Medial patellar ligament splitting for the treatment of upward fixation of the patella in 7 equids.

Summary

# Editorial Summary: Medial Patellar Ligament Splitting for Upward Fixation of the Patella Upward fixation of the patella (UFP) remains a challenging orthopaedic problem in equine practice, particularly in young or unfit horses, and conservative management often yields variable results. Tnibar and Aziz presented a novel surgical approach in which the proximal third of the medial patellar ligament was deliberately split using percutaneous ultrasound-guided scalpel technique in four horses and three Shetland ponies, with the counterintuitive strategy of inducing localised desmitis to promote ligament thickening rather than repair. All seven equids returned to exercise the day following surgery without anti-inflammatory medication, and follow-up imaging demonstrated a 2- to 3-fold increase in proximal medial patellar ligament cross-sectional area, with no recurrence of clinical signs or short-term and long-term complications recorded. The mechanism appears elegant: controlled inflammation-induced hypertrophy of the ligament alters the mechanical geometry of the patellofemoral apparatus sufficiently to prevent fixation. For practitioners managing horses with chronic UFP unresponsive to conditioning or those needing rapid return to work, this minimally invasive technique offers a definitive surgical option with a rapid rehabilitation timeline, though the small sample size and lack of comparison with traditional surgical alternatives (such as desmotomy) mean further evaluation would strengthen confidence in this approach.

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Key Findings

• •Percutaneous splitting of the proximal medial patellar ligament (MPL) resolved UFP in all 7 equids with no complications
• •The procedure induced localized desmitis resulting in 2- to 3-fold increase in MPL size
• •All horses and ponies returned to normal activity with no recurrence of UFP signs

Conditions Studied