Mechanical Characterization of Swine Uterosacral and Cardinal Ligaments

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Virginia Tech

The uterosacral ligament (USL) and cardinal ligament (CL) are the two major suspensory tissues of the uterus, cervix, and vagina. These supportive structures can be weakened or damaged, leading to the development of pelvic floor disorders (PFDs) such as urinary incontinence, fecal incontinence, and pelvic organ prolapse. In the surgical treatment for PFDs, the USL and CL are extensively used as anchor structures to restore the normal position of the prolapsed organs. Therefore, the mechanical properties of the USL and CL may be critical for the development of new surgical reconstruction strategies for PFDs.

In chapter 1, we present the first histo-mechanical characterization of the swine USL and CL using histological analysis, scanning electron microscopy and quasi-static uniaxial tensile tests. Our results suggest that the histological and uniaxial tensile properties of the swine CL and USL are very similar to those in humans. The swine is found to be a suitable animal model for studying the mechanical properties of these ligaments.

To capture both the active and passive mechanical responses of biological tissues containing SMCs such as the USL and CL, a new structural constitutive model is proposed in chapter 2. The deformation of the active component in such tissues during isometric and isotonic contractions is described using an evolution law. This model is tested with published active and passive, uniaxial and biaxial, experimental data on pig arteries due to lack of data on the active properties of the USL and CL.

Subjected to constant forces in-vivo, the structure and length of the USL and CL are sig- nificantly altered over time. In chapter 3, we present the first rigorous characterization of the fiber microstructure and creep properties of the USL/CL complex by using scanning electron microscopy and planar biaxial testing. Fibers are found to be oriented primarily along the main in-vivo loading direction. In such direction, the creep proceeds significantly faster under lower load.

Overall, our experimental findings advance our knowledge about the passive elastic and viscoelastic properties of the USL/CL complex. The novel structural constitutive model proposed enhances our understanding of the active mechanical behavior of biological tissues containing SMCs. Knowledge about the mechanical behavior of the USL and CL from experimental and theoretical studies such as those presented here will help to improve, in the long term, the medical treatment for PFDs.

Uterosacral Ligament, Cardinal Ligament, Scanning Electron Microscopy, Histology, Uniaxial and Biaxial Tests, Nonlinear Elasticity, Viscoelasticity, Isometric Contraction, Isotonic Contraction, Constitutive Modeling