title: Strength of round and uterosacral ligaments: a biomechanical study.
abstract: OBJECTIVE
  To investigate the tensile biomechanical properties of round and uterosacral ligaments.
  
  
  METHODS
  Tissue samples were obtained from 15 female cadavers without pelvic organ prolapse. Uniaxial tensile tests were performed to obtain stiffness and maximum stress of round and uterosacral ligaments. Correlations were calculated using the Pearson correlation coefficient. Statistical differences between groups were tested using Student's paired and unpaired t test.
  
  
  RESULTS
  There was a great variability in the measurements of stiffness and maximum stress in pelvic ligaments. The round ligaments demonstrated stiffness of 9.1 ± 1.6 MPa (mean ± SEM) (ranging from 2 to 25.6 MPa) and maximum stress of 4.3 ± 0.7 MPa (ranging from 1.2 to 11.5 MPa). The stiffness of the uterosacral ligaments was 14.1 ± 1.4 MPa (ranging from 5.7 to 26.1 MPa) with maximum stress of 6.3 ± 0.8 MPa (ranging from 2.2 to 11.9 MPa). There was a strong positive correlation between stiffness and maximum stress in female pelvic ligaments (ρ = 0.851; p < 0.001). The uterosacral ligaments demonstrated higher stiffness and maximum stress compared to the round ligaments (p = 0.006 and p = 0.034; respectively). Age, body mass index and menopausal status were not associated with the biomechanical proprieties of round and uterosacral ligaments. Nulliparous women had lower uterosacral stiffness (15.5 ± 1.3 vs. 10 ± 1.8 MPa; p = 0.033) and maximum stress (8.2 ± 0.9 vs. 4.2 ± 1.1 MPa; p = 0.028) compared to parous women.
  
  
  CONCLUSIONS
  The uterosacral ligaments are significantly more resistant than round ligaments. Parturition seems to enhance the stiffness and maximum stress of the ligaments.
authors.affiliation: IDMEC-Polo FEUP, Faculty of Engineering, University of Porto, Porto, Portugal.
authors.forename: Pedro
authors.initials: P
authors.lastname: Martins
authors.forename: Agnaldo Lopes
authors.initials: AL
authors.lastname: Silva-Filho
authors.forename: Andrea M R M
authors.initials: AM
authors.lastname: Fonseca
authors.forename: Agostinho
authors.initials: A
authors.lastname: Santos
authors.forename: Liliana
authors.initials: L
authors.lastname: Santos
authors.forename: Teresa
authors.initials: T
authors.lastname: Mascarenhas
authors.forename: Renato M N
authors.initials: RM
authors.lastname: Jorge
authors.forename: António M
authors.initials: AM
authors.lastname: Ferreira
mesh_terms: D000328:Adult; D001696:Biomechanical Phenomena; D005260:Female; D006801:Humans; D008022:Ligaments; D008875:Middle Aged; D010298:Parity; D017773:Pelvic Floor; D012404:Round Ligament of Uterus; D012447:Sacrum; D013718:Tensile Strength