Description of the iliolumbar ligament for computer-assisted reconstruction

Hammer, Niels; Steinke, Hanno; Böhme, Jörg; Stadler, Jörg; Josten, Christoph; Spanel‐Borowski, Katharina

doi:10.1016/j.aanat.2010.02.003

Cited by 34 publications

(50 citation statements)

References 25 publications

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“…Additionally, the force vector applied to the pelvic ligaments causing APCII is dramatically different from the force vector applied in the two‐leg stance. Taking these findings and the fiber orientation of the ligaments into account, it can be concluded that the pelvic ligaments are loaded in a highly unphysiological manner.…”

Section: Discussionmentioning

confidence: 95%

“…However, pelvic anatomy is known to differ dramatically and to be gender‐dependent, which has to be taken into account when driving clinically relevant conclusions from our data. Second, as the ligaments of the pelvic ring are known to be age and gender dependent, they will possibly be impaired to an individual extent in APC. The given computer model may therefore be regarded as an individual model with individual results.…”

Section: Discussionmentioning

confidence: 99%

“…All ligaments were modeled with multiple link elements (tension only). The ligaments were implemented on the basis of our previous investigations on the ligament orientations and volumes from anatomical dissection, thin‐slice plastination, CT, and 7 Tesla magnetic resonance imaging in case series with 58 body donors . The following pelvic ligaments were integrated into the model with the number of respective elements given in parentheses: iliolumbar (2), anterior (9), interosseous (5), posterior sacroiliac ligaments (9), sacrospinous (3), and sacrotuberous ligament (3; Fig.…”

Section: Methodsmentioning

confidence: 99%

“…Taking these findings and the fiber orientation of the ligaments into account, [19][20][21][32][33][34][35] it can be concluded that the pelvic ligaments are loaded in a highly unphysiological manner.…”

Section: Apcii Of the Pelvis Causes Unphysiological Ligament Loading mentioning

confidence: 96%

See 3 more Smart Citations

The extent of ligament injury and its influence on pelvic stability following type II anteroposterior compression pelvic injuries––A computer study to gain insight into open book trauma

Böhme

Lingslebe

Steinke

et al. 2014

Journal Orthopaedic Research

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Surgical stabilization of the pelvis following type II anteroposterior compression pelvic injuries (APCII) is based on the assumption that the anterior sacroiliac, sacrospinous, and sacrotuberous ligaments disrupt simultaneously. Recent data on the ligaments contradict this concept. We aimed at determining the mechanisms of ligament failure in APCII computationally. In an individual osteoligamentous computer model of the pelvis, ligament load, and strain were observed for the two-leg stance, APCII with 100-mm symphyseal widening and for two-leg stance with APCII-related ligament failure, and validated with body donors. The anterior sacroiliac and sacrotuberous ligaments had the greatest load with 80% and 17% of the total load, respectively. APCII causes partial failure of the anterior sacroiliac ligament and the pelvis to become horizontally instable. The other ligaments remained intact. The sacrospinous ligament was negligibly loaded but stabilized the pelvis vertically. The interosseous sacroiliac and sacrotuberous ligaments are likely responsible for reducing the symphysis and might serve as an indicator of vertical stability. The sacrospinous ligament appears to be of minor significance in APCII but plays an important role in vertical stabilization. Further research is necessary to determine the influence of alterations in ligament and bone material properties. Keywords: anterior compression pelvic injury; finite element computer study; pelvic biomechanics; sacroiliac joint ligaments; pubic symphysis widening Anteroposterior compression pelvic injuries (APC) or "open book" injuries of the pelvis are most commonly the result of high velocity trauma related to motorcycle or motor vehicle accidents or falls from great heights. 1The Young-Burgess classification system of pelvic injury was developed to predict patient morbidity and mortality and to identify potential needs of non-surgical or operative treatment.1,2 APC are further classified depending on the estimated extent of injury, ranging from mechanically stable APCI via horizontally unstable APCII to completely unstable APCIII disruptions. While, there is a wide consensus that APCII and III should be stabilized surgically, 3,4 the extent of stabilization in all APC is still under discussion.5-7 As a commonly stated postulate, a pubic symphysis widening of more than 25 mm indicates instabilities of the anterior sacroiliac, sacrospinous, and sacrotuberous ligaments 2 (APCII), and therefore requires surgical intervention. However, this value appears to be arbitrary and there is increasing biomechanical 8,9 and clinical evidence 10 that especially the sacrospinous and the sacrotuberous ligaments might not necessarily be injured in APCII and also that sacroiliac joint screws might not provide additional pelvic stability following these cases.11 Moreover, the function of the sacrospinous and sacrotuberous ligaments as pelvic stabilizers is questioned by several authors.12-15 In a previously developed computer model of the pelvic belt, we could prove th...

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Apcii Of the Pelvis Causes Unphysiological Ligament Loading mentioning

confidence: 96%

See 2 more Smart Citations

The extent of ligament injury and its influence on pelvic stability following type II anteroposterior compression pelvic injuries––A computer study to gain insight into open book trauma

Böhme

Lingslebe

Steinke

et al. 2014

Journal Orthopaedic Research

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“…Fracturing occurred in all male cases but in only one female case. Male and female pelves are known to differ with regard to the bones and the connecting ligaments (Hammer et al, , ; Steinke et al, ). S3L could also be gender‐dependent, considering that the male sacrum is smaller than the female (Fick et al, ; Baumgärtel and Kühn, ).…”

Section: Discussionmentioning

confidence: 99%

Ligament‐induced sacral fractures of the pelvis are possible

et al. 2014

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Pelvic ring stability is maintained passively by both the osseous and the ligamentous apparatus. Therapeutic approaches focus mainly on fracture patterns, so ligaments are often neglected. When they rupture along with the bone after pelvic ring fractures, disrupting stability, ligaments need to be considered during reconstruction and rehabilitation. Our aim was to determine the influence of ligaments on open-book injury using two experimental models with body donors. Mechanisms of bone avulsion related to open-book injury were investigated. Open-book injuries were induced in human pelves and subsequently investigated by anatomical dissection and endoscopy. The findings were compared to CT and MRI scans of open-book injuries. Relevant structures were further analyzed using plastinated cross-sections of the posterior pelvic ring. A fragment of the distal sacrum was observed, related to open-book injury. Two ligaments were found to be responsible for this avulsion phenomenon: the caudal portion of the anterior sacroiliac ligament and another ligament running along the ventral surface of the third sacral vertebra. The sacral fragment remained attached to the coxal bone by this second ligament after open-book injury. These results were validated using plastination and the structures were identified. Pelvic ligaments are probably involved in sacral avulsion caused by lateral traction. Therefore, ligaments should to be taken into account in diagnosis of open-book injury and subsequent therapy.

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Effects of Cutting the Sacrospinous and Sacrotuberous Ligaments

et al. 2018

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The sacrospinous (SS) and sacrotuberous (ST) ligaments form a complex at the posterior pelvis, with an assumed role as functional stabilizers. Experimental and clinical research has yielded controversial results regarding their function, both proving and disproving their role as pelvic stabilizers. These findings have implications for strategies for treating pelvic injury and pain syndromes. The aim of the present simulation study was to assess the influence of altered ligament function on pelvis motion. A finite elements computer model was used. The two-leg stance was simulated, with the load of body weight applied via the fifth lumbar vertebra and both femora, allowing for nutation of the sacroiliac joint. The in-silico kinematics were validated with in-vitro experiments using the same scenario of load application following SS and ST transection in six human cadavers. Modeling of partial or complete ligament failure caused significant increases in pelvis motion. This effect was most pronounced if the SS and ST were affected with 164% and 182%, followed by the sacroiliac and iliolumbar ligaments with 123% and 147%, and the pubic ligaments with 113% and 119%, for partial and complete disruption, respectively. Simultaneous ligament transection multiplied the effects on pelvis motion by up to 490%. Unilateral ligament injury altered the motion at the pelvis contralaterally. The experiments presented here provide strong evidence for the stabilizing role of the SS and ST. A fortiori, the instability resulting from partial or complete SS and ST injury merits consideration in treatment strategies involving these ligaments as important stabilizers. Clin. Anat. 32:231-237, 2019.

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Description of the iliolumbar ligament for computer-assisted reconstruction

Cited by 34 publications

References 25 publications

The extent of ligament injury and its influence on pelvic stability following type II anteroposterior compression pelvic injuries––A computer study to gain insight into open book trauma

The extent of ligament injury and its influence on pelvic stability following type II anteroposterior compression pelvic injuries––A computer study to gain insight into open book trauma

Ligament‐induced sacral fractures of the pelvis are possible

Effects of Cutting the Sacrospinous and Sacrotuberous Ligaments

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