Electrosurgical tenoscopic desmotomy of the accessory ligament of the superficial digital flexor muscle (proximal check ligament) in horses.
Authors: David Florent, Laverty Sheila, Marcoux Marcel, Szoke Mihaly, Celeste Christophe
Journal: Veterinary surgery : VS
Summary
# Electrosurgical Tenoscopic Desmotomy of the Proximal Check Ligament in Horses Monopolar electrosurgery offers a technically sound approach to transecting the accessory ligament of the superficial digital flexor muscle via tenoscopy, enabling effective haemostasis of large intrathecal vessels including the nutrient artery—a significant advancement over cold steel techniques that struggle with bleeding control in confined synovial spaces. This case series of 33 horses (64 ligaments transected) comprised primarily Standardbred racehorses undergoing bilateral procedures for SDFT tendonitis, alongside horses treated for flexural deformity, with careful review of surgical recordings and clinical outcomes. Intrathecal haemorrhage occurred in 12 cases but was successfully managed intraoperatively through electrocoagulation; postoperative drainage averaged 4.3 days, though 30% of horses experienced protracted drainage exceeding four days—notably more common in flexural deformity cases (P=.01), necessitating extended hospitalisation. For practitioners managing high-motion SDFT pathology in performance horses, this technique provides reliable vessel management and improved visualisation within the tendon sheath, though awareness of protracted drainage risk in flexural cases warrants adjusted discharge planning and owner communication. The ability to achieve complete desmotomy whilst controlling haemorrhage simultaneously represents a meaningful refinement in minimally invasive tenoscopic surgery, particularly valuable where postoperative synovial inflammation from residual bleeding could compromise rehabilitation outcomes.
Read the full abstract on PubMed
Practical Takeaways
- •Monopolar electrosurgery via tenoscopy is an effective technique for AL-SDFM desmotomy in both racing and flexural deformity cases, with successful hemostasis even of large nutrient vessels.
- •Expect intrathecal hemorrhage in approximately one-third of cases, but this should not prevent procedure completion with proper electrocoagulation technique.
- •Horses treated for flexural deformity are at higher risk for prolonged postoperative wound drainage (>4 days); plan for extended hospitalization and drainage management in these cases.
Key Findings
- •Tenoscopic electrosurgical desmotomy of the AL-SDFM was successfully completed in all 64 ligaments (33 horses) with monopolar electrocoagulation enabling hemostasis of large intrathecal vessels including the nutrient artery.
- •Intrathecal hemorrhage occurred in 12 of 33 horses (36%), with 6 severe and 6 mild cases, but did not prevent procedure completion.
- •Postoperative wound drainage exceeded 4 days in 10 horses (30%), predominantly in the flexural deformity group (P=0.01), requiring prolonged hospitalization.
- •Routine postoperative tenoscopy wound care was adequate for 70% of horses, while 30% required management of protracted aseptic drainage.