Surgeons routinely perform incremental releases on overly tight ligaments during total knee arthroplasty (TKA) to reduce ligament tension and achieve their desired implant alignment. However, current methods to assess whether the surgeon achieved their desired reduction in the tension of a released ligament are subjective and/or do not provide a quantitative metric of tension in an individual ligament. Accordingly, the purpose of this study was to determine whether shear wave tensiometry, a novel method to assess tension in individual ligaments based on the speed of shear wave propagation, can detect changes in ligament tension following incremental releases. In seven medial and eight lateral collateral porcine ligaments (MCL and LCL, respectively), we measured shear wave speeds and ligament tensions before and after incremental releases consisting of punctures with an 18-gauge needle. We found that shear wave speed squared decreased linearly with decreasing tension in both the MCL (average coefficient of determination (R²_avg) = 0.76) and LCL (R²_avg = 0.94). We determined that errors in predicting tension following incremental releases were 26.2 and 14.2 N in the MCL and LCL, respectively, using ligament-specific calibrations. These results suggest shear wave tensiometry is a promising method to objectively measure the tension reduction in released structures. Clinical Significance: Direct, objective measurements of the tension changes in individual ligaments following release could enhance surgical precision during soft tissue balancing in total knee arthroplasty. Thus, shear wave tensiometry could help surgeons reduce the risk of poor outcomes associated with overly tight ligaments, including residual knee pain and stiffness.

中文翻译：

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剪切波张力测量跟踪由于增量释放导致的副韧带张力的减少


在全膝关节置换术 (TKA) 期间，外科医生通常会对过度紧张的韧带进行增量释放，以减少韧带张力并实现所需的植入物对齐。然而，目前评估外科医生是否实现了所期望的释放韧带张力降低的方法是主观的和/或不提供单个韧带张力的定量度量。因此，本研究的目的是确定剪切波张力测定法（一种基于剪切波传播速度评估单个韧带张力的新方法）是否可以检测增量释放后韧带张力的变化。在猪的七个内侧副韧带和八个外侧副韧带（分别为 MCL 和 LCL）中，我们测量了使用 18 号针进行穿刺的增量释放前后的剪切波速度和韧带张力。我们发现，在 MCL（平均决定系数 ( R ² _avg ) = 0.76）和 LCL（ R ² _avg = 0.94）中，剪切波速度平方随着张力的减小而线性减小。我们使用韧带特定校准确定，MCL 和 LCL 中增量释放后预测张力的误差分别为 26.2 N 和 14.2 N。这些结果表明剪切波张力测定法是一种有前途的方法来客观测量释放结构中的张力减少。临床意义：直接、客观地测量释放后各个韧带的张力变化可以提高全膝关节置换术中软组织平衡过程中的手术精度。 因此，剪切波张力测量可以帮助外科医生降低与韧带过紧相关的不良结果的风险，包括残余膝盖疼痛和僵硬。