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Ischiofemoral ligament

The ischiofemoral ligament is one of the three major intrinsic ligaments of the hip joint, along with the iliofemoral and pubofemoral ligaments. It is located posteriorly, reinforcing the hip capsule, and spirals from the ischium around the femoral neck. This orientation allows it to resist excessive internal rotation and extension of the hip.

The ligament plays a crucial role in maintaining posterior stability of the hip joint and is of great importance in orthopedic, sports medicine, and radiologic practice, particularly in cases of hip instability, dislocation, or labral pathology.

Synonyms

  • Posterior ligament of the hip

  • Ligamentum ischiofemorale

  • Capsular ischiatic ligament

Attachments

  • Origin: Arises from the ischium, posteroinferior to the acetabulum

  • Course: Fibers spiral superolaterally, blending with the posterior hip capsule and intertrochanteric line

  • Insertion: Attaches to the posterior aspect of the femoral neck, medial to the greater trochanter

Relations

  • Anteriorly: Posterior surface of femoral neck and capsule

  • Posteriorly: Gluteus minimus and quadratus femoris muscles

  • Superiorly: Capsule near the iliofemoral ligament

  • Inferiorly: Capsule near the pubofemoral ligament

  • Closely related to the posterior labrum and acetabular rim

Function

  • Reinforces the posterior hip capsule

  • Limits internal rotation of the femur

  • Resists excessive extension of the hip joint

  • Contributes to overall hip stability, especially against posterior dislocation

Clinical Significance

  • Hip instability: Weakening or tearing may predispose to posterior hip dislocation

  • Labral pathology: Tightness or injury can be associated with posterior labral tears

  • Impingement syndromes: May play a role in limiting range of motion

  • Surgical relevance: Important landmark during hip arthroscopy and joint capsule repair

  • Imaging relevance: Appears as a low-signal capsular structure; disruption indicates pathology

MRI Appearance

T1-weighted images:

  • Appears as a dark (low-signal) band posterior to the femoral neck

  • Surrounded by bright fat, aiding visualization

T2-weighted images:

  • Ligament remains dark, but edema or partial tear may show focal bright areas

  • Joint fluid provides contrast against dark ligament

STIR (Short Tau Inversion Recovery):

  • Normal ligament appears dark

  • Strain, sprain, or capsular injury appears bright due to fluid or edema

T1 Fat-Sat Post-Contrast:

  • Normal ligament shows no enhancement

  • Pathologic ligament shows focal or diffuse enhancement in cases of capsulitis, synovitis, or tearing

CT Appearance

Non-Contrast CT:

  • Not well visualized directly due to soft tissue density

  • Seen indirectly by relation to posterior femoral neck and acetabular rim

  • Calcification or ossification (rare) may be visible

Post-Contrast CT:

  • Ligament itself does not enhance

  • Periligamentous enhancement may be seen with inflammation or neoplastic infiltration

  • Indirect signs include capsular thickening or irregularity

MRI image

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MRI image

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MRI image

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MRI image

MRI image

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CT image

Ischiofemoral ligament ct axial