A novel ultrasonographic assisted technique for desmotomy of the palmar/plantar annular ligament in horses

Ex vivo evaluation of a percutaneous thread-transecting technique for desmotomy of normal palmar/plantar annular ligaments in horses

OBJECTIVE

To develop and describe a minimally invasive, ultrasound-guided, percutaneous technique for the desmotomy of equine palmar/plantar annular ligaments (PALs) using a transecting thread.

STUDY DESIGN

Ex vivo study.

SAMPLE POPULATION

Twenty-one normal equine distal limb specimens.

METHODS

Under ultrasonographic guidance, a surgical thread was percutaneously placed around the PAL through 2 skin punctures (proximal and distal) using a 18 gauge spinal needle in equine limbs (11 forelimbs, 10 hindlimbs) with normal PALs. The ligament was transected by a back-and-forth motion of the thread until the loop emerged from the proximal skin puncture site. Each specimen was dissected and assessed for completeness of transection and iatrogenic damage under direct visualization. Descriptive statistics were reported.

RESULTS

The PAL was completely transected in 17/21 limbs. The mean duration of the procedure was 16 minutes. Superficial needle puncture or subtle abrasion of the superficial digital flexor tendon was noticed in 4 limbs. No iatrogenic injury to other intrathecal structures was identified. After PAL division, the needle entry and exit points had a mean diameter of 1.2 and 1 mm, respectively.

CONCLUSION

Desmotomy of normal PALs in equine limb specimens was performed effectively using the percutaneous thread-transecting technique with minimal iatrogenic damage to adjacent structures.

CLINICAL SIGNIFICANCE

Information from this study will allow refinement of the technique for use in equine clinical cases either in standing or anesthetized horses.

Minimally invasive tenotomy of the tibial insertion of the semitendinosus muscle: An ex vivo study in horses

OBJECTIVE

To describe a minimally invasive technique for semitendinosus tenotomy with ultrasonographic guidance and to evaluate procedural complications.

STUDY DESIGN

Experimental study.

SAMPLE POPULATION

Cadaveric equine hind limbs (n = 16).

METHODS

A stab incision was performed distocaudal to the tibial insertion of the semitendinosus muscle with ultrasonographic assistance. After transection of the tendon with an arthroscopic retrograde knife, the tendon edges palpably retracted, and complete transection was confirmed by ultrasound. Limbs were dissected to confirm the degree of tendon transection and to identify iatrogenic trauma to surrounding soft tissues.

RESULTS

Tenotomy was complete in all limbs, resulting in a palpable gap forming between tendon edges. Superficial iatrogenic laceration to the underlying gracilis muscle (n = 2) or gracilis fascia (n = 1) was apparent in 3 of 16 limbs.

CONCLUSION

Ultrasound-assisted tenotomy of the tibial insertion of the semitendinosus muscle was reliably performed in a minimally invasive fashion with minor iatrogenic damage.

CLINICAL SIGNIFICANCE

Minimally invasive tenotomy of the semitendinosus muscle can be performed with ultrasonographic assistance and should be considered as an alternative technique for surgical management of fibrotic semitendinosus myopathy.