Ex-vivo evaluation of a percutaneous looped thread desmotomy of the accessory ligament of the deep digital flexor tendon in horses.
Authors: Orozco Lopez David, Mochal-King Cathleen, Fontenot Robin, O'Shea Caitlin M
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Percutaneous Looped Thread Desmotomy of the Accessory Ligament of the Deep Digital Flexor Tendon Surgical division of the accessory ligament of the deep digital flexor tendon (AL-DDFT) can alleviate pain in horses with deep digital flexor tendon pathology, but conventional approaches require larger incisions and dissection. Lopez and colleagues evaluated an ultrasonographically-guided percutaneous technique using a looped FiberWire suture as a cutting device on 24 ex-vivo equine forelimb specimens, assessing completeness of transection, surgical time, and iatrogenic complications. Complete AL-DDFT transection was achieved in 22 of 24 specimens (92%), with a median surgical time of 11 minutes and no suture failures, but the procedure resulted in injury to the neurovascular bundles in 5 specimens (21%)—specifically the medial bundle in 4 limbs and lateral bundle in 1 limb. Whilst the technique demonstrates technical feasibility and the potential for a minimally invasive approach, the risk of vascular and neural injury is a significant concern that must be addressed before clinical application; further refinement of needle placement and operative technique is necessary, alongside progression to in-vivo studies in anaesthetised or standing horses to establish safety margins and clinical efficacy. For practitioners considering this emerging procedure, the current evidence suggests it remains investigational and should not yet be adopted in clinical practice without additional safety validation.
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Practical Takeaways
- •This ex-vivo technique shows promise as a minimally invasive alternative to traditional desmotomy for AL-DDFT lesions, but neurovascular injury risk (21%) requires careful technique refinement before clinical application
- •The relatively quick procedure time (median 11 min) and high transection success rate (92%) suggest feasibility, but additional in-vivo studies in standing or anesthetized horses are essential before clinical adoption
- •Ultrasound-guided needle placement appears critical to procedure success and safety—proper anatomical understanding of the neurovascular anatomy in this region will be vital for practitioners considering this technique
Key Findings
- •Complete transection of AL-DDFT achieved in 22/24 specimens (92%) using percutaneous looped thread desmotomy
- •Procedure met all successful criteria in 18/24 specimens (75%), with median surgical time of 11 minutes
- •Iatrogenic neurovascular bundle injury occurred in 5/24 specimens (21%), including medial bundle injury in 4/24 and lateral in 1/24
- •No suture failure or suture remnants were noted in any specimens tested