SOFT TISSUE PROBLEMS
Equine proximal suspensory desmitis (PSD) is a common cause for lameness. Neurectomy of the deep branch of the lateral plantar nerve and plantar fasciotomy have become accepted as methods of treatment of PSD. We have described follow-up information in horses that had undergone neurectomy and fasciotomy (N&F) with PSD alone or with other injuries contributing to lameness as there are limited studies documenting this. Horses were divided into 3 groups based on clinical assessment and diagnostic analgesia. Group 1 horses had primary PSD and no other musculoskeletal problem. Group 2 horses had primary PSD in association with straight hock conformation and/or hyperextension of the metatarsophalangeal joint. Group 3 horses had PSD and other problems contributing to lameness or poor performance. In Groups 1 and 3, 77.8% and 44.2% respectively, of horses had been in full work for >1year post operatively. All horses in Group 2 remained lame. The results show there is a role for N&F for long-term management of hindlimb PSD, but a prerequisite for successful management requires recognition of risk factors for poor outcome including conformation features of straight hock or fetlock hyperextension.
We have also detailed the MR and histological appearances of the accessory ligament of the deep digital flexor tendon (AL-DDFT), as this has not been documented previously in detail. We found that fibrous bundles were seen between the AL-DDFT and the lateral aspect of the superficial digital flexor tendon (n = 9) and the DDFT (n = 2). The AL-DDFT had low to intermediate signal intensity in most limbs in most high-field and low-field MRI sequences. In 69% of limbs, oblique bands of higher signal intensity than the rest of the ligament were identified in high-field images of the AL-DDFT. The cross-sectional area of the AL-DDFT in the proximal 7 cm of the metacarpal region ranged from 68.1-299 mm(2). There was no significant relationship between age, gender, weight or height and either the cross-sectional area of the AL-DDFT or the presence of oblique higher signal intensity bands. Histological examination revealed that the AL-DDFT had thick collagen bundles arranged in large crimps and sometimes crossing in oblique directions. The cellularity was greater than in the deep digital flexor tendon in all limbs. The large variability in the MRI appearance and size of the AL-DDFT in nonlame horses should be borne in mind when interpreting MR images of lame horses.
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