An Integrated Approach to Improve Healing of Suspensory Ligament Injuries

Although there have been many advances in available treatment options for suspensory ligament (SL) injuries, the prognosis is currently reported to be the same as it was 15 years ago. In fact, the prognosis for return to work without re- injury can be greatly improved.

A complete, whole horse clinical evaluation is important when diagnosing SL injuries because many horses have other, often subtle problems which contribute to the development of an SL injury and which, if unresolved, impair good healing. Concurrent metacarpal/metatarsal bone disease, sesamoid pathology and fetlock joint disease are directly associated with SL injury. Indirectly, problems such as sore feet or sore back can contribute to SL overload and injury. Diagnosing and treating all problems simultaneously will shorten overall healing time and improve the odds for return to work without recurrent SL injury.

Diagnostic ultrasound is safe, non-invasive and accurate in the diagnosis of SL injury in the hands of an examiner with sufficient expertise. It is preferable to refer or consult on a case with a veterinarian who has this level of expertise than to perform sub-optimal ultrasound examinations, which often yield only a fraction of the information available about the status of the injury. Without an accurate diagnosis, it is not possible to formulate or to monitor an effective rehabilitation program. 

Studies have shown that pasture turnout or uncontrolled exercise yields a very low return rate to work without SL re-injury, but horses are often treated in this manner, even following initial aggressive medical and or surgical treatment. A detailed exercise program that is based on an understanding of the phases of ligament healing and the time frame required for each phase, and on regular clinical and ultrasonographic examinations can significantly improve the prognosis for SL injuries
A series of cases will be presented to illustrate these concepts.