Minimally invasive ultrasound-assisted cutting thread tenotomy of the deep digital flexor tendon in horses: An ex vivo study.
Authors: Lalanne Camille, Bonilla Alvaro G
Journal: Veterinary surgery : VS
Summary
# Editorial Summary Researchers evaluated the feasibility of a minimally invasive percutaneous cutting thread technique for deep digital flexor tendon (DDFT) tenotomy in horses, using 20 cadaveric forelimbs positioned to mimic standing posture with the midmetacarpal region prepped for the procedure. A curved 20-gauge spinal needle guided placement of a cutting thread around the DDFT under ultrasound guidance and palpation, with operative time and skin puncture dimensions recorded before dissection to assess transection completeness and collateral damage. Complete DDFT transection was achieved in all cases, though minor superficial digital flexor tendon lesions occurred in 11 limbs (considered inconsequential) and concerning neurovascular bundle damage in 6 limbs—including four instances of nerve injury and two involving both nerve and arterial or venous injury—whilst skin puncture sites ranged from imperceptible to 5 mm and averaged 7 minutes 38 seconds per procedure. For practitioners considering this technique clinically, the reliable transection capability must be weighed against the 30% incidence of neurovascular compromise, indicating that significant refinement is needed before widespread adoption; the methodology shows promise for minimally invasive DDFT management, but controlled refinement studies addressing anatomical variability and needle passage optimisation would be essential before clinical translation.
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Practical Takeaways
- •This technique offers a genuinely minimally invasive option for DDFT tenotomy with small skin wounds and quick procedure time, but the current 30% neurovascular complication rate makes it unsuitable for clinical use without refinement
- •The technique reliably achieves complete tendon transection, suggesting the threading method is mechanically sound—focus should be on refining needle placement to avoid the neurovascular bundle during development
- •Before considering this for clinical cases, await modified protocols that address the collateral damage risk; the concept is promising but requires further optimization
Key Findings
- •Complete DDFT transection was achieved in all 20 cadaveric limbs using the percutaneous cutting thread technique
- •Neurovascular bundle damage occurred in 6/20 limbs (30%), including nerve damage in 4 limbs and combined nerve and vascular damage in 2 limbs
- •Minor superficial digital flexor tendon lesions occurred in 11/20 limbs but were deemed clinically irrelevant
- •Procedure completed in average 7 minutes 38 seconds with minimal skin puncture trauma (0-5 mm)