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Inguinal ligament

The inguinal ligament, also known as the crural ligament or Poupart's ligament, is a prominent band of fibrous tissue in the human lower abdomen that spans from the anterior superior iliac spine (ASIS) to the pubic tubercle, forming the inferior border of the inguinal canal and serving as a critical anatomical and surgical landmark in the groin region.^[1] Derived from the external oblique aponeurosis, it measures approximately 4 to 5 inches in length and acts as a supportive structure that bridges key neurovascular elements, including the femoral artery and vein, while contributing to the stability of the abdominal wall by preventing downward displacement of intra-abdominal contents.^[1]

Anatomy

Structure and Attachments

The inguinal ligament is a fibrous band formed by the thickened, rolled inferior border of the external oblique muscle's aponeurosis, where the obliquely arranged anteroinferior fibers fold inward upon themselves.^[1] This rolling creates a robust, inrolled edge that provides structural integrity to the lower abdominal wall.^[2] The ligament's composition consists primarily of dense collagenous connective tissue, blending seamlessly with the surrounding fascial layers.^[3] In adults, the inguinal ligament measures approximately 12–14 cm in length, extending with a slight inferior and anterior convexity that imparts a gentle curved profile, inclined at about 35–40° to the horizontal plane.^[4] Laterally, it attaches firmly to the anterior superior iliac spine (ASIS), anchoring it to the ilium.^[1] Medially, the ligament inserts onto the pubic tubercle of the pubic bone, from which point its fibers continue and fan out to form the triangular lacunar ligament.^[1] This medial extension reinforces the transition between the abdominal wall and the pelvis.^[3] Inferiorly, the inguinal ligament blends continuously with the fascia lata of the thigh, facilitating a smooth interface between the trunk and lower limb.^[1] Superiorly, it contributes to the reinforcement of the abdominal wall by integrating with the aponeurotic expansions of adjacent muscles.^[1]

Relations to Adjacent Structures

The inguinal ligament forms the inferior boundary of the inguinal region, effectively separating the abdominal cavity from the thigh and serving as a key divider between the abdomen and the lower limb.^[5]^[6] This positional role positions it as the superior boundary of the femoral triangle and the floor of the inguinal canal.^[5]^[6] Superiorly, the ligament overlies the inguinal canal, with fibers of the external oblique muscle aponeurosis forming its rolled edge and lying directly above it, while the ilioinguinal nerve courses along its upper surface within the canal.^[3]^[6] Inferiorly, it is continuous with the pectineal ligament, also known as Cooper's ligament, through the lacunar ligament at its medial end, creating a seamless transition along the pectineal line of the pubis.^[5]^[3] In its lateral third, the external iliac artery and vein transition to become the common femoral artery and vein, crossing beneath its convex inferior surface at the midinguinal point.^[5]^[6]^[3] On its medial aspect, the inguinal ligament forms the anterior boundary of the femoral canal, a potential space medial to the femoral vein that is clinically relevant for herniations.^[6] Adjacent neurovascular structures include the spermatic cord in males or the round ligament of the uterus in females, which pass through the inguinal canal superficial to the ligament's floor, alongside the genital branch of the genitofemoral nerve.^[5]^[6] Posterior to the ligament lie the iliopsoas muscle, femoral nerve, and lateral cutaneous nerve of the thigh, emphasizing its intimate relation to the contents of the femoral triangle.^[5]^[3]

Function

Biomechanical Role

The inguinal ligament serves as a critical tension band in the lower anterior abdominal wall, reinforcing it against increases in intra-abdominal pressure generated during activities such as coughing, sneezing, or heavy lifting. By forming the inferior boundary of the external oblique aponeurosis, it helps contain abdominal contents and prevents their downward protrusion under such pressure, contributing to the overall structural integrity of the abdominal wall.^[7] This mechanical reinforcement is essential for maintaining abdominal stability during dynamic trunk movements. The ligament provides key attachment points for the internal oblique muscle along its lateral two-thirds and the transversus abdominis muscle along its lateral one-third, thereby integrating these muscles into the core stabilizing system. These attachments enhance core stability by facilitating coordinated muscle contraction that supports spinal alignment and resists rotational or flexural forces on the trunk. Additionally, the middle third serves as an origin for the cremaster muscle, further aiding in regional tension management.^[1] Through its connections between the anterior superior iliac spine and the pubic tubercle, the inguinal ligament distributes forces from the pelvis to the abdominal wall and vice versa, balancing loads across the pubic region to prevent excessive strain. In standing posture, it aids in maintaining upright alignment by stabilizing abdominal contents.^[1] It also supports stability during locomotion.^[1]

Contribution to the Inguinal Canal

The inguinal ligament, formed by the inferior border of the external oblique aponeurosis extending from the anterior superior iliac spine to the pubic tubercle, serves as the floor of the inguinal canal throughout its approximately 4 to 6 cm length, providing a firm, supportive base for the passage of abdominal contents.^[1]^[6] This superior surface of the ligament constitutes the inferior boundary of the canal, ensuring structural integrity during the transmission of key neurovascular structures.^[6] Medial to the deep inguinal ring, the ligament contributes indirectly to the formation of the posterior wall through its aponeurotic extensions, such as the lacunar ligament and reflected inguinal ligament (Colles' ligament), which reinforce the medial aspect of the canal.^[1]^[6] The deep inguinal ring is positioned superior to the midpoint of the inguinal ligament, approximately 1.3 cm above its inguinal point (midway between the anterior superior iliac spine and pubic symphysis), serving as the internal entrance to the canal within the transversalis fascia.^[6]^[1] In contrast, the superficial inguinal ring pierces the external oblique aponeurosis just superior to the pubic tubercle, immediately above the medial end of the inguinal ligament, marking the external exit of the canal.^[6] Through this architectural arrangement, the inguinal ligament facilitates the unobstructed passage of the spermatic cord—including the vas deferens, testicular artery, and nerves—in males or the round ligament of the uterus in females, while its robust floor support helps maintain canal stability and resist undue protrusion of peritoneal contents.^[6]^[1] Medially, the ligament interacts with the conjoint tendon (also known as the inguinal aponeurotic falx), where the tendon's attachment to the pubic crest and pectineal line provides reinforced closure to the canal's posterior wall, enhancing overall compartmental security near the superficial ring.^[8]^[6]

Clinical Significance

Associated Pathologies

The inguinal ligament serves as a critical anatomical landmark in the classification of groin hernias, with inguinal hernias occurring superior to the ligament and femoral hernias inferior to it.^[1] Indirect inguinal hernias, which are congenital in origin and more prevalent in males, protrude laterally through the deep inguinal ring above the ligament, following the path of the inguinal canal without directly involving the ligament itself but emerging superior to it.^[1] In contrast, direct inguinal hernias are acquired, typically in older males, and arise medially through Hesselbach's triangle—a region bounded inferiorly by the inguinal ligament, laterally by the inferior epigastric vessels, and medially by the rectus sheath—resulting in a bulge that presses against the weakened transversalis fascia posterior to the ligament.^[1] Femoral hernias, distinguished by their location in the femoral canal inferior to the inguinal ligament, represent a smaller subset of groin hernias and are more common in females due to the wider pelvis and femoral canal; they are bordered anterosuperiorly by the inguinal ligament and carry a higher risk of complications owing to the narrow neck of the hernia sac.^[9] Sportsman's hernia, also known as athletic pubalgia or inguinal disruption, involves chronic groin pain from weakness, dehiscence, or tears in the posterior wall of the inguinal canal and surrounding structures like the external oblique aponeurosis, without a true herniation; it predominantly affects athletes in sports requiring sudden twisting or kicking, leading to posterior wall weakness in the inguinal canal.^[10] Epidemiologically, inguinal hernias have a lifetime prevalence of approximately 27% in men and 3% in women, accounting for about 75% of all abdominal wall hernias, with indirect types twice as common as direct ones.^[11] Risk factors include conditions that elevate intra-abdominal pressure, such as obesity, chronic cough, and pregnancy, alongside male sex, advanced age, and family history.^[12] Common symptoms across these pathologies include a visible or palpable groin bulge that may worsen with straining, coughing, or standing, accompanied by localized pain or discomfort during physical activity.^[12] Complications, particularly with inguinal and femoral hernias, encompass incarceration—where the hernia contents become trapped and irreducible—and strangulation, which can lead to tissue ischemia, bowel obstruction, nausea, vomiting, and potentially life-threatening necrosis if untreated.^[12]

Surgical and Diagnostic Relevance

The inguinal ligament serves as a critical surgical landmark in open hernia repair techniques, such as the Lichtenstein tension-free repair, where prosthetic mesh is fixed to the pubic tubercle and sutured along the superior surface of the ligament to reinforce the posterior wall of the inguinal canal.^[13] In the Bassini repair, the conjoined tendon and transversalis fascia are imbricated and sutured to the inguinal ligament posterior to the spermatic cord, providing a tensioned reconstruction of the canal floor.^[14] These approaches highlight the ligament's role in anchoring repairs to prevent recurrence in direct and indirect inguinal hernias. In vascular procedures, the inguinal ligament guides access to the common femoral artery, with the optimal puncture site located at the midpoint of the artery, approximately 2-3 cm distal to the ligament, to minimize risks of retroperitoneal bleeding or pseudoaneurysm formation.^[15] This positioning ensures safe entry above the femoral bifurcation while avoiding the external iliac artery proximal to the ligament.^[16] Surgical incisions in groin-related procedures, including appendectomy and anterior hip approaches, are often oriented parallel or oblique to the inguinal ligament to align with natural skin creases and reduce the risk of injuring the ilioinguinal or iliohypogastric nerves, which course along or pierce the ligament.^[17] For instance, in open appendectomy via McBurney's incision, placement lateral and superior to the ligament helps preserve nerve integrity, though iatrogenic damage remains a reported complication.^[18] Diagnostically, palpation along the inguinal ligament is essential for detecting and manually reducing inguinal hernias, with the examiner's finger placed superior to the ligament in the inguinal canal to assess for bulges during Valsalva maneuver.^[19] Imaging modalities like ultrasound and MRI are employed to evaluate ligament integrity, identifying tears or disruptions in cases of trauma or chronic groin pain, where dynamic ultrasound detects occult hernias and MRI delineates soft-tissue abnormalities such as enthesopathy or partial avulsions at the ligament's attachments.^[20] These techniques aid in differentiating ligament-related pathology from adjacent muscle strains. Anatomical variations, including rare congenital laxity or partial absence of the inguinal ligament, are associated with elevated hernia risk due to weakened abdominal wall support, often necessitating tailored repairs.^[21] In laparoscopic approaches like transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) repairs, direct visualization of the ligament facilitates precise mesh placement and dissection of the preperitoneal space without peritoneal breach.^[22] Since 2023, robotic-assisted inguinal hernia repairs have seen increased adoption, leveraging enhanced three-dimensional visualization and dexterity, with studies from 2024-2025 reporting comparable recurrence rates to conventional techniques.^[23]^[24]

History and Nomenclature

Early Anatomical Descriptions

The earliest known references to structures in the groin region, including ligaments associated with hernias, appear in the works of the ancient physician Galen (c. 130–210 AD), who described the patency of the processus vaginalis and attributed inguinal hernias to peritoneal rupture, providing indirect insights into the supporting ligaments of the area.^[25] Galen's observations on hernia anatomy, derived from dissections and clinical cases, formed the foundational knowledge that persisted through the Middle Ages, emphasizing the role of groin tissues in containing abdominal contents.^[26] During the Renaissance, the inguinal ligament received its first detailed anatomical description from Gabriele Falloppio (1523–1562) in his 1561 publication Observationes Anatomicae, where he delineated the ligament as a key fibrous band forming part of the inguinal canal and contributing to hernia containment.^[1] Falloppio's work, based on meticulous dissections, highlighted the ligament's extension from the anterior superior iliac spine to the pubic tubercle, establishing it as an essential landmark for surgical interventions in the groin.^[27] This description advanced understanding beyond Galen's era by integrating the ligament into the broader anatomy of the abdominal wall. In the 18th century, anatomists like Petrus Camper (1722–1789) further elucidated the inguinal ligament through dissections focused on hernia etiology, noting its role in the inguinal canal's structure and the mechanisms of hernia protrusion in both children and adults.^[28] Camper's studies, including illustrations in his Icones Herniarum, emphasized the ligament's aponeurotic composition and its vulnerability in congenital weaknesses, influencing early surgical approaches.^[29] Early clinical recognition of the inguinal ligament emerged in 16th-century hernia surgeries performed by barbers-surgeons, who targeted the groin region for reductions and excisions, implicitly relying on the ligament as a boundary structure despite limited anatomical knowledge.^[30] These practitioners, such as those documented in European surgical texts, often used the ligament's palpable edge to guide incisions, linking it to practical hernia management before formal anatomical nomenclature.^[31]

Eponyms and Modern Terminology

The primary eponym for the inguinal ligament is Poupart's ligament, named after the French surgeon and anatomist François Poupart (1661–1709), who provided a detailed description of its structure and function in relation to abdominal support and hernia repair in a 1705 presentation published in the Histoire de l'Académie Royale des Sciences.^[32] Poupart emphasized its role as a key landmark in surgical interventions for inguinal hernias, referring to it as the "suspender of the abdomen" due to its stabilizing properties.^[33] Other historical eponyms include the more general "groin ligament," reflecting its location in the inguinal region, though this is largely descriptive rather than tied to a specific individual.^[1] Less commonly, the term Gimbernat's ligament has been applied to the lacunar ligament, a medial triangular extension of the inguinal ligament, named after Spanish surgeon Antonio de Gimbernat y Arbós (1734–1816), who described it in 1765 as part of his work on femoral hernias.^[34] The term "inguinal" derives from the Latin inguen, meaning "groin," which accurately denotes the ligament's position along the inferior border of the abdomen in the groin area.^[35] By the mid-20th century, anatomical nomenclature began shifting away from eponyms toward descriptive terms to promote universality and reduce historical biases, a trend formalized by the Federative International Programme for Anatomical Terminology (FIPAT) in 1998 under the International Federation of Associations of Anatomists (IFAA).^[36] In the second edition of Terminologia Anatomica (2019), the structure is standardized as ligamentum inguinale, with eponyms like Poupart's ligament listed as historical synonyms but not recommended for primary use. In contemporary medical practice, particularly in radiology and surgery, the descriptive term "inguinal ligament" is overwhelmingly preferred for its clarity and international consistency, though eponyms such as Poupart's ligament occasionally appear in older textbooks or as historical references to honor foundational contributions.^[33]^[1]

References

[1]
Anatomy, Abdomen and Pelvis: Inguinal Ligament (Crural ... - NCBI
Jan 30, 2024 · Clinical Significance The inguinal ligament is an important diagnostic and surgical landmark. This structure helps differentiate groin hernia ...Introduction · Structure and Function · Nerves · Surgical Considerations
[2]
https://teachmeanatomy.info/abdomen/areas/inguinal-canal/
[3]
Inguinal Ligament - Physiopedia
It has 2 surfaces concave and convex, the convex surface toward the thigh attached to the deep fascia that pulling the ligament downward.
[4]
[PDF] Inguinal ligament and canal
Passing through the superficial inguinal ring are: (a) the round ligament of the uterus,. (b) a closely applied fatpad,. (c) the genital branch of the ...
[5]
Inguinal ligament: Attachments, function and relations | Kenhub
The inguinal ligament extends between the anterior superior iliac spine and the pubic tubercle. Learn more about its anatomy at Kenhub!
[6]
Anatomy, Abdomen and Pelvis: Inguinal Region (Inguinal Canal)
It functions as a passageway for structures between the intra- and extra-abdominal structures. In males, it transmits the spermatic cord, gonadal vessels, and ...
[7]
Anatomy, Abdomen and Pelvis: Abdominal Wall - StatPearls - NCBI
The inferior edge of the internal oblique and transversus abdominis form the conjoint tendon. This muscle originates from the iliolumbar ligament and iliac ...Missing: stability | Show results with:stability
[8]
A qualitative literature review exploring the role of the inguinal ...
... A qualitative literature review exploring the role of the inguinal ligament in the context of inguinal disruption management. Surg Radiol Anat. 2019 Mar;41(3): ...
[9]
Conjoint Tendon (Inguinal Aponeurotic Falx) - StatPearls - NCBI - NIH
Jul 24, 2023 · ... role in protecting a weak area in the abdominal wall in which a ... INguinal Ligament. Henry Vandyke Carter, Public domain, via ...
[10]
Femoral Hernia - StatPearls - NCBI Bookshelf
May 3, 2025 · A femoral hernia occurs in the femoral canal and is bordered by the inguinal ligament anterosuperiorly, Cooper's ligament inferiorly, the ...
[11]
Sports hernia: a clinical update - PMC - NIH
Sports hernias usually present with insidious onset exercise-related groin pain. It is often disabling and results in cessation of participation in sport.
[12]
Inguinal hernias - PMC - NIH
Inguinal hernias present with a lump in the groin that goes away with minimal pressure or when the patient is lying down. Most cause mild to moderate discomfort ...Missing: ligament | Show results with:ligament
[13]
Inguinal hernia - Symptoms & causes - Mayo Clinic
An inguinal hernia happens when tissue, such as part of the intestine, pokes through a weak spot in the abdominal muscles. The resulting bulge can be ...
[14]
Open Inguinal Hernia Repair Technique - Medscape Reference
Apr 18, 2023 · Bassini repair. The Bassini technique for inguinal hernia repair involves suturing the transversalis fascia and the conjoined tendon to the ...Approach Considerations · Lichtenstein Tension-Free... · Other Approaches
[15]
Open Inguinal Hernia Repair - StatPearls - NCBI Bookshelf
The shelving edge of the inguinal ligament is the superior attachment of the inguinal ligament to the iliopubic tract. The iliopubic tract forms the ...
[16]
The Anatomy of Femoral Vascular Access - Taming the SRU
Mar 3, 2018 · This portion of the vessel, approximately 2 - 3 cm distal from the inguinal ligament, is the safest site for femoral puncture (see Figure 3 ...
[17]
Femoral artery access | Radiology Reference Article | Radiopaedia.org
Dec 21, 2024 · the common femoral artery (CFA) midpoint is the ideal puncture site to minimize complications related to arterial bifurcation or inguinal ...
[18]
The iliohypogastric and ilioinguinal nerves. Distribution in ... - PubMed
To avoid cutting the anterior branches of the iliohypogastric and ilioinguinal nerves in appendectomy, incisions should be placed at a distance of not less ...
[19]
[PDF] Neuropathic inguinal pain due to nerve injury after a laparoscopic ...
Abstract. Objective To describe the first pediatric case in the literature of neuropathic inguinal pain secondary to iatrogenic nerve injury.
[20]
Inguinal Hernia - Physiopedia
In order to reduce Intra abdominal pressure (IAP), activities like squatting and lifting especially with additional weights should be avoided as these ...
[21]
Imaging of Groin Pain: Magnetic Resonance and Ultrasound ...
Mar 8, 2017 · MRI and US are valuable in diagnosing pathology in athletes with groin pain, with the added utility of treatment using US-guided intervention.
[22]
What is the diagnosis of inguinal (groin area) ligament disruption?
Apr 9, 2025 · Palpation of the inguinal region may reveal defects or gaps in the ligament structure. Imaging studies are essential for confirmation, with MRI ...
[23]
Transabdominal preperitoneal (TAPP) inguinal hernia repair
It is essential to visualize the entrance of the round ligament or vas deferens and spermatic cord elements to the deep inguinal ring, before attempting to ...
[24]
Open vs. robot-assisted preperitoneal inguinal hernia repair ... - NIH
May 4, 2024 · The robot-assisted approach was a significantly longer procedure than the open preperitoneal approach, but the latter required a longer hospital ...
[25]
A Systematic Review of Open, Laparoscopic, and Robotic Inguinal ...
The literature indicates that RHR is safe and effective for the management of groin hernias. Operative times and costs remain a concern when using this ...Missing: preservation | Show results with:preservation
[26]
Fascinating history of groin hernias - NIH
Jul 20, 2021 · Hesselbach also defined the inguinal triangle (i.e., “Hesselbach's triangle”), which is superolaterally bounded by the inguinal ligament (IL) ...
[27]
[The history of treatment of groin hernia] - PubMed
Most essential knowledge concerning hernias in ancient times derives from Galen. This knowledge with minor modifications was valid during Middle Ages and ...
[28]
Anatomy, Abdomen and Pelvis, Inguinal (Crural, Pouparts) Ligament
Jun 11, 2020 · In 1562, Gabrielle Falloppio first described the inguinal ligament and established the landmark as an integral component of groin hernia repair.
[29]
An early observation on the anatomy of the inguinal canal ... - PubMed
An early observation on the anatomy of the inguinal canal and the etiology of inguinal hernias by Petrus Camper in the 18th century · Authors · Affiliation.Missing: ligament | Show results with:ligament
[30]
The Contribution of Petrus Camper to the Anatomy and Aetiology of ...
Oct 19, 2020 · An early observation on the anatomy of the inguinal canal and the etiology of inguinal hernia by Petrus Camper in the 18th Century. World J ...
[31]
Henle's Ligament: A Comprehensive Review of Its Anatomy and ...
Sep 26, 2018 · This review article will cover Henle's original description of the ligament, historical changes in terminology, embryological studies of the ligament, and the ...Missing: 1841 | Show results with:1841
[32]
History of inguinal hernia repair, laparoendoscopic techniques
Repair was mostly done by “barber surgeons. ... Period 2: At the end of the nineteenth-century knowledge about pathogenesis and surgery of inguinal hernia disease ...Missing: 16th | Show results with:16th
[33]
“Respectful Image”: Revenge of the Barber Surgeon - PMC - NIH
The 16th-century Guild of Barbers and Surgeons, forerunner of the Royal ... Rare operations for inguinal hernia (punctum aureum), excision of (bladder) ...
[34]
Francois Poupart - Clinical Anatomy Associates Inc.
Jul 8, 2013 · Poupart died at the age of 48. His name is eponymically associated with the inguinal ligament, which he described in detail in 1705.
[35]
Inguinal ligament | Radiology Reference Article | Radiopaedia.org
Jan 16, 2025 · Attachments. The inguinal ligament arises from the anterior superior iliac spine and attaches to the pubic tubercle, although there are some ...
[36]
Lacunar (Gimbernat's) ligament - Clinical Anatomy Associates Inc.
Dec 2, 2013 · The lacunar ligament is a half-moon shaped ligament between the inguinal and pectineal ligaments, first described by Don Antonio de Gimbernat y ...
[37]
Etymology of Abdominal Wall and Inguinal Terms
Inguinal – Inguen is the Latin word for the groin. For the Romans, this word was also used for ones ”privates”.
[38]
(PDF) De-eponymizing Anatomical Terminology - ResearchGate
Nov 22, 2020 · For example, the iliofemoral ligament is commonly known as Bertin's ligament in France after Exupere Joseph Bertin (1712-1781) and known as ...