A review of the equine suspensory ligament: Injury prone yet understudied.
Authors: Guest Deborah J, Birch Helen L, Thorpe Chavaunne T
Journal: Equine veterinary journal
Summary
# Editorial Summary: The Suspensory Ligament – Critical Need for Evidence-Based Understanding Despite its pivotal role in joint stabilisation and elastic energy storage during locomotion, the equine suspensory ligament remains poorly characterised compared with other load-bearing structures such as the superficial digital flexor tendon, despite affecting horses across all ages and disciplines with alarming frequency. Guest, Birch and Thorpe's comprehensive 2025 review synthesises current knowledge of suspensory ligament composition, structure and mechanical properties alongside epidemiological data on injury patterns, highlighting significant gaps in our understanding of how structural features relate to functional capacity and injury susceptibility. The authors examine existing diagnostic modalities and treatment strategies, revealing considerable variation in clinical approaches that lacks robust supporting evidence for many interventions. Understanding the fundamental biomechanical and compositional differences between the suspensory ligament and better-studied structures—particularly how its specialised elastic function influences injury mechanisms and healing capacity—remains essential for developing evidence-based management protocols. For farriers, veterinarians and rehabilitation specialists, this review underscores the urgency of moving beyond empirical practice towards research-informed strategies, whilst identifying priority areas where targeted investigation could meaningfully improve outcomes for horses with suspensory apparatus pathology.
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Practical Takeaways
- •Suspensory ligament injuries warrant greater clinical attention and investigation given their high prevalence across all horse types and disciplines; current diagnostic and treatment protocols need refinement based on improved understanding of structure-function relationships.
- •Practitioners should recognize that evidence gaps exist in SL management compared to other tendinous structures, suggesting current treatment approaches may not be optimized and should evolve as research clarifies underlying pathophysiology.
- •Future research priorities should focus on elucidating fundamental SL biomechanics and composition to improve injury prevention, diagnosis accuracy, and therapeutic outcomes.
Key Findings
- •The suspensory ligament is highly prone to injury across all horse ages and disciplines despite its critical role in joint stabilization and locomotion energy efficiency.
- •Current knowledge of suspensory ligament structure-function relationships is substantially lacking compared to other injury-prone tendinous structures like the superficial digital flexor tendon.
- •The review identifies and synthesizes information on SL composition, mechanical properties, injury epidemiology, aetiology, pathophysiology, diagnostic approaches, and treatment modalities.