Evaluation of a tenoscopic approach for desmotomy of the accessory ligament of the deep digital flexor tendon in horses.
Authors: Caldwell Fred J, Waguespack R Wayne
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Tenoscopic Desmotomy of the Accessory Ligament of the Deep Digital Flexor Tendon Lameness arising from contracture of the accessory ligament of the deep digital flexor tendon (AL-DDFT) remains a significant clinical challenge in horses, particularly in cases refractory to conservative management. Caldwell and Waguespack developed and validated a novel minimally invasive approach using tenoscopy to divide this ligament, working through the carpal flexor sheath with saline distention to visualise the space between the AL-DDFT and deep digital flexor tendon itself. Across experimental horses, the procedure achieved complete transection of the AL-DDFT in all cases within a mean surgical time of 28.3±11.8 minutes, with ultrasonographic confirmation of complete division and no iatrogenic damage to the suspensory ligament in any animal over the 30-day monitoring period. Early cadaveric work identified technical refinements needed (lateral portal placement and staged medial-to-lateral transection), which were subsequently incorporated into the live surgical protocol. For practitioners considering or referring cases with AL-DDFT contracture, this tenoscopic technique offers the precision and reduced soft tissue trauma inherent to endoscopic surgery, potentially translating to faster rehabilitation and lower complication rates compared with traditional open desmotomy approaches, though longer-term outcome data and comparative studies would strengthen evidence for routine adoption in clinical practice.
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Practical Takeaways
- •Tenoscopic AL-DDFT desmotomy is a viable surgical option with reliable complete transection and minimal collateral soft tissue damage when performed by experienced surgeons
- •The technique can be completed in ~30 minutes, making it an efficient alternative to open approaches
- •Post-operative monitoring and ultrasound confirmation of complete transection are important to assess success and identify any incidental DDFT involvement
Key Findings
- •Tenoscopic desmotomy of AL-DDFT was successfully completed in all 12 experimental horses with complete transection confirmed by ultrasound
- •Mean surgical time was 28.3±11.8 minutes from incision to skin closure
- •Minor complications in cadaver specimens (incomplete division, shallow suspensory ligament incision) were avoided in experimental horses with refined technique
- •Only 1 of 12 experimental horses showed minor DDFT fiber disruption at 30-day ultrasound follow-up