Tensile cervical facet capsule ligament mechanics: failure and subfailure responses in the rat

Clinical, epidemiological, and biomechanical studies suggest the involvement of the cervical facet joint in neck pain. Mechanical studies have suggested the facet capsular ligament to be at risk for subfailure tensile injury during whiplash kinematics of the neck. Ligament mechanical properties can be altered by subfailure injury and such loading can induce cellular damage. However, at present, there is no clear understanding of the physiologic context of subfailure facet capsular ligament injury and mechanical implications for whiplash-related pain. Therefore, this study aimed to define a relationship between mechanical properties at failure and a subfailure condition associated with pain for tension in the rat cervical facet capsular ligament. Tensile failure studies of the C6/C7 rat cervical facet capsular ligament were performed using a customized vertebral distraction device. Force and displacement at failure were measured and stiffness and energy to failure were calculated. Vertebral motions and ligament deformations were tracked and maximum principal strains and their directions were calculated. Mean tensile force at failure (2.96 +/- 0.69 N) was significantly greater (p < 0.005) than force at subfailure (1.17 +/- 0.48 N). Mean ligament stiffness to failure was 0.75 +/- 0.27 N/mm. Maximum principal strain at failure (41.3 +/- 20.0%) was significantly higher (p = 0.003) than the corresponding subfailure value (23.1 +/- 9.3%). This study determined that failure and a subfailure painful condition were significantly different in ligament mechanics and findings provide preliminary insight into the relationship between mechanics and pain physiology for this ligament. Together with existing studies, these findings offer additional considerations for defining mechanical thresholds for painful injuries.     

Anomalous fiber realignment during tensile loading of the rat facet capsular ligament identifies mechanically induced damage and physiological dysfunction

Many pathophysiological phenomena are associated with soft tissue loading that does not produce visible damage or tissue failure. As such, there is an unexplained disconnect between tissue injury and detectable structural damage during loading. This study investigated the collagen fiber kinematics of the rat facet capsular ligament to identify the onset of subfailure damage during tensile loading conditions that are known to induce pain. Quantitative polarized light imaging was used to determine the collagen fiber orientation in the capsular ligament (n=7) under tension, and an alignment vector correlation measurement was employed to identify local anomalous fiber realignment during loading. During the initial portion of loading when tissue stiffness was increasing, anomalous realignment was more likely to be detected than mechanical evidence of structural damage, and as a result, anomalous fiber realignment was identified significantly (p=0.004) before gross failure. The occurrence of anomalous fiber realignment was significantly associated (p=0.013) with a decrease in tangent stiffness during loading (ligament yield), suggesting this optical metric may be associated with a loss of structural integrity. The presence of localized anomalous realignment during subfailure loading in this tissue may explain the development of laxity, collagen fiber disorganization, and persistent pain previously reported for facet joint distractions comparable to that required for anomalous realignment. These optical data, together with the literature, suggest that mechanically induced tissue damage may occur in the absence of any macroscopic or mechanical evidence of failure and may produce local pathology and pain.     

The failure response of the human cervical facet capsular ligament during facet joint retraction

Studies implicate the cervical facet joint and its capsule as a primary anatomical site of injury during whiplash exposures to the neck. Although the facet joint is known to undergo stretch as the superior vertebra is retracted relative to the inferior vertebra during the whiplash kinematic, the response of the facet capsular ligament and its microstructure during failure in joint retraction is unknown. Polarized light imaging and vector correlation analysis were used to measure the collagen fiber alignment in the human capsular ligament, together with traditional mechanical metrics, during joint retraction sufficient to induce ligament failure. Anomalous fiber realignment occurs at 2.95±1.66mm of displacement, which is not different from the displacement when the ligament first yields (2.77±1.55mm), but is significantly lower (p=0.016) than the displacement at tissue failure (5.40±1.65mm). The maximum principal strain at the first detection of anomalous fiber realignment (0.66±0.39) also is significantly lower (p=0.046) than the strain at failure (1.39±0.64), but is not different from the strains at yield or partial failure. The onset of collagen fiber realignment determined in this study corresponds to the ligament's yielding and supports assertions that the facet capsule can undergo tissue injury during joint retraction. Further, such microstructural responses may indicate tissue damage in the absence of rupture.     

Multiscale mechanics of the cervical facet capsular ligament,with particular emphasis on anomalous fiber realignment prior to tissue failure

The facet capsular ligaments encapsulate the bilateral spinal facet joints and are common sources of painful injury due to afferent innervation. These ligaments exhibit architectural complexity, which is suspected to contribute to the experimentally observed lack of co-localization between macroscopic strain and microstructural tissue damage. The heterogeneous and multiscale nature of this ligament, combined with challenges in experimentally measuring its microscale mechanics, hinders the ability to understand sensory mechanisms under normal or injurious loading. Therefore, image-based, subject-specific, multiscale finite-element models were constructed to predict the mechanical responses of the human cervical facet capsular ligament under uniaxial tensile stretch. The models precisely simulated the force–displacement responses for all samples (\(\textit{R}^{2}=0.99\pm 0.01\)) and showed promise in predicting the magnitude and location of peak regional strains at two different displacements. Yet, there was a loss of agreement between the model and experiment in terms of fiber organization at large tissue stretch, possibly due to a lack of accounting for tissue failure. The mean fiber stretch ratio predicted by the models was found to be significantly higher in regions that exhibited anomalous fiber realignment experimentally than in regions with normal realignment (\(\textit{p}<0.002\)). The development of microstructural abnormalities was associated with the predicted fiber-level stretch (\(\textit{p}<0.009\)), but not with the elemental maximum principal stress or maximum principal strain by logistic regression. The multiscale models elucidate a potential mechanical basis for predicting injury-prone tissue domains and for defining the relationships between macroscopic ligament stretch and microscale pathophysiology in the subfailure regime.     

Investigation of impact loading rate effects on the ligamentous cervical spinal load-partitioning using finite element model of functional spinal unit C2–C3

The cervical spine functions as a complex mechanism that responds to sudden loading in a unique manner, due to intricate structural features and kinematics. The spinal load-sharing under pure compression and sagittal flexion/extension at two different impact rates were compared using a bio-fidelic finite element (FE) model of the ligamentous cervical functional spinal unit (FSU) C2–C3. This model was developed using a comprehensive and realistic geometry of spinal components and material laws that include strain rate dependency, bone fracture, and ligament failure. The range of motion, contact pressure in facet joints, failure forces in ligaments were compared to experimental findings. The model demonstrated that resistance of spinal components to impact load is dependent on loading rate and direction. For the loads applied, stress increased with loading rate in all spinal components, and was concentrated in the outer intervertebral disc (IVD), regions of ligaments to bone attachment, and in the cancellous bone of the facet joints. The highest stress in ligaments was found in capsular ligament (CL) in all cases. Intradiscal pressure (IDP) in the nucleus was affected by loading rate change. It increased under compression/flexion but decreased under extension. Contact pressure in the facet joints showed less variation under compression, but increased significantly under flexion/extension particularly under extension. Cancellous bone of the facet joints region was the only component fractured and fracture occurred under extension at both rates. The cervical ligaments were the primary load-bearing component followed by the IVD, endplates and cancellous bone; however, the latter was the most vulnerable to extension as it fractured at low energy impact.     

Through-thickness regional variation in the mechanical characteristics of the lumbar facet capsular ligament

Biomechanics and Modeling in Mechanobiology - The human lumbar facet capsule, with the facet capsular ligament (FCL) that forms its primary constituent, is a common source of lower back pain. Prior...     

Inhibiting the β1integrin subunit increases the strain threshold for neuronal dysfunction under tensile loading in collagen gels mimicking innervated ligaments

Biomechanics and Modeling in Mechanobiology - Stretch injury of the facet capsular ligament is a cause of neck pain, inducing axonal injury, neuronal hyperexcitability, and upregulation of pain...     

Analysis of simulated single ligament transection on the mechanical behaviour of a lumbar functional spinal unit.

The influence of the different lumbar spinal ligaments on intersegmental rotation is not fully understood. In order to explore this effect, a finite element model of the functional spinal unit L3/L4 was loaded with pure moments in the three main anatomic planes. The two extremes--minimum and maximum--ligament stiffness values reported in the literature were applied. After virtual transection of each of the spinal ligaments in turn, the intersegmental rotation and forces in the remaining ligaments were calculated. On flexion, the highest force was found for the posterior longitudinal ligament; on extension and lateral bending for the anterior longitudinal ligament; and on axial rotation for the facet capsular ligament. The strongest influence on intersegmental rotation is exerted by the interspinous ligament on flexion, by the anterior longitudinal ligament on extension and lateral bending, and by the facet capsular ligaments on axial rotation. Ligament stiffness has a strong influence on intersegmental rotation and forces in the ligaments, so that finite element models of spinal segments must be validated by experimental data. This study should help to elucidate the role of the various ligaments.     

Soft tissue strain and facet face interaction in the lumbar intervertebral joint--Part I: Input data and computational technique

A numerical simulation was devised to determine ligament strains, facet face interaction, and disk fiber strain in the lumbar intervertebral joint under load. This technique uses experimentally derived load deflection and morphologic data from lumbar cadaver specimens from which initial and displaced soft tissue attachment points can be calculated. This allows the strain data to be derived. The effect of disk bulge is also considered. The calculated strains of most ligaments except the facet capsular ligaments were found to be insensitive to anatomical measurement variability of +/- 1 mm.     

Subfailure damage in ligament: a structural and cellular evaluation.

Subfailure damage in ligaments was evaluated macroscopically from a structural perspective (referring to the entire ligament as a structure) and microscopically from a cellular perspective. Freshly harvested rat medial collateral ligaments (MCLs) were used as a model in ex vivo experiments. Ligaments were preloaded with 0.1 N to establish a consistent point of reference for length (and strain) measurements. Ligament structural damage was characterized by nonrecoverable difference in tissue length after a subfailure stretch. The tissue's mechanical properties (via stress vs. strain curves measured from a preloaded state) after a single subfailure stretch were also evaluated (n = 6 pairs with a different stretch magnitude applied to each stretched ligament). Regions containing necrotic cells were used to characterize cellular damage after a single stretch. It should be noted that the number of damaged cells was not quantified and the difference between cellular area and area of fluorescence is not known. Structural and cellular damage were represented and compared as functions of subfailure MCL strains. Statistical analysis indicated that the onset of structural damage occurs at 5.14% strain (referenced from a preloaded length). Subfailure strains above the damage threshold changed the shape of the MCL stress-strain curve by elongating the toe region (i.e., increasing laxity) as well as decreasing the tangential modulus and ultimate stress. Cellular damage was induced at ligament strains significantly below the structural damage threshold. This cellular damage is likely to be part of the natural healing process in mildly sprained ligaments.     

Investigation of whiplash injuries in the upper cervical spine using a detailed neck model

Whiplash injuries continue to have significant societal cost; however, the mechanism and location of whiplash injury is still under investigation. Recently, the upper cervical spine ligaments, particularly the alar ligament, have been identified as a potential whiplash injury location. In this study, a detailed and validated explicit finite element model of a 50th percentile male cervical spine in a seated posture was used to investigate upper cervical spine response and the potential for whiplash injury resulting from vehicle crash scenarios. This model was previously validated at the segment and whole spine levels for both kinematics and soft tissue strains in frontal and rear impact scenarios. The model predicted increasing upper cervical spine ligament strain with increasing impact severity. Considering all upper cervical spine ligaments, the distractions in the apical and alar ligaments were the largest relative to their failure strains, in agreement with the clinical findings. The model predicted the potential for injury to the apical ligament for 15.2 g frontal or 11.7 g rear impacts, and to the alar ligament for a 20.7 g frontal or 14.4 g rear impact based on the ligament distractions. Future studies should consider the effect of initial occupant position on ligament distraction.     

Bi-directional mechanical properties of the posterior region of the glenohumeral capsule

The objective of this study was to determine the mechanical properties of the posterior region of the glenohumeral capsule in the directions perpendicular (transverse) and parallel (longitudinal) to the longitudinal axis of the posterior band of the inferior glenohumeral ligament. A punch was used to excise one transverse and one longitudinal tissue sample from the posterior capsule of 11 cadaveric shoulders. All tissue samples exhibited the typical nonlinear behavior reported for ligaments and tendons. Significant differences (p < 0.05) were detected between the transverse and longitudinal tissue samples for ultimate stress (1.5+/-1.4 and 4.9+/-2.9 MPa, respectively) and tangent modulus (10.3+/-6.6 and 31.5+/-12.7 MPa, respectively). No significant differences (p > 0.05) were observed between the ultimate strain (transverse: 22.3+/-12.5%, longitudinal: 22.8+/-11.1%) and strain energy density (transverse: 27.2+/-52.8 MPa, longitudinal: 67.5+/-88.2 MPa) of the transverse and longitudinal tissue samples. The ratio of the longitudinal to transverse moduli (4.8+/-4.2) was similar to that found for the axillary pouch (3.3+/-2.8) in a previous study. Thus, both the axillary pouch and the posterior capsule function to stabilize the joint multi-axially. Future analytical models of the glenohumeral joint should consider the properties of the posterior capsule in its transverse and longitudinal directions to fully describe the behavior of the glenohumeral capsule. These models will be clinically important by providing a more accurate representation of the intact capsule as well as simulated capsular injuries and surgical repair procedures.     

Altered collagen fiber kinematics define the onset of localized ligament damage during loading

Detecting the initiation of mechanical injury to biological tissue, and not just its ultimate failure, is critical to a sensitive and specific characterization of tissue tolerance, development of quantitative relationships between macro- and microstructural tissue responses, and appropriate interpretation of physiological responses to loading. We have developed a novel methodological approach to detect the onset and spatial location of structural damage in collagenous soft tissue, before its visible rupture, via identification of atypical regional collagen fiber kinematics during loading. Our methods utilize high-speed quantitative polarized light imaging to identify the onset of tissue damage in ligament regions where mean collagen fiber rotation significantly deviates from its behavior during noninjurious loading. This technique was validated by its ability to predict the location of visible rupture (P = 0.0009). This fiber rotation-based metric of damage identifies potential facet capsular ligament injury beginning well before rupture, at 51 +/- 12% of the displacement required to produce tissue failure. Although traditional macroscale strain metrics fail to identify the location of microstructural damage, initial injury detection determined by altered fiber rotation was significantly correlated (R = 0.757, P = 0.049) with tissue yield (defined by a decrease in stiffness), supporting the capabilities of this method. Damaged regions exhibited higher variance in fiber direction than undamaged regions (P = 0.0412).     

A multibody modelling approach to determine load sharing between passive elements of the lumbar spine

The human spinal segment is an inherently complex structure, a combination of flexible and semi-rigid articulating elements stabilised by seven principal ligaments. An understanding of how mechanical loading is shared among these passive elements of the segment is required to estimate tissue failure stresses. A 3D rigid body model of the complete lumbar spine has been developed to facilitate the prediction of load sharing across the passive elements. In contrast to previous multibody models, this model includes a non-linear, six degrees of freedom intervertebral disc, facet bony articulations and all spinal ligaments. Predictions of segmental kinematics and facet joint forces, in response to pure moment loading (flexion–extension), were compared to published in vitro data. On inclusion of detailed representation of the disc and facets, the multibody model fully captures the non-linear flexibility response of the spinal segment, i.e. coupled motions and a mobile instantaneous centre of rotation. Predicted facet joint forces corresponded well with reported values. For the loading case considered, the model predicted that the ligaments are the main stabilising elements within the physiological motion range; however, the disc resists a greater proportion of the applied load as the spine is fully flexed. In extension, the facets and capsular ligaments provide the principal resistance. Overall patterns of load distribution to the spinal ligaments are in agreement with previous predictions; however, the current model highlights the important role of the intraspinous ligament in flexion and the potentially high risk of failure. Several important refinements to the multibody modelling of the passive elements of the spine have been described, and such an enhanced passive model can be easily integrated into a full musculoskeletal model for the prediction of spinal loading for a variety of daily activities.     

A multibody modelling approach to determine load sharing between passive elements of the lumbar spine

The human spinal segment is an inherently complex structure, a combination of flexible and semi-rigid articulating elements stabilised by seven principal ligaments. An understanding of how mechanical loading is shared among these passive elements of the segment is required to estimate tissue failure stresses. A 3D rigid body model of the complete lumbar spine has been developed to facilitate the prediction of load sharing across the passive elements. In contrast to previous multibody models, this model includes a non-linear, six degrees of freedom intervertebral disc, facet bony articulations and all spinal ligaments. Predictions of segmental kinematics and facet joint forces, in response to pure moment loading (flexion-extension), were compared to published in vitro data. On inclusion of detailed representation of the disc and facets, the multibody model fully captures the non-linear flexibility response of the spinal segment, i.e. coupled motions and a mobile instantaneous centre of rotation. Predicted facet joint forces corresponded well with reported values. For the loading case considered, the model predicted that the ligaments are the main stabilising elements within the physiological motion range; however, the disc resists a greater proportion of the applied load as the spine is fully flexed. In extension, the facets and capsular ligaments provide the principal resistance. Overall patterns of load distribution to the spinal ligaments are in agreement with previous predictions; however, the current model highlights the important role of the intraspinous ligament in flexion and the potentially high risk of failure. Several important refinements to the multibody modelling of the passive elements of the spine have been described, and such an enhanced passive model can be easily integrated into a full musculoskeletal model for the prediction of spinal loading for a variety of daily activities.     

Preconditioning is correlated with altered collagen fiber alignment in ligament

Although the mechanical phenomena associated with preconditioning are well-established, the underlying mechanisms responsible for this behavior are still not fully understood. Using quantitative polarized light imaging, this study assessed whether preconditioning alters the collagen fiber alignment of ligament tissue, and determined whether changes in fiber organization are associated with the reduced force and stiffness observed during loading. Collagen fiber alignment maps of facet capsular ligaments (n?=?8) were generated before and after 30 cycles of cyclic tensile loading, and alignment vectors were correlated between the maps to identify altered fiber organization. The change in peak force and tangent stiffness between the 1st and 30th cycle were determined from the force-displacement response, and the principal strain field of the capsular ligament after preconditioning was calculated from the fiber alignment images. The decreases in peak ligament force and tangent stiffness between the 1st and 30th cycles of preconditioning were significantly correlated (R ≥ 0.976, p?相似文献   

The role of the facet capsular ligament in providing spinal stability

Abstract

Low back pain (LBP) is the most common type of pain in America, and spinal instability is a primary cause. The facet capsular ligament (FCL) encloses the articulating joints of the spine and is of particular interest due to its high innervation – as instability ensues, high stretch values likely are a cause of this pain. Therefore, this work investigated the FCL's role in providing stability to the lumbar spine. A previously validated finite element model of the L4-L5 spinal motion segment was used to simulate pure moment bending in multiple planes. FCL failure was simulated and the following outcome measures were calculated: helical axes of motion, range of motion (ROM), bending stiffness, facet joint space, and FCL stretch. ROM increased, bending stiffness decreased, and altered helical axis patterns were observed with the removal of the FCL. Additionally, a large increase in FCL stretch was measured with diminished FCL mechanical competency, providing support that the FCL plays an important role in spinal stability.     

Geometric and mechanical properties of human cervical spine ligaments

This study characterized the geometry and mechanical properties of the cervical ligaments from C2-T1 levels. The lengths and cross-sectional areas of the anterior longitudinal ligament, posterior longitudinal ligament, joint capsules, ligamentum flavum, and interspinous ligament were determined from eight human cadavers using cryomicrotomy images. The geometry was defined based on spinal anatomy and its potential use in complex mathematical models. The biomechanical force-deflection, stiffness, energy, stress, and strain data were obtained from 25 cadavers using in situ axial tensile tests. Data were grouped into middle (C2-C5) and lower (C5-T1) cervical levels. Both the geometric length and area of cross section, and the biomechanical properties including the stiffness, stress, strain, energy, and Young's modulus, were presented for each of the five ligaments. In both groups, joint capsules and ligamentum flavum exhibited the highest cross-sectional area (p < 0.005), while the longitudinal ligaments had the highest length measurements. Although not reaching statistical significance, for all ligaments, cross-sectional areas were higher in the C5-T1 than in the C2-C5 group; and lengths were higher in the C2-C5 than in the C5-T1 group with the exception of the flavum (Table 1 in the main text). Force-deflection characteristics (plots) are provided for all ligaments in both groups. Failure strains were higher for the ligaments of the posterior (interspinous ligament, joint capsules, and ligamentum flavum) than the anterior complex (anterior and posterior longitudinal ligaments) in both groups. In contrast, the failure stress and Young's modulus were higher for the anterior and posterior longitudinal ligaments compared to the ligaments of the posterior complex in the two groups. However, similar tendencies in the structural responses (stiffness, energy) were not found in both groups. Researchers attempting to incorporate these data into stress-analysis models can choose the specific parameter(s) based on the complexity of the model used to study the biomechanical behavior of the human cervical spine.     

Rheological properties of the human lumbar spine ligaments

The purpose of this study is to provide a better understanding of the rheological properties of the lumbar spinal ligaments under subfailure physiological loads. Non-destructive tests including an hysteresis experiment, stress-relaxation and stepwise load-relaxation tests were used to investigate the time-dependent properties of the interspinous-supraspinous ligament complex. Using a reduced relaxation function, the viscoelastic behaviour over the experimental time-scale was described by a linear function of the logarithm of time. Internal damping of ligament substance dissipates about 36% of the mechanical energy applied during physiological loading. Local elastic stiffness is found to be two to four times global stiffness of the bone-ligament-bone complex. These physical parameters (stiffness, energy dissipation, hysteresis, relaxation, etc) can be used to improve computer models of the lumbar spinal column.     

Water content alters viscoelastic behaviour of the normal adolescent rabbit medial collateral ligament.

Testing environment is an important factor in the outcome of mechanical tests on connective tissue. The purpose of this investigation was to determine the effect of ligament water content on ligament mechanical behaviour by altering the test environment. Water content of medial collateral ligament (MCLs) from 19 three-month-old New Zealand White rabbits was varied in subsets of ligaments pairs by means of immersion in 2, 10 or 25% sucrose or 0.9% phosphate-buffered saline (PBS) solutions for 1 h. One knee joint was cycled 50 times in the designated solution (experimental), while the contralateral knee (uncycled control) was simultaneously soaked in the same tank. Following cycling, the water contents of both test and control ligaments were determined. Water contents of 22 normal MCLs were determined immediately post-sacrifice and served as 'normal water content' controls. Normalized peak cyclic load changes were used as a measure of the viscoelastic behaviour of each MCL. Results demonstrated that only ligaments soaked (but not cycled) in a 10% sucrose solution had water contents (60.5 +/- 2.5%) which were statistically similar to the 22 fresh normal MCLs (63.9 +/- 6.0%). Ligaments soaked in PBS (74.0 +/- 1.3%) or 2% sucrose (69.2 +/- 2.3%) had significantly higher water contents compared to fresh normal MCLs. Ligaments with higher water contents (e.g. soaked in PBS or 2% sucrose) demonstrated greater cyclic load relaxation compared to ligaments with lower contents (e.g. soaked in 25 or 10% sucrose). Different fluid test environments can significantly alter ligament water content and, in turn, significantly affect ligament viscoelastic behaviour.