Page 95 - Manual of Equine Field Surgery
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Proximal Check Ligament Desmotomy 91
healing by draining hematomas or seromas asso- intact, the majority of the load during weight
ciated with the core lesion and creating a com- bearing is sustained by the tendon from the prox-
rnunication between the tendon core and the imal check ligament distally. Desmotorny is
peritenon that promotes healing. The procedure thought to allow the muscle to assume a greater
is often performed in conjunction with proximal portion of the load and contribute to the elastic-
check ligament desmotomy:'? ity of the entire unit.14 The actual strain i11 vitro
Tenoscopically assisted superior check liga- on the SDFT after proximal check ligament
ment desmotomy has also been described and desmotomy increases, but the elongation of the
may offer the advantages of decreased incisional musculotendinous unit also increases during load
complications and operative time.":" application.15 This elongation and recruitment of
Flexural limb deformities of the metacar- muscle fibers may allow for increased elasticity in
pophalangeal joint will sometimes respond to the musculotendon unit compared with those
inferior check ligament desmotomy alone or that heal without desmotomy.14
in combination with proximal check ligament
desmotomy.2•13 Fetlock flexural deformities have REFERENCES
also been treated with superficial digital flexor
tenotomy.2 1. Auer JA: Flexural deformities. In Auer JA, Stick JA,
editors: Equine surgery, ed 2, Philadelphia, 1999,
WB Saunders.
COMMENTS 2. Adams SB, Santschi EM: Management of congeni-
tal and acquired flexural deformities, Proc Am Assoc
Proximal check ligament desmotomy is more dif- Equine Pract 46: 117, 2000.
ficult than distal check ligament desmotomy. A 3. Kidd JA, Barr ARS: Flexural deformities in foals,
thorough understanding of the anatomy, careful Equine Vet Educ 14(6):311, 2002.
attention to hemostasis, and strict asepsis are 4. Fulton IC, MacLean AA, O'Reilly JL, et al: Superior
check ligament desmotomy for treatment of super-
important for consistently good results. ficial digital flexor tendonitis in Thoroughbred or
Determining the most appropriate surgical Standardbred horses, Aust Vet J 71:233, 1994.
treatment for fetlock flexural deformities can be 5. Hawkins JF, Ross MW: Transection of the accessory
difficult. For mild cases where the fetlock angle is ligament of the superficial digital flexor muscle for
less than 180 degrees, the limb can be forced into the treatment of superficial digital flexor tendonitis
extension and the superficial and deep digital in Standardbreds: 40 cases (1988-1992), J Am Vet
flexor tendons palpated. If the tautest structure is Med Assoc 206(5):674, 1995.
the DDFT, distal check ligament desmotomy may 6. Hogan PM, Bramlage LR: Transection of the acces-
be beneficial. If the tautest structure is tl1e SDFT sory ligament of the superficial digital flexor
or the superficial and deep feel equally taut, prox- tendon for treatment of tendonitis: long term
imal check ligament desmotomy is then per- results in 61 standardbred racehorses horses (1985-
1992), Equine Vet J 27(3):221, 1995.
formed. In moderate or severe cases where the 7. Adams SB, Fessler JF: Proximal check desmo-
fetlock angle is greater than 180 degrees, both pro- torny/Percutaneous tendon splitting. In Adams SB,
cedures are performed.2 If response is not ade- Fessler JF, editors: Atlas of equine surgery, Philadel-
quate after transection of both check ligaments, phia, 2000, WB Saunders,
tenotomy of the SDFT is performed. As discussed 8. Alexander GR, Gibson KT, Day RE: Effects of supe-
previously, severe cases have a poor prognosis for rior check desmotomy on flexor tendon and sus-
correction because of joint capsule and suspen- pensory ligament strain i11 equine cadavers, Vet
sory ligament contracture. These cases are candi- Surg 30:522, 2001.
dates for fetlock arthrodesis. 9. Gibson KT, Burbdige HM, Pfeiffer DU: Super-
Several, but not all, studies suggest that proxi- ficial digital flexor tendonitis in thoroughbred race
mal check ligament desmotomy increases the like- horses: outcome following non-surgical treatment
and superior check desmotomy, Aust Vet J 75:631,
lihood of return to racing after superficial digital 1997.
flexor tendonitis. 4-6•9 The reason for improvement 10. Henninger R, Bramlage L, Schneider R: Short term
is not clearly understood but is likely related to the effect of superior check ligament desmotomy and
functional lengthening of the superficial digital percutaneous tendon splitting as treatment for
flexor musculotendinous unit that occurs after acute tendonitis, Proc Am Assoc Equine Pract
desmotomy. When the proximal check ligament is 36:539, 1990.
