The cardinal (Mackenrodt) ligament is the primary lateral cervical support structure, connecting the cervix to the pelvic sidewall alongside the uterosacral ligaments. Its laxity from vaginal delivery or collagen disorders is the primary cause of uterine prolapse. The ureter runs immediately above the cardinal ligament as it crosses the cardinal ligament ('water under the bridge') — the classic site of ureteral injury during hysterectomy.
| Origin | Lateral cervix and upper vaginal wall |
|---|---|
| Insertion | Pelvic sidewall (tendinous arch of the levator ani) |
| Actions | Primary lateral support of the cervix and upper vagina; resists uterine descent |
|---|
The ureter crosses the cardinal ligament 2 cm lateral to the cervix ('water under the bridge') — inadvertent clamping of the cardinal ligament at hysterectomy is the most common cause of ureteral injury. The cardinal ligament is incorporated in sacrocolpopexy and sacral colpoperineorrhaphy for pelvic floor reconstruction.
Ureter at risk as it crosses under the cardinal ligament during hysterectomy — systematic lateral dissection before clamping prevents ureteral injury.
This website uses cookies to enhance your experience. Some are essential for site functionality, while others help us analyze and improve your usage experience. Please review your options and make your choice.
If you are under 16 years old, please ensure that you have received consent from your parent or guardian for any non-essential cookies.
Your privacy is important to us. You can adjust your cookie settings at any time. For more information about how we use data, please read our privacy policy. You may change your preferences at any time by clicking on the settings button below.
Note that if you choose to disable some types of cookies, it may impact your experience of the site and the services we are able to offer.
Some required resources have been blocked, which can affect third-party services and may cause the site to not function properly.
This website uses cookies to enhance your browsing experience and ensure the site functions properly. By continuing to use this site, you acknowledge and accept our use of cookies.
