Minimally invasive desmotomy of the accessory ligament of the deep digital flexor tendon in horses
Authors: Tnibar A., Christophersen M. T., Lindegaard C.
Journal: Equine Veterinary Education
Summary
# Minimally Invasive Desmotomy of the Accessory Ligament of the Deep Digital Flexor Tendon Contracture of the accessory ligament of the deep digital flexor tendon is a significant cause of flexural deformity in horses, and whilst traditional surgical approaches are effective, they carry considerable morbidity and cosmetic concerns. Tnibar and colleagues reviewed 35 cases treated with ultrasound-guided minimally invasive desmotomy performed on standing horses, employing a custom-designed surgical instrument to isolate and transect the ligament with minimal soft tissue trauma. Success was achieved in 97% of cases, with excellent wound healing in all but four patients, demonstrating that the procedure is both technically reliable and clinically effective. Notably, the authors found that corrective farriery undertaken prior to surgery significantly improved outcomes, highlighting the importance of integrated musculoskeletal management alongside surgical intervention. For practitioners, this technique offers a valuable alternative to conventional open surgery—reduced incision length, lower post-operative morbidity, and improved cosmetic results make it particularly suited to performance horses where rapid return to function and minimal scarring are priorities, though success remains dependent on appropriate pre-surgical shoeing support.
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Practical Takeaways
- •Standing ultrasound-guided desmotomy of the accessory DDFT ligament is a viable minimally invasive option with high success rates and minimal complications—consider for your lame horses with this diagnosis
- •Implement corrective shoeing before surgery to optimize outcome; this conservative approach should be attempted first
- •The reduced morbidity and cosmetic outcome of this minimally invasive technique compared to open surgery makes it attractive for client communication and recovery
Key Findings
- •Ultrasound-guided desmotomy of the accessory ligament of the deep digital flexor tendon was successful in 97% of cases (34/35)
- •Excellent wound healing occurred in 31 of 35 cases (89%)
- •The procedure can be performed on the standing horse using minimally invasive technique with reduced incision length
- •Corrective shoeing prior to surgery contributes to successful outcomes