The sacrotuberous ligament is a broad, fan-shaped band connecting the posterior ilium, sacrum, and coccyx to the ischial tuberosity. It converts the sciatic notches into foramina alongside the sacrospinous ligament and resists sacral nutation.
Resists sacral nutation (forward rotation of the sacral base) and sacroiliac joint distraction, creates the boundaries of the greater and lesser sciatic foramina, and provides the surface for the attachment of the long head of biceps femoris and gluteus maximus.
The sacrotuberous ligament is assessed in pelvic ring instability — its disruption contributes to sacroiliac instability that requires posterior sacroiliac screw fixation. Chronic sacrotuberous ligament pain (following ligament avulsion from the ischial tuberosity in hamstring origin injuries) produces posterior pelvic pain reproduced by direct pressure.
The sacrotuberous ligament attaches near the hamstring ischial tuberosity origin — complete hamstring avulsion may partially disrupt this ligament, contributing to pelvic floor dysfunction.
Sacrotuberous ligament integrity assessed by provocation testing in posterior pelvic ring injuries — intact ligament limits sacroiliac distraction and may indicate relative stability.
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