NDLI: In Vivo Properties of Uterine Suspensory Tissue in Pelvic Organ Prolapse

Content Provider	The American Society of Mechanical Engineers (ASME) Digital Collection
Author	Luo, Jiajia Smith, Tovia M. DeLancey, John O. L. James A. Ashton-Miller
Copyright Year	2014
Abstract	The uterine suspensory tissue (UST), which includes the cardinal (CL) and uterosacral ligaments (USL), plays an important role in resisting pelvic organ prolapse (POP). We describe a technique for quantifying the in vivo time-dependent force-displacement behavior of the UST, demonstrate its feasibility, compare data from POP patients to normal subjects previously reported, and use the results to identify the properties of the CL and USL via biomechanical modeling. Fourteen women with prolapse, without prior surgeries, who were scheduled for surgery, were selected from an ongoing study on POP. We developed a computer-controlled linear servo actuator, which applied a continuous force and simultaneously recorded cervical displacement. Immediately prior to surgery, the apparatus was used to apply three “ramp and hold” trials. After a 1.1 N preload was applied to remove slack in the UST, a ramp rate of 4 mm/s was used up to a maximum force of 17.8 N. Each trial was analyzed and compared with the tissue stiffness and energy absorbed during the ramp phase and normalized final force during the hold phase. A simplified four-cable model was used to analyze the material behavior of each ligament. The mean ± SD stiffnesses of the UST were 0.49 ± 0.13, 0.61 ± 0.22, and 0.59 ± 0.2 N/mm from trial 1 to 3, with the latter two values differing significantly from the first. The energy absorbed significantly decreased from trial 1 (0.27 ± 0.07) to 2 (0.23 ± 0.08) and 3 (0.22 ± 0.08 J) but not from trial 2 to 3. The normalized final relaxation force increased significantly with trial 1. Modeling results for trial 1 showed that the stiffnesses of CL and USL were 0.20 ± 0.06 and 0.12 ± 0.04 N/mm, respectively. Under the maximum load applied in this study, the strain in the CL and USL approached about 100%. In the relaxation phase, the peak force decreased by 44 ± 4% after 60 s. A servo actuator apparatus and intraoperative testing strategy proved successful in obtaining in vivo time-dependent material properties data in representative sample of POP. The UST exhibited visco-hyperelastic behavior. Unlike a knee ligament, the length of UST could stretch to twice their initial length under the maximum force applied in this study.
Starting Page	021016
Ending Page	021016
Page Count	1
File Format	PDF
ISSN	01480731
e-ISSN	15288951
Journal	Journal of Biomechanical Engineering
Volume Number	136
Issue Number	2
DOI	10.1115/1.4026159
Language	English
Publisher	The American Society of Mechanical Engineers
Publisher Date	2014-02-05
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Actuators Biological tissues Biomechanics Cables Displacement Materials properties Package on package Relaxation (Physics) Servomechanisms Stiffness Stress Surgery Testing
Content Type	Text
Resource Type	Article
Subject	Physiology (medical) Biomedical Engineering

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