This document summarizes the key joints and structures of the lower limb, including the hip, knee, ankle, and foot joints. It describes the bones, ligaments, muscles, blood supply and nerve innervation of each joint. The synovial joints of the lower limb allow for movements like flexion, extension, abduction, adduction, rotation and inversion/eversion. Lymphatic drainage from the lower limb travels to either the superficial inguinal nodes or deep iliac nodes.

1. Joints of the Lower Limb
Dr. Asma’ Hassan
Department of Anatomy
Pusat Pengajian Sains Perubatan
Universiti Sains Malaysia

2. Features of a Synovial Joint
Synovial Joint
• Synovial cavity
• Articular cartilage
• Synovial membrane + fluid
• Articular capsule / fibrous capsule
Joint stability
• Articular surfaces
• Ligaments
• Muscle tone
Additional features
• Articular discs
• Labrum
• A tendon

3. HILTON’S LAW
A nerve supplying a joint also supplies the
muscles moving the joint and the skin
over the distal attachments of these muscles

4. Hip Joint
• ball and socket type
• strongest joint in the body
• bony parts
– head of femur + acetabulum
• Capsule of the joint
– proximal attachment: rim of
acetabular labrum
– distal attachment:
• anterior – intertrochanteric
line
• posterior – middle of neck of
femur
– fibres of capsule are reflected
back along neck of femur:
Retinacula fibres
– contain nutrient arteries to head
and neck of femur

5. Hip Joint
• Strengthened by 3 ligaments
which spiral around the femoral
neck
• Anterior part of capsule:
– Iliofemoral
– Pubofemoral
• Posterior part of capsule:
– Ischiofemoral
• Ligament of the head of femur
(Ligamentum teres)
– From pit of head of femur to
transverse ligament
Iliofemoral
ligament
Pubofemoral
ligament
Ischiofemoral
ligament

6. Hip Joint
• Acetabular labrum
– Attached to circumference of
acetabulum
– Serves to deepen the
acetabular cavity
• Transverse ligament
– Extend across acetabular notch
– Create an acetabular foramen:
allow nerve and vessels
• Synovial membrane
– Form a tube surrounding
ligamentum teres
– Covers the acetabular fat pad
(in acetabular fossa)

7. Arteries and Nerves to Hip Joint
Cruciate anastomosis
• Main source of blood for head of femur
– Inferior gluteal a - internal iliac
artery
– 1st perforating artery
deep femoral a
– Lateral circumflex femoral a
(femoral a - external iliac a)
– Medial circumflex femoral a
• Branches pass along femoral neck
beneath the reticular fibres of capsule
Nerve supply:
• Femoral nerve
• Obturator nerve
– same nerves that supply knee joint;
“referred pain to the knee”

8. Movements of Hip Joint
• Flexion - Iliopsoas muscle
Sartorius
Rectus femoris
Pectineus
• Extension – Gluteus maximus
Gracilis
• Adduction – Adductors muscles
Gracilis
• Abduction – Gluteus medius
Gluteus minimus

9. Movements of Hip Joint
• Rotation
• Lateral / External
– Gluteus maximus
– Quadratus femoris, Piriformis
– Obturator internus and externus
– Gemelli
• Medial / Internal
– anterior part of Gluteus minimus
– Gluteus medius
– Tensor fasciae latae

10. Knee Joint
• Largest joint, hinge type
• Bony parts: consist of 2 joints
– Tibiofemoral joint
– Patellofemoral joint
(fibula is excluded from knee joint)
Capsule of the joint
• Loose and thin
• Tibia – margin of tibial condyles
• Femur – lies above the articular surfaces of bone
• Patella – attached to medial and lateral margins
• Nerve supply: sciatic, femoral, obturator nerves

11. Knee Joint
External Ligaments
• Quadriceps muscle tendons
- contribute significantly to the stability
of knee joint
• Ligamentum patellae - anterior
• Oblique ligament - posterior
• Medial & lateral collateral ligaments – each side
• Medial & lateral patellar retinacula – each side of patella

12. Knee Joint
Internal structures
• Cruciate ligaments
• Semilunar cartilages
• Transverse ligament
Synovial membrane
• Largest synovial cavity
• Lines inner aspect of
articular capsule
• Communicate superiorly
with suprapatellar bursa

13. Knee Joint - cruciate ligaments
• Intracapsular but extrasynovial
1. Anterior cruciate ligament
• Origin: anterior intercondylar
area of tibia
• Insertion: lateral condyle of
femur
• Prevents hyperextension
2. Posterior cruciate ligament
• Origin: posterior intercondylar
area of tibia
• Insertion: medial condyle of
femur
• Prevents hyperflexion

14. Knee Joint - Semilunar cartilages
• Fx: create more receptive
articular surfaces for femur and
tibia
1. Medial meniscus
- larger, less curved than lateral
- attachment: in front and
behind intercondylar eminence
*Medial: attached to medial
collateral ligament
2. Lateral meniscus
- smaller, more freely mobile
- separated from lateral
collateral ligament by popliteus
tendon

15. Movements of Knee Joint
Flexion
• hamstring muscles
• Sartorius, gracilis
• gastrocnemius
Extension
• Quadriceps femoris
Locks knee into full extension
• Tensor fasciae latae
• Gluteus maximus - by way of the
iliotibial tract
Unlocks full extension and start
flexion
• Popliteus muscle
this muscle pulls on the lateral
condyle of the femur causing it to
rotate laterally

17. Ankle Joint
• Hinge joint
• Between tibia & fibula and talus
• Movements: Dorsiflexion / Plantarflexion
Articular capsule:
• Thin anterior and posterior
• Strong collateral ligaments on each side
Lateral ligaments Medial Ligaments
Anterior talofibular Tibionavicular
Posterior talofibular Tibiotalar (ant & post)
Calcaneofibular Tibiocalcaneal

19. Foot Joints
• Talocrural joint
– Dorsiflexion
– Plantarflexion
• 1-Transverse tarsal joint (TT)
– Talocalcaneonavicular joint
– Calcaneocuboid joint
• 2-Subtalar joint (ST)
Inversion
Eversion
T T
ST
1
2

20. Lymphatic drainage of Lower limb
1. Superficial lymphatic vessels
accompany saphenous veins
• lymphatic vessels accompany
great saphenous veins end in
superficial inguinal nodes
• lymphatic vessels accompany
small saphenous veins end in
popliteal lymph nodes
2. Deep lymphatic vessels
accompany deep veins
• both pass to external iliac nodes

21. Superficial inguinal nodes
1. Vertical group: lower limb
2. Horizontal group:
a) Superolateral group
: buttock, flank, back below
waist
b) Superomedial group
: below umbilicus
: perineum
- lower part of anal canal
- urethra
- external genitalia of both
sexes (exclude testes)
vertical
horizontal