Our bones, muscles and joints work together in a coordinated way to move our body and give it stability. Tendons and ligaments play an important role here, too: Tendons connect muscles to bones, allowing us to move, and ligaments help to hold things in place.

What are ligaments, and what do they do?

Ligaments are made out of connective tissue that has a lot of strong collagen fibers in it. They are found in different shapes and sizes in the body. Some look like pieces of string, others look like narrow or wide bands. There are arch-shaped ligaments, too.

Ligaments often connect two bones together, particularly in the joints: Like strong, firmly attached straps or ropes, they stabilize the joint or hold the ends of two bones together. This ensures that the bones in the joint don’t twist too much or move too far apart and become dislocated.

Like firm straps or ropes, ligaments stabilize the upper ankle joint

But there are also some ligaments that aren’t connected to bones. For instance, some make sure that internal organs are kept in place. A typical example is the womb, which is kept in the right position in the pelvis by ligaments. Ligaments may also connect two or more organs to each other. For instance, the liver, intestine and stomach are held in place by ligaments in the abdominal cavity. These ligaments often have sensitive structures like blood vessels or gland ducts running through them. The strong connective tissue in the ligaments protects these structures and prevents them from bending, twisting or tearing.

Regardless of whether they connect bones or organs to each other, ligaments help to maintain stability in the body. Their function is reflected in their name, which comes from “ligare” – the Latin word for “bind” or “tie.”

The knee joint has multiple ligaments that provide support, particularly in the extended position (see Figure c). Outside of the articular capsule, located at the sides of the knee, are two extrinsic ligaments. The fibular collateral ligament (lateral collateral ligament) is on the lateral side and spans from the lateral epicondyle of the femur to the head of the fibula. The tibial collateral ligament (medial collateral ligament) of the medial knee runs from the medial epicondyle of the femur to the medial tibia. As it crosses the knee, the tibial collateral ligament is firmly attached on its deep side to the articular capsule and to the medial meniscus, an important factor when considering knee injuries. In the fully extended knee position, both collateral ligaments are taut (tight), thus serving to stabilize and support the extended knee and preventing side-to-side or rotational motions between the femur and tibia.

The articular capsule of the posterior knee is thickened by intrinsic ligaments that help to resist knee hyperextension. Inside the knee are two intracapsular ligaments, the anterior cruciate ligament and posterior cruciate ligament. These ligaments are anchored inferiorly to the tibia at the intercondylar eminence, the roughened area between the tibial condyles. The cruciate ligaments are named for whether they are attached anteriorly or posteriorly to this tibial region. Each ligament runs diagonally upward to attach to the inner aspect of a femoral condyle. The cruciate ligaments are named for the X-shape formed as they pass each other (cruciate means “cross”). The posterior cruciate ligament is the stronger ligament. It serves to support the knee when it is flexed and weight bearing, as when walking downhill. In this position, the posterior cruciate ligament prevents the femur from sliding anteriorly off the top of the tibia. The anterior cruciate ligament becomes tight when the knee is extended, and thus resists hyperextension.

Joints

Injuries to the knee are common. Since this joint is primarily supported by muscles and ligaments, injuries to any of these structures will result in pain or knee instability. Injury to the posterior cruciate ligament occurs when the knee is flexed and the tibia is driven posteriorly, such as falling and landing on the tibial tuberosity or hitting the tibia on the dashboard when not wearing a seatbelt during an automobile accident. More commonly, injuries occur when forces are applied to the extended knee, particularly when the foot is planted and unable to move. Anterior cruciate ligament injuries can result with a forceful blow to the anterior knee, producing hyperextension, or when a runner makes a quick change of direction that produces both twisting and hyperextension of the knee.

A worse combination of injuries can occur with a hit to the lateral side of the extended knee (Knee Injury Figure). A moderate blow to the lateral knee will cause the medial side of the joint to open, resulting in stretching or damage to the tibial collateral ligament. Because the medial meniscus is attached to the tibial collateral ligament, a stronger blow can tear the ligament and also damage the medial meniscus. This is one reason that the medial meniscus is 20 times more likely to be injured than the lateral meniscus. A powerful blow to the lateral knee produces a “terrible triad” injury, in which there is a sequential injury to the tibial collateral ligament, medial meniscus, and anterior cruciate ligament.

Arthroscopic surgery has greatly improved the surgical treatment of knee injuries and reduced subsequent recovery times. This procedure involves a small incision and the insertion into the joint of an arthroscope, a pencil-thin instrument that allows for visualization of the joint interior. Small surgical instruments are also inserted via additional incisions. These tools allow a surgeon to remove or repair a torn meniscus or to reconstruct a ruptured cruciate ligament. The current method for anterior cruciate ligament replacement involves using a portion of the patellar ligament. Holes are drilled into the cruciate ligament attachment points on the tibia and femur, and the patellar ligament graft, with small areas of attached bone still intact at each end, is inserted into these holes. The bone-to-bone sites at each end of the graft heal rapidly and strongly, thus enabling a rapid recovery.

Adjacent vertebrae are united by ligaments that run the length of the vertebral column along both its posterior and anterior aspects (Ligaments of Vertebral Column Figure). These serve to resist excess forward or backward bending movements of the vertebral column, respectively.

The anterior longitudinal ligament runs down the anterior side of the entire vertebral column, uniting the vertebral bodies. It serves to resist excess backward bending of the vertebral column. Protection against this movement is particularly important in the neck, where extreme posterior bending of the head and neck can stretch or tear this ligament, resulting in a painful whiplash injury. Prior to the mandatory installation of seat headrests, whiplash injuries were common for passengers involved in a rear-end automobile collision.

The supraspinous ligament is located on the posterior side of the vertebral column, where it interconnects the spinous processes of the thoracic and lumbar vertebrae. This strong ligament supports the vertebral column during forward bending motions. In the posterior neck, where the cervical spinous processes are short, the supraspinous ligament expands to become the nuchal ligament (nuchae = “nape” or “back of the neck”). The nuchal ligament is attached to the cervical spinous processes and extends upward and posteriorly to attach to the midline base of the skull, out to the external occipital protuberance. It supports the skull and prevents it from falling forward. This ligament is much larger and stronger in four-legged animals such as cows, where the large skull hangs off the front end of the vertebral column. You can easily feel this ligament by first extending your head backward and pressing down on the posterior midline of your neck. Then tilt your head forward and you will fill the nuchal ligament popping out as it tightens to limit anterior bending of the head and neck.

Additional ligaments are located inside the vertebral canal, next to the spinal cord, along the length of the vertebral column. The posterior longitudinal ligament is found anterior to the spinal cord, where it is attached to the posterior sides of the vertebral bodies. Posterior to the spinal cord is the ligamentum flavum (“yellow ligament”). This consists of a series of short, paired ligaments, each of which interconnects the lamina regions of adjacent vertebrae. The ligamentum flavum has large numbers of elastic fibers, which have a yellowish color, allowing it to stretch and then pull back. Both of these ligaments provide important support for the vertebral column when bending forward.

Annular ligament is a intrinsic ligament of the elbow articular capsule that surrounds and supports the head of the radius at the proximal radioulnar joint.

Anterior cruciate ligament is a intracapsular ligament of the knee; extends from anterior, superior surface of the tibia to the inner aspect of the lateral condyle of the femur; resists hyperextension of knee.

Anterior talofibular ligament is a intrinsic ligament located on the lateral side of the ankle joint, between talus bone and lateral malleolus of fibula; supports talus at the talocrural joint and resists excess inversion of the foot.

Calcaneofibular ligament is aintrinsic ligament located on the lateral side of the ankle joint, between the calcaneus bone and lateral malleolus of the fibula; supports the talus bone at the ankle joint and resists excess inversion of the foot

Coracohumeral ligament is aintrinsic ligament of the shoulder joint; runs from the coracoid process of the scapula to the anterior humerus.

Deltoid ligament is a broad intrinsic ligament located on the medial side of the ankle joint; supports the talus at the talocrural joint and resists excess eversion of the foot.

Fibular collateral ligament is a extrinsic ligament of the knee joint that spans from the lateral epicondyle of the femur to the head of the fibula; resists hyperextension and rotation of the extended knee.

Glenohumeral ligament is a one of the three intrinsic ligaments of the shoulder joint that strengthen the anterior articular capsule.

Iliofemoral ligament is a intrinsic ligament spanning from the ilium of the hip bone to the femur, on the superior-anterior aspect of the hip joint.

Ischiofemoral ligament is a intrinsic ligament spanning from the ischium of the hip bone to the femur, on the posterior aspect of the hip joint.

Patellar ligament is a ligament spanning from the patella to the anterior tibia; serves as the final attachment for the quadriceps femoris muscle.

Posterior cruciate ligament is a intracapsular ligament of the knee; extends from the posterior, superior surface of the tibia to the inner aspect of the medial condyle of the femur; prevents anterior displacement of the femur when the knee is flexed and weight bearing.

Posterior talofibular ligament is a intrinsic ligament located on the lateral side of the ankle joint, between the talus bone and lateral malleolus of the fibula; supports the talus at the talocrural joint and resists excess inversion of the foot.

Pubofemoral ligament is a intrinsic ligament spanning from the pubis of the hip bone to the femur, on the anterior-inferior aspect of the hip joint.

Radial collateral ligament is a intrinsic ligament on the lateral side of the elbow joint; runs from the lateral epicondyle of humerus to merge with the annular ligament.

Ulnar collateral ligament is a intrinsic ligament on the medial side of the elbow joint; spans from the medial epicondyle of the humerus to the medial ulna.