Tenoscopic‐assisted subcutaneous approach to a plantar annular ligament desmotomy in a horse with severe constriction of the fetlock canal
Authors: Sharon Jeong, A. Young, Albert Sole Guitart
Journal: Equine Veterinary Education
Summary
# Editorial Summary When the palmar/plantar annular ligament (PAL) becomes pathologically constrictive, it can impede normal sliding of the flexor tendons through the fetlock canal and cause lameness unresponsive to conservative management, necessitating surgical intervention. Standard tenoscopic PAL desmotomy is typically performed via an intrathecal approach using various instruments, though severe adhesions or canal constriction can make this technically challenging and risk iatrogenic damage to the tendon sheath. This case report documents a horse with marked fetlock canal stenosis where the conventional intrathecal route proved unsafe, successfully managed instead by performing the ligament transection via a subcutaneous approach under tenoscopic guidance using a hook knife. The authors argue that adopting a subcutaneous-first technique in chronic tenosynovitis cases with significant fibrosis or constriction may better protect delicate intra-sheath structures from inadvertent trauma during the initial examination phase. For practitioners managing recurrent or refractory flexor tendon sheath pathology, this alternative approach represents a valuable technical option that prioritises safety when standard instrumentation access is compromised.
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Practical Takeaways
- •When severe fetlock canal constriction or adhesions prevent standard intrathecal PAL desmotomy, consider a subcutaneous approach with tenoscopic guidance as a safer alternative that reduces risk of damaging flexor tendons or sheath
- •For chronic tenosynovitis cases with restricted canal access, performing subcutaneous PAL transection at the beginning of tenoscopic examination may prevent iatrogenic injury and improve surgical outcomes
- •This technique expands your surgical options when anatomical constraints make conventional intrathecal approaches unsafe or impossible
Key Findings
- •Tenoscopic-assisted subcutaneous hook knife approach successfully transected the PAL in a horse where severe fetlock canal constriction prevented standard intrathecal technique
- •Subcutaneous PAL desmotomy approach minimized risk of iatrogenic injury to flexor tendon sheath structures in severe constriction cases
- •Hook knife via subcutaneous route provided adequate visualization and safe access despite anatomical constraints that would limit instrument manoeuvrability within the sheath