Holographic Analysis of the Human Pelvis

VUKlČEVIĆ, SLOBODAN; MARUŠĆ, ANA; Stavljenić, A; VUJUČĆ, GORAN; ŠKAVĆ, JOSIP; VUKlČEVĆ, DALIBOR

doi:10.1097/00007632-199116020-00021

Cited by 5 publications

(10 citation statements)

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“…These observed values were in line with the cadaveric validation experiments. Side‐asymmetry of the load‐deformations has also been observed over a physiological range, resulting in unequal load distribution between the pelvic sides in line with previous cadaveric studies (Vukičević et al, ).…”

Section: Discussionsupporting

confidence: 86%

“…Miller et al () in their cadaver experiments on the pelvis failed to include the SS–ST, though those experiments have formed the basis for a number of in‐silico studies (Eichenseer et al, ; Zhang et al, ). Vrahas et al (), Vukičević et al (), and Philippeau et al () also concluded from their data that the ST and SS contribute little to overall pelvic stability. However, their experiments need be considered critically, as the SS‐ST complex was removed in a number of specimens and therefore could not be assessed (Vrahas et al, ), or the experiments were limited to interferometric patterns of surface features (Vukičević et al, ), or the tissues were exposed to non‐physiological loading conditions (Philippeau et al, ).…”

Section: Discussionmentioning

confidence: 89%

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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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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 89%

Effects of Cutting the Sacrospinous and Sacrotuberous Ligaments

et al. 2018

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“…Nine biomechanical studies related to the STL have assessed the role of this ligament on pelvic biomechanics in variable numbers of cadaveric specimens (Abdelfattah and Moed ; Conza et al ; Shobeiri et al ; Slocumb and Terry ; Varga et al ; Vleeming et al ; Vleeming et al ; Vrahas et al ; Vukicević et al ) (Table ). In two studies, the STL was purported to limit pelvic motion.…”

Section: Resultsmentioning

confidence: 99%

“…This observation was supported by findings that showed an increase in sacral nutation after sectioning the STL and SSL (Slocumb and Terry ) and increased tension of this ligament when sacral nutation was externally induced (Vleeming et al ). On the other hand, the contribution of the STL on pelvic kinematics appears to be minimal (Abdelfattah and Moed ; Conza et al ; Varga et al ; Vrahas et al ; Vukicević et al ). For instance, some studies have explored the effect of load on pelvic kinematics, with a fixed load applied to the lumbar spine or sacrum prior to, and after, the removal of the STL.…”

Section: Resultsmentioning

confidence: 99%

“…For instance, some studies have explored the effect of load on pelvic kinematics, with a fixed load applied to the lumbar spine or sacrum prior to, and after, the removal of the STL. Findings suggest no changes in pelvic deformation (Vukicević et al ), pelvic stiffness (Vrahas et al ), vibrometry (Conza et al ), and pubic symphysis or sacroiliac joint dislocation (Varga et al ) between pre‐STL and post‐STL removal. In addition, data regarding the mechanical properties of the STL in isolation are conflicting with the mean point failure of this ligament occurring on average at 80 N (Varga et al ) or 434.4 N (Shobeiri et al ).…”

Section: Resultsmentioning

confidence: 99%

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A systematic review of the morphology and function of the sacrotuberous ligament

et al. 2019

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The sacrotuberous ligament (STL) has been linked to conditions such as pelvic girdle pain and pudendal nerve entrapment, yet its contribution to pelvic stability is debated. The purpose of this review was to explore the current understanding of the STL and highlight any gaps in knowledge regarding its anatomy and function. A systematic search of the literature was conducted, focussing on the morphology and attachments of the STL, the relationship of the STL with surrounding structures, and its neurovascular supply and function. A total of 67 papers and four textbooks were obtained. The attachment sites of the STL are largely consistent; however, the extent of its connections with the long head of biceps femoris, gluteus maximus, piriformis, the posterior layer of the thoracolumbar fascia, and sacrospinous ligament are unclear. Morphometric parameters, such as mean STL length (6.4-9.4 cm), depth (0.3-0.4 cm), and width (1.8-3.5 cm, at its midpoint) are variable within and between studies, and little is known about potential side-, age-, or sex-related differences. The STL is pierced in several sites by the inferior and superior gluteal arteries, but information on its innervation pattern is sparse. Functionally, the STL may limit sacral nutation but it appears to have a limited contribution to pelvic stability. Some morphological aspects of the STL warrant further investigation, particularly its connections with surrounding structures, innervation pattern and function. Knowledge of the detailed anatomy and function of this ligament is important to better understanding its role in clinical conditions. Clin. Anat. 32:396-407, 2019.

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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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Holographic Analysis of the Human Pelvis

Cited by 5 publications

References 0 publications

Effects of Cutting the Sacrospinous and Sacrotuberous Ligaments

Effects of Cutting the Sacrospinous and Sacrotuberous Ligaments

A systematic review of the morphology and function of the sacrotuberous ligament

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

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