This study aimed to delineate the macroscopic and microscopic topography of muscles surrounding the anterior aspect of the hip joint and the underlaying joint capsule. Seven fresh-frozen cadavers were bilaterally dissected as per study protocol. Eleven hip joints were evaluated macroscopically, while three hip joints underwent histological analysis. Additionally, twenty hip bones and femurs were examined for the osseous morphology near the anterior portion of the articulating surfaces. Macroscopically, the rectus femoris muscle contributed to the articular capsule exclusively through its reflected head. The iliocapsularis and iliopsoas muscles were in direct contact with the articular capsule. Although the iliocapsularis muscle was adherent to the capsule throughout its whole course, the iliopsoas muscle was connected to the capsule through the iliopectineal bursa. Microscopically, different spatial thickness of the capsule was observed, with the thicker regions corresponding to the capsular ligaments. Osseous landmarks, relevant to the course of the iliopsoas muscle, included the iliopsoas notch and a groove for the psoas major muscle. Furthermore, split of the anterior inferior iliac spine and the "subspine" were constant findings corresponding to the origin of the direct head of the rectus femoris and the iliocapsularis muscles, and attachment of the medial band of the iliofemoral ligament, respectively. On the head of the femur, the Poirier's facet (35.0%), the Allen's fossa (60.0%), and the so-called plaque (50.0%) were observed. Conclusively, we introduce the concept of a four-layered anterior musculocapsular complex of the hip, aiming to aid the orthopaedic surgeon in both hip replacement and preservation procedures.

1st Department of Orthopaedics 1st Faculty of Medicine Charles University and Motol University Hospital Prague Czech Republic

Center for Endoscopic Surgical and Clinical Anatomy 2nd Faculty of Medicine Charles University Prague Czech Republic

Clinic of Trauma Surgery Faculty of Health Studies J E Purkyne University and Masaryk Hospital Usti nad Labem Czech Republic

Department of Anatomy 2nd Faculty of Medicine Charles University Prague Czech Republic

Department of Histology and Embryology 2nd Faculty of Medicine Charles University Prague Czech Republic

Department of Orthopaedic Surgery Faculty of Medicine in Hradec Kralove Charles University Hradec Kralove Czech Republic

Department of Orthopaedics Faculty of Health Studies J E Purkyne University and Masaryk Hospital Usti nad Labem Czech Republic

Zobrazit více v PubMed

Dvorak M, Duncan CP, Day B. Arthroscopic anatomy of the hip. Arthroscopy. 1990;6:264–73. doi: 10.1016/0749-8063(90)90055-I. PubMed DOI

Konno K, Hagiwara S, Nakamura J, Suzuki T, Eguchi Y, Ohtori S. An anatomic study of the relationship between the iliocapsularis muscle and iliofemoral ligament in total hip arthroplasty. Arthroplast Today. 2021;12:57–61. doi: 10.1016/j.artd.2021.09.010. PubMed DOI PMC

Nam D, Osbahr DC, Choi D, Ranawat AS, Kelly BT, Coleman SH. Defining the origins of the iliofemoral, ischiofemoral, and pubofemoral ligaments of the hip capsuloligamentous complex utilizing computer navigation. HSS J. 2011;7:239–43. doi: 10.1007/s11420-011-9214-3. PubMed DOI PMC

Philippon MJ, Michalski MP, Campbell KJ, Goldsmith MT, Devitt BM, Wijdicks CA, LaPrade RF. An anatomical study of the acetabulum with clinical applications to hip arthroscopy. J Bone Joint Surg Am. 2014;96:1673–82. doi: 10.2106/JBJS.M.01502. PubMed DOI

Ryan JM, Harris JD, Graham WC, Virk SS, Ellis TJ. Origin of the direct and reflected head of the rectus femoris: an anatomic study. Arthroscopy. 2014;30:796–802. doi: 10.1016/j.arthro.2014.03.003. PubMed DOI

Tamaki Y, Goto T, Wada K, Hamada D, Tsuruo Y, Sairyo K. Anatomic evaluation of the insertional footprints of the iliofemoral and ischiofemoral ligaments: a cadaveric study. BMC Musculoskelet Disord. 2020;21:828. doi: 10.1186/s12891-020-03848-4. PubMed DOI PMC

Telleria JJ, Lindsey DP, Giori NJ, Safran MR. An anatomic arthroscopic description of the hip capsular ligaments for the hip arthroscopist. Arthroscopy. 2011;27:628–36. doi: 10.1016/j.arthro.2011.01.007. PubMed DOI

Walters BL, Cooper JH, Rodriguez JA. New findings in hip capsular anatomy: dimensions of capsular thickness and pericapsular contributions. Arthroscopy. 2014;30:1235–45. doi: 10.1016/j.arthro.2014.05.012. PubMed DOI

Tsutsumi M, Nimura A, Honda E, Utsunomiya H, Uchida S, Akita K. An anatomical study of the anterosuperior capsular attachment site on the acetabulum. J Bone Joint Surg Am. 2019;101:1554–62. doi: 10.2106/JBJS.19.00034. PubMed DOI PMC

Carton P, Filan D. Anterior inferior iliac spine (AIIS) and subspine hip impingement. Muscles Ligaments Tendons J. 2016;6:324–36. doi: 10.32098/mltj.03.2016.08. PubMed DOI PMC

Domb BG, Shindle MK, McArthur B, Voos JE, Magennis EM, Kelly BT. Iliopsoas impingement: a newly identified cause of labral pathology in the hip. HSS J. 2011;7:145–50. doi: 10.1007/s11420-011-9198-z. PubMed DOI PMC

Fagotti L, Utsunomiya H, Philippon MJ. An anatomic study of the damage to capsular hip stabilizers during subspine decompression using a transverse interportal capsulotomy in hip arthroscopy. Arthroscopy. 2020;36:116–23. doi: 10.1016/j.arthro.2019.06.040. PubMed DOI

Kopydlowski NJ, Tannenbaum EP, Smith MV, Sekiya JK. Characterization of human anterosuperior acetabular depression in correlation with labral tears. Orthop J Sports Med. 2014;2:2325967114551328. doi: 10.1177/2325967114551328. PubMed DOI PMC

Vandenbussche E, Saffarini M, Taillieu F, Mutschler C. The asymmetric profile of the acetabulum. Clin Orthop Relat Res. 2008;466:417–23. doi: 10.1007/s11999-007-0062-x. PubMed DOI PMC

Kuhns BD, Weber AE, Levy DM, Bedi A, Mather RC, 3rd, Salata MJ, Nho SJ. Capsular management in hip arthroscopy: an anatomic, biomechanical, and technical review. Front Surg. 2016;3:13. doi: 10.3389/fsurg.2016.00013. PubMed DOI PMC

Moraux A, Wawer R, Lefevbre G, Cotten H, Demondion X, Cotten A. An anatomical study of the indirect tendon of the rectus femoris using ultrasonography. Eur Radiol. 2015;25:3614–9. doi: 10.1007/s00330-015-3769-1. PubMed DOI

Tubbs RS, Stetler W, Jr, Savage AJ, Shoja MM, Shakeri AB, Loukas M, Salter EG, Oakes WJ. Does a third head of the rectus femoris muscle exist? Folia Morphol (Warsz) 2006;65:377–80. PubMed

Tsutsumi M, Nimura A, Utsunomiya H, Kudo S, Akita K. Spatial distribution of loose connective tissues on the anterior hip joint capsule: a combination of cadaveric and in-vivo study. Sci Rep. 2021;11:22813. doi: 10.1038/s41598-021-02381-1. PubMed DOI PMC

Tsutsumi M, Nimura A, Akita K. New insight into the iliofemoral ligament based on the anatomical study of the hip joint capsule. J Anat. 2020;236:946–53. doi: 10.1111/joa.13140. PubMed DOI PMC

Lee JH, Kim KJ, Jeong YG, Lee NS, Han SY, Lee CG, Kim KY, Han SH. Pes anserinus and anserine bursa: anatomical study. Anat Cell Biol. 2014;47:127–31. doi: 10.5115/acb.2014.47.2.127. PubMed DOI PMC

González-Arnay E, Galluccio F, Pérez-Santos I, Merlano-Castellanos S, Bañón-Boulet E, Jiménez-Sánchez L, Rivier-Julien C, Barrueco-Fernández M, Olea MS, Yamak-Altinpulluk E, Teles AS, Fajardo-Pérez M. Permeable spaces between glenohumeral ligaments as potential gateways for rapid regional anesthesia of the shoulder. Ann Anat. 2022;239:151814. doi: 10.1016/j.aanat.2021.151814. PubMed DOI

Benes M, Kunc V, Nanka O, Kachlik D, Bartak V. Anatomy of the iliopsoas notch and its relationship with morphology of the proximal femur. Surg Radiol Anat. 2024;46:51–7. doi: 10.1007/s00276-023-03263-z. PubMed DOI

Babst D, Steppacher SD, Ganz R, Siebenrock KA, Tannast M. The iliocapsularis muscle: an important stabilizer in the dysplastic hip. Clin Orthop Relat Res. 2011;469:1728–34. doi: 10.1007/s11999-010-1705-x. PubMed DOI PMC

Guerra J, Jr, Armbuster TG, Resnick D, Goergen TG, Feingold ML, Niwayama G, Danzig LA. The adult hip: an anatomic study. Part II: the soft-tissue landmarks. Radiology. 1978;128:11–20. doi: 10.1148/128.1.11. PubMed DOI

Vandeputte FJ, Vanbiervliet J, Sarac C, Driesen R, Corten K. Capsular resection versus capsular repair in direct anterior approach for total hip arthroplasty: a randomized controlled trial. Bone Joint J 2021;103-B:321-8. 10.1302/0301-620X.103B2.BJJ-2020-0529.R2 PubMed DOI

Yano S, Hagiwara S, Iida S, Nakamura J, Kawarai Y, Ohtori S. Effects of anterior capsule repair during total hip arthroplasty using the anterolateral approach in the supine position. J Joint Surg Res. 2023;1:163–7. doi: 10.1016/j.jjoisr.2023.07.004. DOI

Bartonícek J. [Weitbrecht's retinacula of the hip joint]. Acta Chir Orthop Traumatol Cech. 1990;57:385–91. Czech. PubMed

Gojda J, Bartoníček J. The retinacula of Weitbrecht in the adult hip. Surg Radiol Anat. 2012;34:31–8. doi: 10.1007/s00276-011-0829-3. PubMed DOI

Kachlik D, Musil V, Baca V. Contribution to the anatomical nomenclature concerning lower limb anatomy. Surg Radiol Anat. 2018;40:537–62. doi: 10.1007/s00276-017-1920-1. PubMed DOI

Finnegan M, Faust MA. Variants of the femur. In: Finnegan M, Faust MA, editors. Research report 14: bibliography of human and non-human nonmetric variation. University of Massachusetts Amherst; 1974. p.7-19.

Göhring A. Allen's fossa- an attempt to dissolve the confusion of different nonmetric variants on the anterior femoral neck. Int J Osteoarchaeol. 2021;31:513–22. doi: 10.1002/oa.2968. DOI

Tsutsumi M, Nimura A, Utsunomiya H, Akita K. Dynamic changes of the joint capsule in relation to the zona orbicularis: an anatomical study with possible implications for hip stability mechanism. Clin Anat. 2021;34:1157–64. doi: 10.1002/ca.23767. PubMed DOI PMC