Critical review on outcomes of treatments for hind limb Musculus Interosseous Medius (suspensory ligament) injury

Purpose

To systematically evaluate medical and surgical techniques and clinical outcomes of treatments of hind limb musculus interosseous medius injury (MLM).

Introduction

The MLM is also known as the suspensory ligament in the horse. Injuries to the MLM can be divided by location to those of: the proximal part, the mid body or the branches. Diagnosis, treatment and outcome of injuries to the MLM vary considerably between the forelimb and hind limbs. This review focuses on papers describing outcome of treatment for injuries to the proximal part of the MLM in the hind limb (also known as proximal suspensory desmopathy (PSD)) only. Proximal plantar metatarsal pain has become one of the most commonly diagnosed causes of hind limb lameness in Sports horses. This umbrella term gives rise to a substantial differential diagnosis list including: proximal suspensory desmopathy, avulsion injuries of the enthesis of the MLM, plantar cortical changes within the proximal metatarsus, osteoarthritis of the distal tarsal joints, and desmopathy of the intertarsal ligaments. Multiple treatments are described for management of injury to the proximal part of the MLM and these include conservative management (rest, application of egg bar shoes, injection of corticosteroids, bone marrow, autologous conditioned serum, platelet rich plasma, bone marrow derived mesenchymal stromal cells (MSC), umbilical cord blood MSC, iodine in almond oil, radial pressure wave therapy, extracorporeal shock wave treatment (ESWT)) and surgical management (osteostixis, neurectomy of the deep branch of the lateral plantar nerve, neurectomy of the tibial nerve, ligament desmotomy and fasciotomy and microfracture). Assessments of treatment efficacy are dependent on the accuracy of the initial diagnoses. [...]