Multiscale fracture resistance of human annulus fibrosus and its deterioration with degeneration

Soft fibrous tissues must resist fracture under repeated loading, yet how degeneration compromises this resistance remains unclear. We investigated human annulus fibrosus using fracture and fatigue testing, proteoglycan depletion, microscopy, and X-ray scattering. Non-degenerate tissue exhibited pronounced fracture anisotropy, with axial toughness nearly fourfold higher than interlamellar delamination toughness. Degeneration reduced axial and radial toughness despite comparatively preserved tensile modulus and strength. Proteoglycan depletion reduced toughness most strongly in radial and delamination loading. Neither tissue state showed measurable macroscopic crack extension over 20,000 cycles at 70% of its respective monotonic failure strain. Nevertheless, fatigue produced localized structural changes, and degenerate tissue exhibited secondary delamination and diffuse collagen damage. X-ray scattering revealed fatigue- and degeneration-dependent changes in collagen periodicity and intermolecular packing. These findings connect tissue fracture resistance to collagen-matrix interactions across scales and inform the design of crack-resistant biomaterials.