The inguinal ligament is a thickened, rolled lower border of the external oblique aponeurosis, running from the anterior superior iliac spine to the pubic tubercle. At its pubic attachment it fans out as the lacunar ligament and the reflected inguinal ligament.
The inguinal ligament pubic insertion is the landmark for femoral vessel and nerve access, with the femoral artery palpable just medial to the midpoint of the inguinal ligament. The pubic attachment is the medial anchor in McVay (Cooper ligament) inguinal hernia repair. Osteitis pubis and pubic symphysis pathology may involve the inguinal ligament attachment creating medial groin pain.
Degenerative tendinopathy at the inguinal ligament pubic insertion producing medial groin pain reproduced by hip flexion loading, contributing to athletic pubalgia syndrome in kicking sport athletes.
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