite non-surgical treatments.

5. Osteoarthritis (OA)

Relation to Ligaments: Chronic instability from damaged ligaments can accelerate joint wear,
leading to OA.

Symptoms: Pain, stiffness, reduced range of motion, and swelling.

Management: Includes physical therapy, weight management, pain relief, and possibly hip
replacement surgery in advanced cases.

6. Hip Replacement Surgery

Relevance: Needed in cases of severe arthritis or irreparable ligament damage.

Preoperative Considerations: Assessing ligament integrity and joint stability to plan the surgery.

7. Congenital Conditions

Developmental Dysplasia of the Hip (DDH): A condition where the hip joint is improperly
formed, often resulting in loose ligaments.

Early Detection: Ultrasound screening in infants, especially with a family history of DDH.

Treatment: Bracing, physical therapy, or surgery to ensure proper hip development and prevent long-
term issues.

Knee Joint Ligaments

Intracapsular Ligaments
Anterior Cruciate Ligament (ACL)
Location: Connects the anterior tibia to the posterior femur.

Function: Prevents anterior translation of the tibia relative to the femur.

Posterior Cruciate Ligament (PCL)

Location: Connects the posterior tibia to the anterior femur.

Function: Prevents posterior translation of the tibia relative to the femur.

Extracapsular Ligaments
Medial Collateral Ligament (MCL)
Location: Extends from the medial femur to the medial tibia.

Function: Prevents valgus (inward) stress on the knee.

Lateral Collateral Ligament (LCL)

Location: Extends from the lateral femur to the head of the fibula.

Function: Prevents varus (outward) stress on the knee.

Patellar Ligament
Location: Runs from the patella to the tibial tuberosity.

Function: Acts as a continuation of the quadriceps tendon, helping to extend the knee.

Ankle Joint Ligaments

Medial (Deltoid) Ligament
Location: Comprises four parts (tibionavicular, tibiocalcaneal, posterior tibiotalar, and anterior
tibiotalar ligaments) extending from the medial malleolus to the navicular, calcaneus, and talus.

Function: Stabilizes the medial aspect of the ankle and prevents excessive eversion.

Lateral Ligaments

Anterior Talofibular Ligament (ATFL)

Location: Extends from the lateral malleolus to the talus.

Function: Prevents anterior displacement of the talus.

Calcaneofibular Ligament (CFL)

Location: Runs from the lateral malleolus to the calcaneus.

Function: Provides stability to the lateral ankle.

Posterior Talofibular Ligament (PTFL)

Location: Connects the lateral malleolus to the posterior talus.

Function: Prevents posterior displacement of the talus.

 Clinical Relevance

Knee Joint Ligaments

Anterior Cruciate Ligament (ACL)

ACL Tears: Common in athletes, especially in sports that involve sudden stops and changes in
direction.

Symptoms: A "pop" sound, severe pain, swelling, and instability of the knee.

Diagnosis: MRI is the gold standard for diagnosis.

Treatment: May involve physical therapy for partial tears or surgical reconstruction for
complete tears.

Posterior Cruciate Ligament (PCL)

PCL Injuries: Often occur due to direct impact to the front of the knee, such as in car accidents or
sports.

Symptoms: Pain, swelling, and difficulty walking.

Treatment: Often treated conservatively with physical therapy, but severe cases may require
surgery.

Medial and Lateral Collateral Ligaments (MCL and LCL)

MCL Injuries: Common in contact sports, often due to a blow to the outer side of the knee.

Symptoms: Pain on the inside of the knee, swelling, and instability.

Treatment: Generally managed with bracing and physical therapy; surgery is rare.

LCL Injuries: Less common, usually caused by a blow to the inner side of the knee.

Symptoms: Pain on the outer side of the knee, swelling, and instability.

Treatment: Similar to MCL injuries, focusing on bracing and rehabilitation.

Ankle Joint Ligaments

Lateral Ligaments (ATFL, CFL, PTFL)

Ankle Sprains: The most common injury in the ankle, particularly affecting the ATFL during
inversion injuries.
 Symptoms: Pain, swelling, bruising, and difficulty bearing weight.

Diagnosis: Physical examination and sometimes imaging.

Treatment: RICE (Rest, Ice, Compression, Elevation), physical therapy, and in severe cases,
surgery.

Medial (Deltoid) Ligament

Eversion Ankle Sprains: Less common than inversion sprains and often associated with fractures.

Symptoms: Pain on the inside of the ankle, swelling, and instability.

Treatment: Similar to lateral ankle sprains but may require more intensive treatment if
associated with fractures.