Desmitis of the accessory ligament of the deep digital flexor tendon in the forelimb: A retrospective case study of 91 horses.
Authors: Lynch Nicola, Taylor Camilla J, McGilvray Tegan, Tucker Rachel, Bathe Andy, Elliott Christopher R B, Smith Roger K W
Journal: Equine veterinary journal
Summary
# Accessory ligament injuries: What determines return to work? This retrospective analysis of 91 horses treated for desmitis of the accessory ligament of the deep digital flexor tendon over an 18-year period provides much-needed clarity on prognosis and prognostic indicators for this common forelimb injury. The research team reviewed cases from four equine hospitals, extracting detailed information on presentation, treatment protocols (which ranged from controlled exercise alone to intra-lesional injections, therapeutic ultrasound, extracorporeal shockwave therapy, or desmectomy) and clinical outcomes, with return to work defined as success. Overall, 64% of the 85 horses with adequate follow-up data returned to work; however, persistence of lameness at follow-up was a powerful predictor of failure, reducing the likelihood of return to work by a factor of nearly 108, whilst ultrasonographic identification of adhesions reduced the odds of successful outcome by 90%. These findings suggest that clinicians should place particular emphasis on achieving complete resolution of lameness during rehabilitation and should view adhesion formation as a concerning sign warranting reassessment of management strategy, potentially influencing decisions around the timing and type of intervention (particularly whether invasive treatments such as desmectomy might be warranted earlier in cases showing adhesion development).
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Practical Takeaways
- •Expect approximately two-thirds of horses with ALDDFT injuries to return to work; baseline lameness status and imaging findings are important prognostic indicators
- •Adhesion formation on ultrasound is a significant negative prognostic indicator—monitor imaging carefully and consider more aggressive intervention if adhesions develop
- •Controlled exercise appears to be a reasonable first-line approach for many cases, but persistent lameness warrants consideration of advanced treatments or reassessment of rehabilitation strategy
Key Findings
- •64% (54/85) of horses returned to work following ALDDFT injury over an 18-year period
- •Persistence of lameness at follow-up reduced return to work odds by 107.93-fold (p<0.001)
- •Ultrasonographic identification of adhesions was associated with 90% reduced odds of return to work (OR 0.10, p=0.03)
- •68% of horses were managed with controlled exercise alone, while 28% received advanced interventions including injection, ultrasound, shockwave therapy or desmectomy