Ex vivo evaluation of a percutaneous thread-transecting technique for desmotomy of normal palmar/plantar annular ligaments in horses.
Authors: De Gasperi Diego, Guo Danqing, Guo Danzhu, Lu Yan, Brounts Sabrina H
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Percutaneous Thread Desmotomy of Equine Annular Ligaments Palmar and plantar annular ligament (PAL) constriction remains a challenging condition in equine practice, traditionally requiring open surgical approaches with their associated tissue trauma and recovery complications. De Gasperi and colleagues developed a novel minimally invasive technique using an ultrasound-guided percutaneous thread loop to transect the PAL, testing the method on 21 ex vivo equine limb specimens (11 forelimbs, 10 hindlimbs) by threading a suture around the ligament through two small skin punctures and cutting it with reciprocating motion until complete division. The procedure successfully achieved complete PAL transection in 17 of 21 specimens (81%) with a mean operative time of 16 minutes; whilst superficial needle puncture or subtle tendon abrasion occurred in four cases, no damage to critical intrathecal structures was observed, and skin puncture sites measured only 1.2 mm and 1 mm in diameter respectively. For equine practitioners managing PAL-related conditions, this technique potentially offers a genuine advance in minimally invasive surgical options, significantly reducing soft tissue trauma, post-operative complications and recovery time compared to traditional open desmotomy—though the refinement needed for clinical application and the 81% complete transection rate suggest careful technique development and case selection will be essential before routine use becomes standard practice.
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Practical Takeaways
- •This minimally invasive ultrasound-guided technique shows promise as an alternative to traditional surgical desmotomy with very small skin puncture sites and rapid procedure time
- •The 81% complete transection rate in normal tissue suggests the technique is viable, but clinical refinement is needed to address the 19% complication rate of superficial tendon contact
- •Standing or anesthetized clinical application appears feasible based on this ex vivo validation, but in vivo trials are necessary before widespread adoption
Key Findings
- •Complete transection of the PAL was achieved in 17/21 limbs (81%) using the percutaneous thread-transecting technique
- •Mean procedure duration was 16 minutes with minimal skin trauma (entry 1.2 mm, exit 1.0 mm mean diameter)
- •Superficial needle puncture or subtle abrasion of the superficial digital flexor tendon occurred in 4 limbs (19%) with no other intrathecal structure injuries identified