Management of hindlimb proximal suspensory desmopathy by neurectomy of the deep branch of the lateral plantar nerve and plantar fasciotomy: 155 horses (2003-2008).
Authors: Dyson S, Murray R
Journal: Equine veterinary journal
Summary
# Editorial Summary: Long-term Outcomes of Neurectomy and Fasciotomy for Proximal Suspensory Desmopathy Proximal suspensory desmopathy represents a challenging diagnosis in performance horses, and whilst neurectomy of the deep branch of the lateral plantar nerve combined with plantar fasciotomy has gained clinical acceptance as a treatment approach, evidence regarding long-term efficacy remains sparse. Dyson and Murray's retrospective analysis tracked 155 horses undergoing this combined surgical procedure between 2003 and 2008, stratifying outcomes according to the presence of concurrent musculoskeletal pathology identified through clinical examination and diagnostic analgesia. Success rates proved substantially dependent on case complexity: horses with isolated proximal suspensory desmopathy achieved a 77.8% return to full work for over one year (70 of 90 horses), whilst this figure declined dramatically to 44.2% when additional lesions contributed to lameness (23 of 52 horses), and notably all horses presenting with straight hock conformation or metatarsophalangeal joint hyperextension remained persistently lame. Recognised complications included iatrogenic suspensory ligament damage during fasciotomy, seroma formation, residual curb-like swellings, and white hair development over the surgical site. For practitioners considering this intervention, rigorous pre-operative assessment of conformation—particularly hock angulation and fetlock extension mechanics—is essential for realistic prognostication, as these anatomical features appear to be primary determinants of failure rather than the primary suspensory pathology itself.
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Practical Takeaways
- •Neurectomy and fasciotomy for PSD works well (78% success) in horses with isolated suspensory disease, but consider conformation and concurrent injuries before recommending surgery
- •Straight hock conformation or fetlock hyperextension are strong predictors of treatment failure—horses with these conformational features should not be considered good surgical candidates
- •In cases with concurrent lameness problems, success rate drops to 44%; carefully select which horses will benefit from this procedure
Key Findings
- •In horses with primary PSD alone (Group 1), 77.8% (70/90) achieved successful long-term outcome (>1 year in full work) following neurectomy and fasciotomy
- •In horses with PSD and concurrent musculoskeletal problems (Group 3), only 44.2% (23/52) returned to full function for >1 year
- •All horses in Group 2 (PSD with straight hock or metatarsophalangeal hyperextension) remained lame despite treatment
- •Complications included iatrogenic suspensory ligament damage, seroma formation, residual swellings, and white hair development