Tendons in horses are fibrous connective tissues that attach muscles to bones, facilitating movement and providing stability to the musculoskeletal system. They are composed primarily of collagen fibers, which confer strength and flexibility, allowing horses to perform various physical activities. Equine tendons are subject to significant mechanical stress during locomotion, making them susceptible to injury, particularly in performance horses. Common tendon injuries include strains, tears, and tendinitis, which can impact a horse's mobility and performance. This page compiles peer-reviewed research studies and scholarly articles that explore the structure, function, and pathology of tendons in horses, as well as advancements in diagnostic and therapeutic approaches for tendon injuries.
Shively JA, Van Sickle DC.The scanning electron microscopy of synovial membrane from the radiocarpal and intercarpal joints near the lateral and medial borders of the tendon of the extensor carpi radialis muscle was studied in 5 ponies. Three different morphologic types of synovial membrane were observed. Type 1 synovial membrane was folded and had a surface mat of fibers separated by 1- to 5-micron-diameter holes. The 2nd and 3rd types of synovial membrane were both villous. The surface of type 2 synovial membrane was fibrillar but the surface of type 3 synovial membrane was cellular. The type of synovial membrane pre...
Webbon PM.The results of a survey are presented in which 589 limbs from 206 horses were dissected. In174 of the limbs lesions were found in either the superficial (131) or deep (43) digital flexor tendons. Changes occurring with age were also recorded. The sites of the abnormalities and their macroscopical appearance are described and the value of the results is considered in relation to the diagnosis and the treatment of clinical lesions.
Rose RJ.Complications from neurectomy have been well known for many years. A 16-year-old mare suffered bilateral luxation of the coffin joints following palmar neurectomy and was destroyed. Autopsy showed complete rupture of the deep flexor tendons, and the supporting ligaments of the coffin joints. Arthritis of the coffin joints, with erosion of articular cartilage was evident.
Knudsen O.The paper briefly describes the percutaneous tendon splitting operation as performed in general practice and evaluates its effectiveness on the basis of races run during a 2 year follow-up period. The results are compared with similar figures for normal Standardbred trotters. A higher percentage of horses subjected to splitting of the suspensory ligament failed to remain sound long enough to run more than 10 races during the follow-up period. The percentage of horses returning to racing whose superficial flexor was operated upon was somewhat lower than the control group.
Norrie RD.The concept of regenerative healing has been used to manipulate the healing process in experimental animals and clinically to augment bone healing in people after orthopedic operation. An implanted electrical device was used in an attempt to produce regenerative healing in experimentally created equine tendon injury. The bimetallic electrical implant did not produce regenerative healing under the conditions of this experiment. The mechanism of implantation and discussion of the results are included.
Strömberg B.Thermography in veterinary medicine has hitherto been proven to be a method of great value in the detection of orthopaedic lesions in racehorses. Lesions of the musculo-skeletal system affecting tendons, joints, bones and skeletal muscle can be demonstrated and documented at an early stage thereby preventing the development of more serious lesions.
Evans JH, Barbenel JC.Tendon normally fulfills its primary role as a flexible force transmitting element very effectively and yet failure of this passive tissue leads to great disability. As a connective tissue its structure is relatively simple and the peculiar helical arrangement of collagen fibres confers highly non-linear as well as time-dependent mechanical properties. Functional significance cannot be attributed to any facet of mechanical response until the physiological pattern of loading is established. In particular the rate of deformation and the minimum force experienced by tendon in normal locomotion ha...
Strömberg B.Thermography is the pictorial representation of infra-red (IR) emission from the surface of an object. IR emission from biological surfaces originates from two principal sources, circulation and metabolism, which are interdepen-dent. Changes in IR emission as recorded by thermography were correlated to changes in local blood circulation (BrAnemark & Nilsson 1969) and to changes in '33Xe disappearance rate (Stromberg & Norberg 1971). In 1969 Stromberg & Tufvesson, using microradiography, demonstrated that there were vascular changes in the superficial flexor tendon (SFT) even before clinical si...
Robinson RC.Most practitioners will have experienced the
frustration encountered in the treatment of sprains
of the flexor tendons and suspensory ligaments
of racehorses. After apparent recovery, the
damaged structure will often break down again
when the horse returns to hard training. Milne
(1960), Reed (1962), Jubb and Kennedy (1963)
and Hickman (1964) have written detailed ac-
counts of the pathology of tendon injuries and the
mechanism of repair of tendon tissue. These
writers substantiate that when a tendon is
sprained, there is a tearing or rupture of some of
the tendon fibres, varying i...
Abrahams M.The mechanical behaviour of horse and human tendon, as characterised by the stress-strain curve, has been examined with respect to load-strain cycling and strain rate. It was found that the tendon stress-strain curve for successive cycles was reporducible provided that strain on the specimen did not exceed 2·0–4·0%. If this strain level was exceeded, a permanent deformation occurred. This phenomenon was verified by histological studies on strained tendon which showed that some of the collagen fibres did not return to their original orientation. Variation in the rate of strain was found to ...
Scharf A, Acutt E, Bills K, Werpy N.Deep digital flexor (DDF) tendinopathy is a significant cause of lameness and poor performance in equine athletes with substantial implications for their return to athletic performance. Magnetic resonance imaging (MRI) is increasingly integrated into the diagnostic workup of horses with foot pain and has revolutionised the diagnosis and management of these injuries. This review discusses the principles of MRI in the context of deep digital flexor tendon (DDFT) injury, comparing high-field and low-field systems and highlighting the clinical relevance of technical parameters, including field str...
Cardinaux EM, Oltmanns H, Beineke A, Meißner J, Geburek F.Flexural limb deformities are a widespread condition in foals. Oxytetracycline is a common conservative treatment option with relaxing effects on the muscle-tendon-unit, potentially mediated through a matrix-metalloproteinase (MMP)-inhibitor mechanism. Its high therapeutic dose for this indication, potential negative side effects, and the guidelines for prudent use of antimicrobials make investigating alternatives desirable. In this study, the influence of substances with potentially similar mechanisms of action, however without antimicrobial properties, on viability and proliferation of juven...
Quam V.Inflammation plays a role in acute and chronic equine tendon/ligament injury; anti-inflammatories are often indicated. Local corticosteroids provide consistent and profound short-term effects on pain and inflammation across species. However, there is no demonstrated benefit in the long term, and complications can occur. Alternative biologic anti-inflammatory treatments are available and should be used in horses at risk of complications. Nonetheless, corticosteroids remain an affordable and effective anti-inflammatory that, with continued research, may be indicated on a case-by-case basis as pa...
Marine L, Wilfried P, Joëlle P, Justine J, Axel D, Vinciane T, Benoît V, Laurent G, Luc G, Jean-François K, Nadine A.In situ injection of mesenchymal stem cells appears as a promising treatment of tendinopathies. Tendon-derived mesenchymal stem cells (TDSCs) are widely studied and show a lot of interesting characteristics for clinical use. The aim of this study is to confirm the tenogenic potential of cryopreserved TDSCs and to confirm their ability to produce type I and/or type III collagens fibers in culture. Tendon-derived mesenchymal stem cells are harvested from the tendon no later than 72 h post-mortem. Their tenogenic potential has been assessed by quantitative reverse transcriptase polymerase chain ...
Clarke EJ, Jensen A, Gillen AM, Bardell D, Senior M, Anderson JR, Peffers MJ.To determine the protein composition of equine platelet-rich plasma (PRP) and PRP-derived extracellular vesicles (EVs) and evaluate their effects on tendon inflammation in vitro. As tendon injuries are common in horses and treatment with PRP derived from the horse's own blood shows promise, but outcomes vary due to inconsistent composition. PRP contains EVs that facilitate cell communication. Unassigned: From December 2022 through May 2023, equine plasma (n = 3, adult) was isolated via double centrifugation and PRP produced using a commercial kit. Extracellular vesicles were isolated using dif...
Beaumont A, Emond AL, Pourcelot P, Fayaubot L, Ravary-Plumioen B, Dupays AG, Desquilbet L, Denoix JM, Crevier-Denoix N.To quantify changes in the cross-sectional area (CSA) of the midmetacarpal superficial digital flexor tendon (SDFT) in young Trotters during training. Unassigned: In this experimental study, 12 healthy 3-year-old French Trotters, assigned to either a soft-track or a hard-track group, were trained for 4 months (June through September of 2012 and 2013). Both groups followed the same exercise program of increasing intensity. Ultrasonographic examinations of both forelimb SDFTs of each horse were performed before the beginning of training (D0), after 2 months of training (M2), and after 4 months o...
Ellis K, Van Zeeland EM, Ashton L, Wist S, Broeckling C, Harris M, Frisbie DD, Sikes KJ.To (1) identify tissue-specific metabolic profiles of the superficial digital flexor tendon (SDFT), deep digital flexor tendon (DDFT), and suspensory ligament (SL) and (2) evaluate metabolic profile differences in the SDFT, DDFT, and SL between the equine forelimb and hindlimb. Unassigned: 2 SDFT, DDFT, and SL specimens were collected from the forelimbs and hindlimbs of 10 horses of mixed breed, age, and sex that were euthanized for other reasons. One specimen was processed for histology to confirm that there were no underlying soft-tissue pathologies. One specimen was processed for 2 forms of...
Pluim M, Reynolds A, McClure S.High-power laser therapy and extracorporeal shock wave therapy (ESWT) can be safely used to treat tendon and ligament injuries in horses, and the potential beneficial effects have been described. The power of low level lasers is not sufficient for treatment of tendon and ligament injuries in horses. ESWT is used more often to treat tendon and ligament injuries than it is for any other type of condition in horses, but there is limited supporting scientific evidence. Further research should focus on establishing dosage and treatment protocols for both laser therapy and ESWT in horses with clinic...
Connard SS, Schnabel LV.This review explores the use of biologics in the treatment of tendon and ligament injuries in horses, focusing on current and emerging therapies aimed at enhancing tissue repair and regeneration. It discusses the role of scaffold-based therapies, growth factors, blood-derived and tissue-derived biologics, and gene therapy as biologic regenerative therapies for improving healing outcomes. The review evaluates the mechanisms, efficacy, and challenges of biologics in clinical applications, highlighting recent advances and clinical studies. It provides an overview of current trends and future dire...
Tay A, McMaster M.Equine tendon lacerations are not uncommon secondary to traumatic wounds and degloving lacerations. These wounds are often contaminated and, therefore, basic principles of wound assessment and management are critical to identify the extent of an injury. Ancillary tools to aid physical examination include radiography, ultrasonography, and synoviocentesis (eg, if involving a joint and/or tendon sheath). Prolonged convalescence period, continued external coaptation, and controlled exercise are mainstays of treatment following tenorrhaphy. A poor prognosis for return to full athletic function is e...
Miles S, McCauley C, Carossino M, Del Piero F, Liu CC, Gaschen L.Manica flexoria tears are increasingly recognized as a cause of lameness in horses resulting in a need for improved pre-operative diagnosis. Partial tears are difficult to pre-operatively diagnose and thus research for diagnostics of manica flexoria tears has been seen in increasing frequency over the past decade, though a deficit of information exists for the features of this structure on MRI, which is best suited for evaluation of soft tissues. The goal is to perform an observational study on the morphometry of the normal manica flexoria prospectively and describe it retrospectively on MRI. ...
Durgam S.The mid-metacarpal SDFT, intrasynovial DDFT and suspensory ligament are frequently injured soft tissues in the equine athlete. The mid-metacarpal SDFT exhibits a hierarchical structure and encounters repetitive strains at its functional limit. The intrasynovial DDFT possesses fibrocartilage where opposing bony surfaces to facilitate resistance-free gliding and contains chondrocyte-like cells embedded in a proteoglycan-rich ECM. While suspensory ligament enthesis injuries are common, collagen and non-collagen ECM structure-function specializations at the bone-ligament interface are understudied...
Aßmann AD, Sànchez-Andrade JS, Argüelles D, Bischofberger AS.Diagnosing digital flexor tendon sheath (DFTS) pathologies, particularly manica flexoria (MF) tears, can be challenging with standard imaging modalities. Standing low-field MRI tenography (MRIt) may improve the detection rate of MF tears. This study aimed to compare ultrasonography, contrast radiography, pre-contrast MRI, and MRIt to detect naturally occurring MF lesions in horses undergoing tenoscopy. Ten horses with a positive DFTS block, which underwent contrast radiography, ultrasonography, MRI, MRIt, and tenoscopy were included. Two radiologists evaluated the images and recorded whether a...
Bosman LM, Logan MG, Miszewski A, Pepper MS.Translational regenerative medicine, integrating human and veterinary approaches within the "One Health" framework, increasingly uses horses as models for human musculoskeletal conditions due to shared anatomical and functional features. Osteoarthritis and tendon disorders affect both species, often resulting from high-impact or repetitive strain activities. Regenerative medicine offers therapeutic opportunities by promoting tissue repair and modulating inflammation. Cellular orthobiologics such as mesenchymal stromal/stem cells (MSCs) show promise for treating osteoarthritis and tendon injuri...
Eren G, López-Albors O, López Corbalán M, Latorre R.Digital technologies have improved the visualization of anatomical structures for veterinary education and clinical practice. In this study, a detailed three-dimensional anatomical model of the equine palmar metacarpal region was generated using E12-based epoxy sheet plastination combined with digital reconstruction in Amira V5.6 software. Serial cross-sections of the metacarpal region provided high-resolution visualization of bones, tendons, ligaments, nerves, vessels, fasciae, and synovial structures, with minimal shrinkage or deformation, ensuring improved anatomical accuracy. These section...
Mazzucco L, Marcatili M, Withers J, Cantatore F.Superficial digital flexor tendinopathy is a common cause of forelimb lameness in Thoroughbred racehorses and sports horses; however, this condition is rarely observed in the hindlimb. A 16-year-old Irish sports horse gelding was presented with bilateral swelling in the plantar metatarsal region and severe bilateral hindlimb lameness visible at the walk. The lameness occurred after the cross-country phase of an eventing competition. The clinical suspicion of superficial digital flexor tendon (SDFT) injury was confirmed after ultrasonographic examination, which revealed an extensive core lesion...
Urion R, Lustgarten M, Hostnik ET.Technological developments in imaging modalities have advanced the diagnostic capabilities for equine tendon and ligament injuries beyond the traditional methods. This review examines elastography techniques in ultrasonography that assess tissue stiffness and strain properties, computed tomography (CT) innovations including PET/CT fusion and dual-energy CT, and emerging applications of diffusion-weighted MRI for evaluating fiber microstructure and functionality. These complementary approaches offer veterinarians improved means to detect early injuries, assess structural integrity, monitor heal...
Moreno C, Rice H.Diagnostic and treatment strategies for infectious equine tendon and ligament disorders are continually evolving where recent progress is focused on advanced imaging and evidence supporting endoscopic lavage and regional antimicrobial therapy.
Beasley B.The overall objective of therapeutic farriery for equine tendon and ligament injuries is to provide a biomechanical environment conducive to healing by limiting excessive strain on the injured structure. With an understanding of equine limb anatomy and the pathophysiology of tendon/ligament injuries, the rationale used in therapeutic farriery for soft tissue injuries of the distal limb is quite logical. Through therapeutic farriery, foot manipulation is used to reduce the tension on the injured tendon(s) or ligament(s).
Zamboulis DE, Thorpe CT.The high stresses and strains experienced by the superficial digital flexor tendon (SDFT) make it prone to age-related injury. The SDFT exhibits cellular and structural specializations, localized to the interfascicular matrix (IFM), enabling it to resist its extreme mechanical environment. With aging, these specializations are lost, impacting the ability of the tendon to withstand repeated loading. Within the IFM, there is loss of mechanical properties and organization accompanying cell senescence and a decreased resolution of inflammation. Developing therapeutics to reverse these changes may,...
Freeman KD, Adams MN, Salinger AE, White NA, Barrett JG.Suspensory desmopathy is a frequently documented cause of lameness in performance horses; proximal suspensory desmopathy is the most frequent site of injury in dressage horses [...].
Nelson B.Complications of equine musculoskeletal procedures and surgery are an inevitable occurrence. This article summarizes complications principally encountered by primary equine veterinarians who perform and manage musculoskeletal procedures and surgeries. Topics discussed include complications of musculoskeletal diagnostic procedures, angular/flexural limb deformities, and muscle, tendon, and ligament surgery; surgery of the foot, orthopedic and arthroscopic surgery, and cast management. Each section lists complications encountered and includes diagnostic and treatment considerations. Awareness of...
Tommasa SD, Raspe S, Farí G, Imperante A, Brehm W.Tendon and ligament injuries in equine athletes pose significant challenges, often leading to prolonged recovery, reduced performance, and increased risk of reinjury. Current treatment strategies, including conservative and surgical approaches, have shown limited success in fully restoring tendon integrity. Autologous blood derivatives, such as autologous conditioned serum (ACS), have emerged as potential regenerative therapies. However, the clinical efficacy of ACS in the treatment of equine tendinopathies remains under investigation. Unassigned: This study aimed to compare the clinical outco...
Shaw KA, Brounts SH.To evaluate the effect of heel elevation on measurement of stiffness gradients by means of acoustoelastography in the digital flexor tendons of clinically normal horses. Unassigned: 15 clinically normal horses. Unassigned: For each horse, stiffness gradient index (SGI) for superficial digital flexor tendons (SDFT) and deep digital flexor tendons (DDFT) were evaluated in both forelimbs at 0, 4 and 8 degrees of heel elevation. Acoustoelastography (AEG) was used for data acquisition at three sites, approximately 6, 12, and 18 cm distal to the accessory carpal bone in the metacarpal region. Lif...
Racine J, Ungermann A, Blatter M, von Plato G, Rijkenhuizen ABM.To describe a modified two-portal tenoscopic technique for proximal manica flexoria (MF) resection designed to preserve the mesotendons (MTs) of the deep digital flexor tendon (DDFT). Methods: Prospective clinical study. Methods: Client-owned horses (n = 30). Methods: MF resection was performed in four steps: (1) Transection of the lateral attachment of the MF to the superficial digital flexor tendon (SDFT), staying abaxial to the lateral MT; (2) transection of the medial attachment of the MF to the SDFT between the flexor tendons from distal to proximal until reaching the level of the med...
Pilger F, Aurich C, Aurich JE.The early career start of racehorses, the pretraining of two-year-old Warmblood stallions for licensing, and individual housing of young horses increasingly raise animal welfare concerns. Objective: Assess pretraining practices and the opinion of trainers on housing of young horses, minimum age to commence training and pretraining injuries. Methods: Qualitative interviews with trainers of Warmblood stallions and Thoroughbred and Trotter racehorses (n = 10 each). Results: Pretraining of Thoroughbreds and Trotters began at 18 months, whereas licensing preparation of Warmblood stallions began at ...
McDonald S, Verheyen KLP, Chang YM, Allen SE.Race-related injuries in horse racing, especially those requiring extended recovery, are a welfare concern and threaten the sport's social licence. Previous studies predominantly report on fatalities; however, serious non-fatal musculoskeletal injuries often end horses' racing careers or have a high recurrence risk. No recent studies have described or quantified long-term injuries (LTIs) in racing Thoroughbreds, which is essential to inform targeted risk prevention strategies. Objective: To describe the types, frequencies and incidences of LTIs in British jump racing. Methods: Retrospective co...
Honnas DH, Fiske-Jackson AR, Fulkerson CV, Wilhite DR.An injury of a tendon or ligament of the equine foot is frequently a cause of lameness. The optimal radiographic projections delineating the entheses of five commonly injured tendons and ligaments of the foot should be described. Methods: The entheses of the collateral ligaments of the distal interphalangeal joint, the collateral sesamoidean ligaments of the navicular bone, the deep digital flexor tendon, the common digital extensor tendon and the distal sesamoidean impar ligament were isolated from a thoracic foot of three cadavers. Three standard radiographic projections (60-degree, dorsopro...
Qiu Z, Wang J, Zhang Y, Liu X, Wei C, Ma T.Musculoskeletal injuries represent a primary cause of suboptimal performance and early retirement in equine athletes. To address this challenge, the veterinary community has long endeavored to develop safer and more effective therapeutic strategies. Extracorporeal shock wave therapy (ESWT), as a treatment for equine musculoskeletal injuries, has garnered substantial attention among equine veterinarians. Focused on the theme ESWT Therapy for Equine Musculoskeletal Disorders: From biological mechanisms to clinical applications, this article systematically reviews existing literature on the biolo...
Beggan CP, Panizzi L, Oliver LJ.To measure microsphere recovery following needle-through-and-through lavage (NTAT) of the metacarpo-/metatarsophalangeal joint (fetlock) and digital flexor tendon sheath (DFTS) compared to endoscopic lavage (EL). Methods: Ex vivo experimental study. Methods: Adult equine cadavers immediately following euthanasia (n = 10). Methods: Colored 15 μm microspheres (2 million) were injected into fetlock joints and DFTS. Synovial structures were assigned to NTAT or EL groups. Each lavage was performed using 5 L of 0.9% NaCl, sequentially collecting egress fluid for microsphere quantification. Re...
