Shear wave speeds track axial stress in porcine collateral ligaments

Ligament tension is an important factor that can affect the success of total knee arthroplasty (TKA) procedures. However, surgeons currently lack objective approaches for assessing tension in a particular ligament intraoperatively. The purpose of this study was to investigate the use of noninvasive shear wave tensiometry to characterize stress in medial and lateral collateral ligaments (MCLs and LCLs) ex vivo and evaluate the capacity of shear wave speed to predict axial load. Nine porcine MCL and LCL specimens were subjected to cyclic axial loading while shear wave speeds were measured using laser vibrometry. We found that squared shear wave speed increased linearly with stress in both the MCL (r²_avg = 0.94) and LCL (r²_avg = 0.98). Shear wave speeds were slightly lower in the MCL than the LCL when subjected to a comparable axial stress (p < 0.001). Specimen-specific calibrations predicted tension within 13.0 N, or 5.2% of the maximum load. A leave-one-out analysis was also performed and showed that calibrated relationships based on ligament type could predict axial tension within 15% of the maximum load. These observations suggest it may be feasible to use noninvasive shear wave speed measures as a proxy of ligament loading, which in the future might enhance decision making during orthopedic procedures such as TKA.