Two-dimensional Distribution of Anterior Longitudinal Ligament Strength

This study aims to characterize the variation in pullout strength of the anterior longitudinal ligament (ALL) across its two-dimensional surface to optimize graft fixation for sacrocolpopexy. The authors found that pullout strength significantly decreases as one moves caudally and laterally from the midsacral promontory, highlighting the importance of selecting appropriate fixation sites to enhance surgical outcomes. Understanding this distribution of ligament strength can improve graft attachment techniques in challenging anatomical contexts.