Tenoscopically guided proximal digital annular ligament desmotomy for the treatment of proximal digital annular ligament desmitis.
Authors: Wood Andrew D, Parker Russell A
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Tenoscopically Guided PDAL Desmotomy Proximal digital annular ligament (PDAL) desmitis remains a challenging diagnosis in equine practice, with limited surgical options available to practitioners. Wood and Parker developed and evaluated a tenoscopically guided technique for complete PDAL desmotomy, utilising multiple instrument portals within the digital flexor tendon sheath to address different anatomical portions of the ligament; their work combined cadaver validation (10 hindlimbs) with five clinical cases to assess both technical feasibility and clinical outcomes. While the technique successfully transected the proximolateral attachment and distal body of the PDAL in all cadaver limbs, complete transection of the proximal body proved elusive, and iatrogenic damage to the superficial digital flexor tendon occurred in 40% of specimens—findings that highlight the anatomical complexity of this procedure. Nevertheless, four of five clinical cases returned to their previous exercise level and remained sound, with only one horse developing postoperative synovial sepsis; this disparity between cadaver and clinical results suggests the technique is transferable to clinical practice despite technical limitations in the model. For equine professionals managing cases of PDAL desmitis, this work establishes tenoscopically guided desmotomy as a viable treatment option with reasonable prognosis for return to function, though careful surgical execution and rigorous infection prevention are essential given the potential for iatrogenic tendon damage and septic complications.
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Practical Takeaways
- •PDAL desmitis is a significant diagnosis that warrants surgical intervention; tenoscopically guided desmotomy offers a viable treatment option with reasonable success rates for return to athletic function.
- •Surgeons should be aware of the risk of iatrogenic SDFT damage during the procedure and the potential for postoperative synovial infection, requiring careful surgical technique and appropriate perioperative management.
- •This technique requires specialized equipment and endoscopic expertise; refer cases to facilities with tenoscopic capabilities rather than attempting open approaches in primary care settings.
Key Findings
- •Tenoscopically guided PDAL desmotomy successfully transected the proximolateral attachment and distal body of the PDAL in all cadaver limbs, though the proximal body was never completely transected.
- •Iatrogenic damage to the superficial digital flexor tendon occurred in 4 of 10 cadaver limbs (40%), indicating surgical risk.
- •Four of five clinical cases returned to previous exercise levels postoperatively with good long-term soundness outcomes.
- •One clinical case developed fatal synovial sepsis 3 weeks after surgery, representing a significant postoperative complication risk.