Evaluation of a New Surgical Treatment for Equine Hind Limb Proximal Suspensory Desmitis.
Authors: Brokken Matthew T, Schneider Robert K, Roberts Gregory D, Holmes Shannon P, Gavin Patrick R, Sampson Sarah N, Farnsworth Kelly D, Dahlgren Linda A
Journal: Veterinary surgery : VS
Summary
# Equine Proximal Suspensory Desmitis: Investigating a Novel Surgical Approach Proximal suspensory ligament (PSL) injuries in horses' hind limbs present significant clinical challenges, prompting exploration of regenerative surgical techniques beyond conservative management. Brokken and colleagues evaluated a microfracture and ligament splitting procedure using six healthy horses in which PSL damage was experimentally induced via collagenase injection; one hind limb received surgical treatment whilst the contralateral limb served as an untreated control, with serial magnetic resonance (MR) imaging and post-mortem tissue analysis conducted over a 210-day period. The procedure successfully stimulated tissue formation at the bone-ligament interface, evidenced by histological connective tissue bridging the microfracture perforations and significantly elevated gene expression for cartilage oligomeric matrix protein and decorin in treated ligaments compared to controls, though standard histological parameters showed no statistical difference between groups. MR imaging proved valuable for longitudinal monitoring, reliably tracking both the initial collagenase-induced lesions and subsequent bone remodelling without requiring repeated tissue sampling. Whilst the microfracture approach demonstrates promise in triggering a biological response at the PSL origin, clinical validation in naturally occurring cases remains necessary to establish whether this enhanced cellular activity translates to improved functional outcomes and reduced recurrence rates in working horses.
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Practical Takeaways
- •This surgical technique shows promise for PSL desmitis by stimulating tissue remodeling at the bone-ligament interface, but clinical efficacy remains unproven—use cautiously until outcome data are available
- •MR imaging can effectively monitor PSL healing progression over time, which may help guide rehabilitation timelines and return-to-work decisions
- •Gene expression changes suggest biological activity favoring tissue remodeling, but histologic similarity between treated and control limbs indicates the clinical benefit of this procedure requires further investigation
Key Findings
- •Microfracture and ligament splitting procedure induced connective tissue formation at the bone-ligament interface with resolution of abnormal MR signal intensity
- •Gene expression for cartilage oligomeric matrix protein and decorin were significantly increased in treated limbs compared to controls at 210 days
- •Collagenase-induced PSL lesions on MR imaging appeared similar to clinically observed lesions, validating the model
- •Serial MR imaging successfully tracked tissue formation and healing response over time despite no significant histologic differences between treated and control limbs