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Research Article: Use of strain and shear wave elastography in the ultrasonographic evaluation of the intermediate patellar ligament in horses: comparison and consistency of data

Date Published: 2026-05-20

Abstract:
The clinical significance and ultrasonographic features of intermediate patellar ligament (IPL) desmopathy in horses are still debated and considered nonspecific. Elastosonography allows assessment of tissue elasticity in response to an external stimulus. The aim of the study was to describe the elastosonographic characteristics of the equine IPL, evaluate the feasibility of both strain (SE) and two-dimensional shear wave elastography (2D-SWE), and assess the consistency of the data obtained from these techniques. 20 adult horses of mixed breed, sex and athletic use were selected and allocated to a Sound Group (GS, n.15) or a Lame Group (GL, n.5) based on orthopedic examination findings, according to the presence a stifle-originating lameness and/or with ultrasonographic evidence of IPL lesion. SE and 2D-SWE of both IPLs were performed in longitudinal and transverse scans. Using the same Region of Interest (ROI), SE evaluated the Elasticity Index of the IPL (EI IPL ) and the Strain Ratio (SR) between the IPL and infrapatellar fat pad, while 2D-SWE measured Shear Wave Velocity (m/s) and Young’s modulus (kPa). Feasibility of both techniques was good, with acceptable to good Intraclass Correlation Coefficient (0.7?<?ICC?<?0.9) ( p <?0.05). No significant differences were found between left and right limb, or between intraoperator measurements (Wilcoxon test). No correlation was observed between SE variables (EI and SR) or SWE variables (m/s and kPa) and IPL diameter/thickness ratio (Pearson correlation). SE was able to differentiate between GS and GL, with an EI of the IPL that was statistically higher in GS in transverse scan (respectively, 1.9 and 1.7; p =?0.001). Equine IPL can be efficiently investigated using SE and 2D-SWE. It exhibits elastosonographic characteristic of a hard, non-deformable structure, with increased stiffness in cases of chronic injuries.

Introduction:
Stifle disorders in sport horses account for 8–42% of hindlimb lameness, with different etiologies depending on the horse’s athletic use, conformation, age and level of work ( 1–4 ). Patellar ligament desmopathy have been described in 4–18% of horses undergoing stifle ultrasonography ( 5–8 ), likely due to improved access to advanced imaging equipment rather than increased prevalence of the disorder ( 9 ). Technological improvement has also enabled the identification of breed-related ultrasonographic differences…

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