Bicondylar joint
- Key People:
- Sir Benjamin Collins Brodie, 1st Baronet
- Related Topics:
- knee
- elbow
- wrist
- sacroiliac
- knuckle
The condylar joint is better called bicondylar, for in it two distinct surfaces on one bone articulate with corresponding distinct surfaces on another bone. The two male surfaces are on one and the same bone and are of the same type (ovoid or sellar). These joints have two types of movement: one is always a swing, and the other is either another swing or a spin. Bicondylar joints are quite common. The largest is the tibiofemoral joint, in which both pairs of mating surfaces are within a single joint. At this joint, flexion and extension are the main movements; but active rotation of the leg on the femur is possible in most people when the leg and thigh are at right angles to each other. Every vertebra of the cervical, thoracic, and lumbar series is connected to (or separated from) the one below it by a pair of synovial joints as well as by an intervertebral disk. This pair of joints constitutes a bicondylar joint, the shape of whose articular surfaces determines the amount of movement permitted between the vertebra. The atlanto-occipital joint, between the skull and the vertebral column, is also a bicondylar joint. Finally, the right and left temporomandibular joints, between the lower jaw and the skull, are really two parts of a bicondylar joint, not only by definition—if the base of the skull is considered as a single bone—but also functionally, for one mandibular condyle cannot move without the other moving also.
Joint ligaments
Any set of collagen fibres joining one bone of an articulating pair to the other is called a ligament. Thus, the articular bursal wall is a ligament, called either the fibrous capsule or the joint capsule.
There are two types of these sets: capsular and noncapsular. Capsular ligaments are simply thickenings of the fibrous capsule itself that take the form of either elongated bands or triangles, the fibres of which radiate from a small area of one articulating bone to a line upon its mating fellow. The iliofemoral ligament of the hip joint is an example of a triangular ligament. Capsular ligaments are found on the outer surface of the capsule. There is one exception to this rule: ligaments of the shoulder joint (glenohumeral ligaments) are found on the inner surface.
Noncapsular ligaments are free from the capsule and are of two kinds: internal and external. The internal type is found in the knee, wrist, and foot. In the knee there are two, both arising from the upper surface of the tibia; each passes to one of the two femoral condyles and lies within the joint cavity, surrounded by synovial membrane. They are called cruciate ligaments because they cross each other X-wise. At the wrist most of the articulations of the carpal bones share a common joint cavity, and neighbouring bones are connected sideways by short internal ligaments. The same is true of the tarsal bones that lie in front of the talus and the calcaneus.
The external noncapsular ligaments are of two kinds: proximate and remote. The proximate ligaments pass over at least two joints and are near the capsules of these joints. They are found only on the outer side of the lower limb. Examples are the outer (fibular) ligament of the knee, which passes from the femur to the upper part of the fibula over both the knee and tibiofibular joints, and the middle part of the outer ligament of the ankle joint, which passes from the lowest part of the fibula to the heel bone. These two ligaments, particularly that passing over the ankle, are especially liable to damage (sprain).
The remote ligaments are so called because they are far from, rather than close to, the joint capsule. A notable example is that of the ligaments that pass between the back parts (spines and laminae) of neighbouring vertebrae in the cervical, thoracic, and lumbar parts of the spinal column. These are the chief ligaments of the pairs of synovial joints between the vertebrae of these regions. Unlike most ligaments, they contain a high proportion of elastic fibres that assist the spinal column to return to its normal shape after it has been bent forward or sideways.
Contrary to the opinion of earlier anatomists, ligaments are not normally responsible for holding joint surfaces together. This is because a set of collagen fibres, like a string, can exert a reactive force only if stretched and tightened by some tensile stress. Normally, the bones at a joint are pressed together (when at rest) by the action of muscles or by gravity. An individual ligament can stop a movement that tightens it. Such a movement will loosen the ligaments that would be tightened by the opposite movement. The one exception to this case is the movement that brings a joint into the close-packed position. This movement is brought about by a combination of a swing with a spin of the moving bone. Experiments show that the combination of movement screws the articular surfaces firmly together so that they cannot be separated by traction and that the capsule and most of the ligaments are in simultaneous maximal tautness.
Nerve supply and blood supply
The nerve and blood supply of synovial joints follows the general rule for the body: “Ubi nervus ibi arteria” (“Where there is a nerve, there also is an artery”).
Articular nerves
The sources of nerve fibres to a joint conform well to Hilton’s law—the nerves to the muscles acting on a joint give branches to that joint as well as to the skin over the area of action of these muscles. Thus, the knee joint is supplied by branches from the femoral, sciatic, and obturator nerves, which among them supply the various muscles moving the joint. Some of these nerves go to the fibrous capsule and ligaments; others innervate this capsule and reach the synovial membrane. Some of these nerves are sensory; others give both motor and sensory fibres to the arteries that accompany them.
The sensory fibres to the fibrous capsule are of two kinds: (1) algesic, responsible for painful sensation, particularly when the capsule or other ligaments are overstretched or torn, and (2) proprioceptive, which terminate in various forms of specialized structures and convey information to all parts of the central nervous system, including the cerebellum and the cerebrum. It has been established that this information includes the posture of a resting joint and both the rate and extent of motion at a moving joint. The latter is supplemented by impulses conveyed by the nerves from the muscles acting and the skin affected by the movement.
The sensory fibres to the synovial membrane reach it by innervating the fibrous capsule at various points and form wide-meshed networks in the subsynovial layer. They are mainly algesic in function, and stimulation of them gives rise to diffused rather than localized pain (unlike the corresponding fibres to the fibrous capsule). They are found wherever the synovial membrane is, being especially abundant in the fatty pads, and are also present over the peripheral (nonarticulating) parts of the articular cartilage, disks, and menisci. This fact accounts for the excruciating pain that accompanies injury of these latter structures. The articulating part of the articular cartilage has no nerve supply.
Articular blood and lymph vessels
The joints are surrounded by a rich network of arteries and veins. The arteries in the vicinity of a synovial joint give off subdivisions that join (anastomose) freely on its outer surface. From the network of vessels so formed, branches lead to the fibrous capsule and ligaments and to the synovial membrane. Blood vessels to the synovial membrane are accompanied by nerves, and, when these vessels reach the subsynovial membrane, they proliferate to form another anastomotic network from which capillaries go to all parts of the membrane. These subsynovial arteries also ramify to the fatty pads and the nonarticulating parts of the articular cartilage, disks, and menisci. None, however, go to the articulating part of an articular cartilage, which therefore depends upon the synovial fluid for its nourishment.
Veins align with the arteries. In addition, a joint has a well-developed set of lymphatic vessels, the ultimate channels of which join those of the neighbouring parts of the limb or body wall.
Joint metabolism and nutrition
The metabolism and nutrition of the fibrous capsule and ligaments are similar to that of fibrous tissues elsewhere. Their blood supply is relatively small, indicating a low rate of metabolic changes. Unlike skin, for example, they heal slowly if injured.
The metabolism of articular cartilage is primarily dependent upon that of its cells (chondrocytes). Carbohydrate metabolism in these cells is similar to that of cells elsewhere and is unaffected by age. The oxygen consumption of the chondrocytes, on the other hand, decreases with age once the cells have matured. All the evidence suggests that the intracellular combustion is of glucose and protein, in that order of preference, rather than of fat. Sulfur passes from the blood to the synovial fluid and from there to the chondrocytes. From these it is transferred to the matrix to help to form chondroitin sulfate and keratosulfate molecules, the main constituents of the cartilaginous material. Chondroitin sulfate could be described as a sulfonated form of hyaluronic acid, the characteristic constituent of synovial fluid. Its presence in the matrix of the cartilage, but not in the synovial fluid, shows that the chondrocytes are necessary for its formation. After the second decade of life, the proportion of chondroitin sulfate falls and that of keratosulfate rises, as would be expected in view of the corresponding diminution of metabolic activity of the cells.
Excepting the articular cartilages, disks, and menisci, all other tissues of synovial joints are nourished directly by the blood vessels. The excepted parts are nourished indirectly by the synovial fluid. This is distributed over the surface of the articulating cartilage by the movements of the joint. The need for keeping joints healthy by frequent exercise of all of them is thus apparent.
Michael A. MacConaill