This, the exact reverse of the condition just referred to, may, in the absence of very extensive laceration of the capsule, etc, for practical purposes be considered to be due to wasting of muscles on the proximal side of the articulation, the knee for many reasons being the joint mainly concerned. Wasting of the muscles of the thigh invariably leads to laxness of the capsule of the knee-joint, and the bagginess of the capsule thus resulting means passive effusion, a fact which does not seem to be familiar to some people. The resulting fulness of the joint, especially when the patient stands, leads the inexperienced to devote the entire attention to the 'fluid in the joint,' with the result that one of two extremes in the way of treatment is adopted - (1) prolonged use of splints, or (2) vigorous methods confined to the joint itself for example, blisters, actual cautery, strapping, etc, the result being almost invariably a 'wobbly' joint.

If, in cases of this kind, it were generally recognised that the primary factor of importance is the muscle-waste, the condition of the joint being secondary, the number of lax joints would be very small, because, with very few exceptions, the condition follows only in cases improperly treated. If voluntary movements be commenced sufficiently early, whilst the patient is resting, and are aided by massage, and later on by passive movements plus resistance exercises, muscle-waste will be entirely avoided unless the injury has caused gross tearing of muscles, especially at their aponeurotic or tendinous attachments; for example, the muscle-waste in 'rider's sprain' (laceration of the tendon of origin of the adductor longus in the thigh) is rarely, if ever, so far as I have seen it, completely repaired.