Surgical management of marginal tears of the suspensory ligament branches in Thoroughbred racehorses

Desmitis of the suspensory ligament branches (SLB) is a common injury in all types of sport horses [1]. Aside from a description of avulsion injuries of the dorsal (articular) surface of the suspensory ligament branches (SLB) [2] most injuries of the SLB are grouped together and considered as a single pathological entity. A plethora of non-specific treatment modalities are recorded in the literature. These are similar to those employed for desmitis of the suspensory ligament body and include rest, cold applications, topical anti-inflammatory medicaments, farriery techniques, support bandaging, varying forms and duration of controlled exercise, oral glycosaminoglycans, systemic polysulphated glycosaminoglycans, systemic hyaluronan, intralesional injection of autologous platelet concentrates and ligament splitting techniques [1, 3- 5]. There are also anecdotal reports of intralesional β aminopropionitrile fumarate and stem cell therapy [1]. Despite current concepts associated with regenerative therapies, it is generally accepted that horses cannot recreate the exact structure of the insertion of the SLB following injury [7]. Healing consists of scar tissue and it is improbable that any type of scar tissue will be able to function in a similar fashion to the undamaged SLB [7]. Associated prognoses have been poorly documented in the literature and are mostly anecdotal. In general injuries of the suspensory ligament branches have a guarded prognosis [8] and when accompanied by periligamentous fibrosis this has been described as poor [1, 3]. The prognosis for SLB injuries in both fore and hindlimbs for dressage and show jumping is reported to be fair [3]. However, the long term prognosis for racehorses has been considered poor [9]. In one report a degree of objectivity was introduced for juvenile injuries in Thoroughbreds. This study demonstrated that horses with juvenile insertional suspensory branch lesions race significantly less as two and three year olds (27% and 62% respectively) compared to unaffected horses (58% and 82%) [6]. [...]