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Nerves: obturator nerve supply to obturator externus versus the separate nerve to obturator internus.

Arterial and venous vessels accompanying the obturator nerve through the obturator canal.

The knee is a compound synovial joint comprising tibiofemoral and patellofemoral articulations. It permits chiefly flexion and extension, with controlled rotation and translation. The head of the fibula provides important ligamentous attachments nearby but does not form a principal articular surface of the knee cavity.

The medial and lateral femoral condyles articulate with the corresponding superior surfaces of the tibia. Anteriorly, the patella articulates with the femoral patellar surface. These load-bearing surfaces are covered by hyaline cartilage. The relatively incongruent tibiofemoral surfaces are supplemented by the medial and lateral knee menisci, wedges of fibrocartilage whose thicker outer borders attach towards the capsule and tibial margins. Their anterior and posterior roots attach in the intercondylar tibial region. The medial meniscus of the knee is more C-shaped and relatively less mobile; the lateral is more nearly circular and more mobile. An anterior transverse connection may join them.

The fibrous capsule encloses the articulations but is strengthened and partly replaced by neighbouring tendons and ligaments. Anteriorly, the extensor apparatus includes the quadriceps tendon, patella, patellar ligament to the tibial tuberosity, and medial and lateral patellar retinacula. Posteriorly, the capsule is reinforced by the oblique popliteal ligament, an expansion related to semimembranosus, and the arcuate posterolateral complex. The popliteus tendon passes in relation to the posterolateral capsule and lateral meniscus.

The tibial collateral ligament extends from the medial femoral side to the medial tibia and is closely related to the capsule and medial meniscus of the knee. The cord-like fibular collateral ligament runs from the lateral femoral epicondyle to the fibular head. It is separated from the lateral meniscus by the popliteus tendon. Thus the two collateral ligaments do not have identical meniscal attachments.

The anterior cruciate ligament runs from the anterior intercondylar tibial area towards the inner surface of the lateral femoral condyle. The posterior cruciate ligament runs from the posterior intercondylar tibial area towards the inner surface of the medial femoral condyle. They cross within the fibrous capsule but lie outside the synovial cavity proper. The anterior cruciate ligament checks excessive anterior displacement of the tibia relative to the femur and contributes to rotational control; the posterior cruciate ligament checks excessive posterior displacement. Their effects depend on joint position and interact with the collateral ligaments and muscular support.^[ref]

The synovial membrane lines the inner non-articular capsule, reflects around the cruciate region and the infrapatellar fat pad, and forms recesses. The fat pad is intracapsular but excluded from the synovial cavity by the membrane covering it. The suprapatellar recess extends above the patella beneath the quadriceps. The prepatellar bursa and the superficial and deep infrapatellar bursae reduce friction outside the principal cavity and should not all be described as compulsory communications with it. Posterior bursal communications are variable.

The quadriceps femoris extends the knee; the hamstrings and other crossing muscles contribute to flexion and dynamic stability. Rotation is freer in flexion than in full extension. Terminal extension includes a coupled locking movement, commonly described as external rotation of the unloaded tibia or the corresponding internal rotation of the loaded femur. Popliteus helps initiate unlocking. This is a constrained three-dimensional articulation rather than a simple door hinge.^[ref]

The genicular arterial anastomoses, chiefly associated with popliteal artery branches and contributions from neighbouring arterial systems, supply the region; accompanying veins drain it. Articular sensory supply comes from branches of the femoral nerve, obturator nerve, tibial nerve and common fibular nerve. Their relation to the muscles crossing the articulation illustrates the connection between movement, stabilization and sensation. Dissection with the joint flexed and extended, and inspection of a section through the cruciate and synovial reflections, reveal relations that a single external view cannot show.

The four names identify distinct pathways: chorda tympani, the sensory buccal nerve, the radial nerve formerly called musculospiral, and the obturator nerve. Origin must include the parent nerve or nerve plexus, while the function must follow the actual fibre supply rather than the name of a structure crossed.

Chorda tympani. This branch leaves the facial nerve in its descending facial canal before the stylomastoid foramen. It enters the tympanic cavity from behind, passes forwards between the malleus and incus close to the inner surface of the tympanic membrane, and leaves through the petrotympanic fissure. In the infratemporal fossa it joins the lingual nerve, a branch of the mandibular division of the trigeminal nerve. It then travels with that carrier towards the tongue and submandibular ganglion.

The chorda tympani carries taste from the anterior two thirds of the tongue, with sensory cell bodies in the geniculate ganglion and central connections to the nucleus of the solitary tract. It also carries preganglionic parasympathetic fibres from the superior salivatory nucleus towards the submandibular ganglion; postganglionic fibres supply the submandibular gland and sublingual gland. It does not provide the general touch supply of that part of the tongue; that travels through the lingual nerve's trigeminal nerve pathway. Taste and tactile testing can consequently distinguish two functions that briefly share one peripheral trunk.^[ref]

Buccal nerve. In the usual anatomical meaning intended by this list, this is the long buccal nerve from the anterior division of the mandibular trigeminal nerve. It commonly emerges between the heads of the lateral pterygoid muscle, descends near the anterior border of the mandibular ramus and the temporalis muscle insertion, and passes towards the cheek. Its branches reach cheek skin, the buccal mucosa, and the buccal gingiva beside the lower molars. It is principally sensory. The motor supply of the buccinator muscle comes from the facial nerve, whose buccal branches are a different set of nerves. Thus the ability to hold the cheek against the teeth and sensation in the cheek are not tests of the same efferent pathway.^[ref]

Radial nerve, historically musculospiral. This is the major continuation of the posterior cord of the brachial plexus, usually containing fibres from C5–T1. It passes from the axilla into the posterior arm, accompanying the profunda brachii artery in the radial groove of the humerus. It pierces the lateral intermuscular septum and reaches the anterior compartment between brachialis and brachioradialis. Near the lateral elbow it divides into a superficial sensory branch and a deep motor branch. The latter passes through the supinator muscle and continues as the posterior interosseous nerve.

The radial nerve supplies triceps brachii and anconeus, then brachioradialis, the radial wrist extensors and, through its deep continuation, the principal finger and thumb extensors and associated posterior forearm muscles. Its sensory branches supply posterior arm and forearm regions and part of the dorsolateral hand. A lesion's level matters: an arm lesion can impair wrist and finger extension, while an isolated superficial branch lesion is sensory and does not itself cause a wrist drop. Conversely, a posterior interosseous nerve lesion chiefly affects motor function. The fingertip pads are not the characteristic autonomous sensory territory of the superficial radial nerve.^[ref]

Obturator nerve. It arises from the anterior divisions of the anterior rami of L2–L4 in the lumbar plexus. It emerges from the medial border of psoas major, crosses the pelvic side wall and leaves through the obturator canal with the obturator vessels. Its anterior and posterior divisions characteristically run on opposite sides of adductor brevis, although the level of division varies. The anterior division supplies adductor longus, gracilis and commonly adductor brevis; the posterior division supplies obturator externus and the adductor portion of adductor magnus, with variable additional contributions. The hamstring portion of adductor magnus has a different supply. Cutaneous supply to a variable medial-thigh patch and articular branches to the hip and knee supplement its principal motor role in thigh adduction. Obturator internus is supplied by its own sacral-plexus nerve, not by the obturator nerve merely because the names resemble one another.^[ref][ref]