Mid-metacarpal deep digital flexor tenotomy in the management of refractory laminitis in horses.
Authors: Hunt, Allen, Baxter, Jackman, Parks
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Mid-Metacarpal Deep Digital Flexor Tenotomy for Refractory Laminitis Hunt and colleagues evaluated mid-metacarpal deep digital flexor (DDF) tenotomy as a salvage procedure for 20 horses with severe laminitis unresponsive to conventional management, recognising that cases resistant to standard treatment represent a critical welfare and prognostic challenge. Surgical transection of the DDF tendon was performed on all horses, with post-operative outcomes tracked over the following months. Within 72 hours, 16 of the 20 horses (80%) demonstrated clinical improvement, though only one horse deteriorated and two showed no change; however, long-term survival proved bleak, with 11 horses euthanised within one month and only six surviving beyond six months. Of those six longer-term survivors, all remained lame and none returned to any level of athletic work, indicating that whilst DDF tenotomy may provide acute pain relief during the critical refractory phase, it does not alter the fundamental disease trajectory or offer realistic prospects for functional recovery. This work suggests the procedure's role is strictly palliative—potentially extending the window for decision-making in severe cases—rather than curative, and should be positioned within a broader discussion of welfare and prognosis rather than as a route to ridden soundness.
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Practical Takeaways
- •Mid-metacarpal DDFT tenotomy may provide rapid pain relief in severe refractory laminitis cases, but should be considered a short-term salvage procedure rather than a curative treatment
- •Improved early clinical signs should not be interpreted as prognostic for long-term survival or return to function—counsel clients accordingly
- •High post-operative mortality (70% within 6 months) limits clinical utility; use only when conventional management has failed and humane euthanasia alternatives are being considered
Key Findings
- •16 of 20 horses (80%) showed clinical improvement within 72 hours of mid-metacarpal deep digital flexor tenotomy
- •Only 6 of 20 horses (30%) survived longer than 6 months post-surgery
- •None of the surviving horses returned to athletic performance; 3 survivors remained lame
- •Early pain relief does not correlate with improved long-term survival or functional recovery