The iliofemoral ligament is the strongest ligament in the body, shaped like an inverted Y (the Y ligament of Bigelow). It runs from the anterior inferior iliac spine and acetabular rim to the intertrochanteric line, its two limbs reaching the upper and lower parts of the line. It primarily resists hip extension and external rotation.
| Origin | Anterior inferior iliac spine and adjacent acetabular rim |
|---|---|
| Insertion | Intertrochanteric line of the femur |
Prevents hip hyperextension in standing, allowing upright posture with hip extensors relaxed.
The iliofemoral ligament is the primary restraint to hip hyperextension and tolerates very high loads. It tightens in hip extension and external rotation, the close-packed position of the hip joint. Anterior hip dislocation tears this ligament. In total hip arthroplasty via the anterior approach and in hip arthroscopy, it must be carefully managed, because excessive capsulotomy without repair can leave anterior instability or microinstability with groin pain in extension. Capsular repair or plication of the iliofemoral ligament is performed in arthroscopic hip instability surgery. Dancers and gymnasts with repetitive end-range hip extension may develop iliofemoral ligament microtrauma contributing to anterior hip pain.
High-energy traumatic dislocation requiring iliofemoral ligament failure, demanding urgent reduction to prevent avascular necrosis of the femoral head.
Anterior hip microinstability after excessive release of the iliofemoral ligament during arthroscopic or open hip surgery, treated with capsular plication.
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