Four-step tenoscopic technique to resect a torn proximal manica flexoria while sparing the mesotendons of the deep digital flexor tendon in 30 horses.
Authors: Racine Julien, Ungermann Alexander, Blatter Marlis, von Plato Guido, Rijkenhuizen Astrid B M
Journal: Veterinary surgery : VS
Summary
# Editorial Summary Proximal manica flexoria (MF) tears in horses present a challenging surgical problem, particularly because standard resection techniques risk compromising the mesotendons (MTs) of the deep digital flexor tendon (DDFT), which are critical for maintaining blood supply to the flexor apparatus. Rijkenhuizen and colleagues describe a methodical four-step tenoscopic approach using two portals that specifically preserves these vital MT attachments whilst systematically transecting the MF from lateral to medial aspects, progressing from distal to proximal before final removal using a Kocher-Ochsner clamp and controlled rotation. In this prospective series of 30 horses (predominantly hindlimb cases), the technique achieved complete MF resection regardless of tear location—with medial tears predominating at 66.7%—and 21 of 28 horses (75%) with long-term follow-up returned to their previous or higher work level, including 81.8% of sport horses. The step-by-step precision of this approach represents a meaningful refinement in minimising iatrogenic trauma to an already-compromised region, and the consistent preservation of MT integrity may translate to superior tendon healing and functional recovery compared with less anatomically selective techniques. For practitioners referring horses with proximal flexor tendon pathology, this demonstrates that meticulous surgical planning and technique can achieve both complete lesion management and restoration to athletic function.
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Practical Takeaways
- •This refined tenoscopic technique offers surgeons a systematic four-step approach to safely remove proximal MF tears while preserving critical blood supply to the flexor tendons, potentially improving healing outcomes
- •Return-to-work rates exceeded 70% for both sport and leisure horses, making this a viable treatment option for working equines with proximal MF injuries
- •The technique's success regardless of tear location (medial, lateral, or bilateral) suggests broad clinical applicability for this common soft tissue injury
Key Findings
- •A four-step tenoscopic MF resection technique successfully preserved mesotendons of the DDFT in all 30 horses regardless of tear location
- •Proximal MF tears were medial (66.7%), lateral (23.3%), or bilateral (10.0%), with 90% affecting hindlimbs
- •81.8% of sport horses and 70.6% of leisure horses returned to the same or higher level of work at >6 months follow-up
- •The modified two-portal technique reduced surgical trauma while maintaining extrinsic blood supply to flexor tendons