Comparison of Two Surgical Techniques for the Treatment of Equine Hindlimb Proximal Suspensory Desmopathy
Authors: Kendra D. Freeman, M. N. Adams, Allison E. Salinger, Nathaniel A. White, Jennifer G Barrett
Journal: Animals : an Open Access Journal from MDPI
Summary
Proximal suspensory desmopathy (PSD) is a significant cause of hindlimb lameness in performance horses, yet optimal surgical management remains debated between those favouring tissue-sparing approaches and those accepting nerve sacrifice. Freeman and colleagues evaluated 141 horses treated surgically for PSD via two distinct techniques: desmoplasty with fasciotomy (DF), which preserves the deep branch of the lateral plantar nerve whilst splitting the ligament and releasing constricting fascia, versus nerve ablation combined with fasciotomy (NF), which removes the constrictive tissue but deliberately denervates the suspensory ligament. Both approaches achieved comparable functional outcomes, with similar proportions of horses returning to work at their pre-injury level, though surgeons preferentially selected DF in cases with ultrasonographic evidence of ligament fibre disruption, suggesting technique choice may reflect perceived tissue architecture rather than clinical indication. Whilst neither approach generated serious operative complications, three horses (approximately 2%) developed fetlock subluxation secondary to excessive ligament laxity post-operatively—a notable consideration for informed client consent. These findings support both techniques as viable options for PSD management, though the nerve-sparing benefits of DF may warrant it as a first-line approach, particularly where tearing is evident, whilst maintaining awareness of iatrogenic instability risk regardless of technique selected.
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Practical Takeaways
- •Both surgical approaches (desmoplasty with fasciotomy and neurectomy with fasciotomy) produce comparable outcomes for proximal suspensory desmopathy; surgeon experience and horse presentation should guide technique selection
- •Fetlock laxity is a potential post-operative complication (2.1% incidence) that should be discussed with owners; clinical monitoring is warranted in early recovery
- •Presence of suspensory ligament tearing on imaging may influence surgical approach selection, though both methods yield similar functional outcomes
Key Findings
- •Both desmoplasty with fasciotomy (DF) and neurectomy with fasciotomy (NF) achieved similar rates of soundness and return to work in 141 horses with proximal suspensory desmopathy
- •Desmoplasty with fasciotomy was preferentially used in horses with evidence of suspensory ligament tearing, suggesting surgeon preference based on tear presentation
- •Three horses (2.1%) developed fetlock laxity (dropped fetlocks) post-operatively, the only significant complication observed
- •Neither surgical technique was associated with serious operative complications