Cooper's pectineal ligament (also called the pectineal ligament or ligament of Cooper in the inguinal region — distinct from Cooper's breast ligaments) is the thickened periosteal condensation along the pectineal line of the pubic bone (iliopectineal line), running from the pubic tubercle to the iliopectineal eminence. It forms the posterior boundary of the femoral ring and the floor of the inguinal canal posterior wall at the medial aspect.
Provides the posterior anchor for the pectineal component of the inguinal ligament; forms the posterior boundary of the femoral canal (where femoral hernias occur medially to the femoral vein); is the fixation point for the Burch colposuspension sutures and the Lotheissen (McVay) hernia repair.
Cooper's pectineal ligament is the anatomical target for two important surgical procedures: the McVay (Lotheissen) hernia repair sutures the transversus abdominis aponeurosis to the pectineal ligament rather than the inguinal ligament, providing stronger repair for femoral and recurrent inguinal hernias; and the Burch colposuspension sutures the paravaginal fascia to Cooper's ligament bilaterally to elevate the bladder neck for stress urinary incontinence correction.
The Burch colposuspension fixes the paravaginal fascia at the bladder neck and proximal urethra level to Cooper's pectineal ligament bilaterally with permanent sutures, elevating the bladder neck and restoring the continence mechanism in stress urinary incontinence; open or laparoscopic techniques achieve similar long-term success rates of approximately 80% at 5 years.
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