The pectineal ligament (Cooper's ligament) is formed by the thickened periosteum and aponeurotic fibres of the pectineus muscle blending with the periosteum of the superior pubic ramus along the pectineal line. The tendinous component of pectineus contributes substantially to this structure.
The pectineal ligament is the posterior anchor in the McVay hernia repair (Cooper's ligament repair) for femoral and inguinal hernias. It is the strongest available tissue in the medial groin for suture fixation. In laparoscopic hernia repair (TEP/TAPP), mesh is fixed to Cooper's ligament posteriorly. The iliopectineal arch runs adjacent to the ligament, dividing the lacuna musculorum from the lacuna vasorum.
Avulsion or disruption of the pectineal ligament in high-energy pelvic trauma producing loss of the posterior inguinal floor support and contributing to femoral or inguinal hernia formation.
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