A review of the equine suspensory ligament: Injury prone yet understudied.
- Journal Article
- Review
Summary
The article reviews the equine suspensory ligament (SL), a crucial part of the horse’s anatomy that is often prone to injuries, but surprisingly understudied in the scientific literature. It discusses the SL’s composition, structure, and role, the types and causes of injuries it commonly sustains, and the different methods of diagnosing and treating these injuries.
The Suspensory Ligament in Horses
In horses, the SL plays a significant role:
- It contributes to the stability of the metacarpophalangeal joint.
- It works like a spring to reduce the energetic cost of locomotion.
Regardless of its importance, studies about the SL structure and function in relation to its susceptibility to injuries are surprisingly scarce, especially compared to other horse tendinous structures prone to injuries such as the superficial digital flexor tendon.
Composition, Structure and Mechanical Properties of the SL
The review explores:
- The composition of the SL, including the type of cells, proteins, and extracellular matrix components that it contains.
- The structure of the SL, including its size, shape, and how its components are arranged.
- The mechanical properties of the SL, such as its strength, flexibility, and how it behaves under different degrees of tension and compression.
Injury Epidemiology, Aetiology and Pathophysiology
The article reports on:
- The prevalence and types of SL injuries in horses, spanning across all ages and various disciplines.
- The causes of these injuries, whether from acute trauma, chronic wear and tear, anatomical anomalies, or other factors.
- The pathophysiology of these injuries, or how they affect the normal function of the SL and the horse’s locomotion.
Diagnostic Approaches and Treatment Modalities
Aside from shining a light on the nature and causes of SL injuries, the review also provides insights into:
- The different ways to diagnose SL injuries, which could include physical examinations, imaging techniques like X-rays or ultrasound, and biomarker tests.
- The different treatment options for SL injuries, which could include physical therapies, medications, surgeries, or lifestyle changes.
Directions for Future Research
Finally, the article identifies key gaps in the current state of knowledge about the equine SL, which opens up directions for future research. These gaps could involve understanding more about the structure-function relationships in the SL, improving methods for diagnosing and treating SL injuries, or devising preventive measures to protect the SL from injury.
Cite This Article
Publication
Researcher Affiliations
- Department of Clinical Science and Services, Royal Veterinary College, London, UK.
- Department of Orthopaedics and Musculoskeletal Science, University College London, London, UK.
- Department of Comparative Biomedical Sciences, Royal Veterinary College, London, UK.
References
- Denoix JM. Essentials of clinical anatomy of the equine locomotor system. 1st ed. Boca Raton: CRC Press; 2019.
- Schramme M, Josson A, Linder K. Characterization of the origin and body of the normal equine rear suspensory ligament using ultrasonography, magnetic resonance imaging, and histology. Vet Radiol Ultrasound 2012;53(3):318–328.
- Budras KD, Sack WO, Rock S. Anatomy of the horse. 3rd ed. Hanover, Germany: Schluetersche; 2001.
- Dyce KM, Sack WO, Wensing CJG. Textbook of veterinary anatomy. 3rd ed. Saint Louis, MO: Elsevier; 2002.
- Souza MV, Van Weeren PR, Van Schie HT, Van De Lest CH. Regional differences in biochemical, biomechanical and histomorphological characteristics of the equine suspensory ligament. Equine Vet J 2010;42(7):611–620.
- NaT B, Pandy MG, Kawcak CE, Mcilwraith CW. Force‐ and moment‐generating capacities of muscles in the distal forelimb of the horse. J Anat 2003;203(1):101–113.
- Biewener AA. Muscle‐tendon stresses and elastic energy storage during locomotion in the horse. Comp Biochem Physiol B Biochem Mol Biol 1998;120(1):73–87.
- Gussekloo SWS, Lankester J, Kersten W, Back W. Effect of differences in tendon properties on functionality of the passive stay apparatus in horses. Am J Vet Res 2011;72(4):474–483.
- Schuurman S, Kersten W, Weijs W. The equine hind limb is actively stabilized during standing. J Anat 2003;202:355–362.
- Thorpe CT, Streeter I, Pinchbeck GL, Goodship AE, Clegg PD, Birch HL. Aspartic acid racemization and collagen degradation markers reveal an accumulation of damage in tendon collagen that is enhanced with aging. J Biol Chem 2010;285(21):15674–15681.
- Riemersma DJ, De Bruyn P. Variations in cross‐sectional area and composition of equine tendons with regard to their mechanical function. Res Vet Sci 1986;41(1):7–13.
- Birch HL. Tendon matrix composition and turnover in relation to functional requirements. Int J Exp Pathol 2007;88(4):241–248.
- Sell DR, Monnier VM. Structure elucidation of a senescence cross‐link from human extracellular matrix. Implication of pentoses in the aging process. J Biol Chem 1989;264(36):21597–21602.
- Verzijl N, Degroot J, Thorpe SR, Bank RA, Shaw JN, Lyons TJ. Effect of collagen turnover on the accumulation of advanced glycation end products. J Biol Chem 2000;275(50):39027–39031.
- Shikh Alsook MK, Gabriel A, Salouci M, Piret J, Alzamel N, Moula N. Characterization of collagen fibrils after equine suspensory ligament injury: an ultrastructural and biochemical approach. Vet J 2015;204(1):117–122.
- Smith T. The relationship between tendon morphology and function. London, UK: University College London; 2006.
- Yoon JH, Halper J. Tendon proteoglycans: biochemistry and function. J Musculoskelet Neuronal Interact 2005;5(1):22–34.
- Peffers MJ, Thorpe CT, Collins JA, Eong R, Wei TK, Screen HR. Proteomic analysis reveals age‐related changes in tendon matrix composition, with age‐ and injury‐specific matrix fragmentation. J Biol Chem 2014;289(37):25867–25878.
- Bischofberger AS, Konar M, Ohlerth S, Geyer H, Lang J, Ueltschi G. Magnetic resonance imaging, ultrasonography and histology of the suspensory ligament origin: a comparative study of normal anatomy of warmblood horses. Equine Vet J 2006;38(6):508–516.
- Wilson DA, Baker GJ, Pijanowski GJ, Boero MJ, Badertscher RR. Composition and morphologic features of the interosseous muscle in standardbreds and Thoroughbreds. Am J Vet Res 1991;52(1):133–139.
- Shikh Alsook MK, Antoine N, Piret J, Moula N, Busoni V, Denoix J‐M. Morphometric analyses of the body and the branches of the normal third interosseous muscle (suspensory ligament) in standardbreds. Anat Histol Embryol 2013;42(6):461–470.
- Birch HL, Wilson AM, Goodship AE. Physical activity: does long‐term, high‐intensity exercise in horses result in tendon degeneration?. J Appl Physiol 2008;105(6):1927–1933.
- Soffler C, Hermanson JW. Muscular design in the equine interosseus muscle. J Morphol 2006;267(6):696–704.
- Williams MR, Arnoczky SP, Pease AP, Stick JA. Microvasculature of the suspensory ligament of the forelimb of horses. Am J Vet Res 2013;74(12):1481–1486.
- Kraus‐Hansen A, Fackelman G, Becker C. Preliminary studies on the vascular anatomy of the equine superficial digital flexor tendon. Equine Vet J 1992;24:46–51.
- Muylle S, Desmet P, Simoens P, Lauwers H, Vlaminck L. Histological study of the innervation of the suspensory ligament of the forelimb of the horse. Vet Rec 1998;142(22):606–610.
- Keg PR, Schamhardt HC, Weeren PRV, Barneveld A. The effect of the high palmar nerve block and the ulnar nerve block on lameness provoked by a collagenase‐induced tendonitis of the lateral branch of the suspensory ligament. Vet Q 1996;18(sup2):103–105.
- Werpy NM, Denoix JM. Imaging of the equine proximal suspensory ligament. Vet Clin North Am Equine Pract 2012;28(3):507–525.
- Milner PI, Dimmock O, Barnes K. Neurovascular variations in the proximal plantar metatarsal region of the horse. Equine Vet J 2022;54(4):782–787.
- Smith JJ, Ross MW, Smith RK. Anabolic effects of acellular bone marrow, platelet rich plasma, and serum on equine suspensory ligament fibroblasts in vitro. Vet Comp Orthop Traumatol 2006;19(1):43–47.
- Dyson S. Is degenerative change within hindlimb suspensory ligaments a prelude to all types of injury?. Equine Vet Educ 2010;22(6):271–274.
- Smith RKW. Regenerative medicine in equine orthopaedics: what and when?. UK‐Vet Equine 2020;4(1):8–13.
- Thorpe CT. Extracellular matrix synthesis and degradation in functionally distinct tendons. London: Institute of Orthopaedics and Musculoskeletal Science, University College London; 2010.
- Bonilla‐Gutiérrez AF, Castillo‐Franz C, López C, Álvarez ME, Giraldo CE, Carmona JU. Equine suspensory ligament and tendon explants cultured with platelet‐rich gel supernatants release different anti‐inflammatory and anabolic mediators. Biomed Pharmacother 2018;108:476–485.
- McCarrel T, Fortier L. Temporal growth factor release from platelet‐rich plasma, trehalose lyophilized platelets, and bone marrow aspirate and their effect on tendon and ligament gene expression. J Orthop Res 2009;27(8):1033–1042.
- Schnabel LV, Mohammed HO, Jacobson MS, Fortier LA. Effects of platelet rich plasma and acellular bone marrow on gene expression patterns and DNA content of equine suspensory ligament explant cultures. Equine Vet J 2008;40(3):260–265.
- Zamboulis DE, Marr N, Lenzi L, Birch HL, Screen HRC, Clegg PD. The interfascicular matrix of energy storing tendons houses heterogenous cell populations disproportionately affected by aging. Aging Dis 2024;15(1):295–310.
- Kendal AR, Layton T, Al‐Mossawi H, Appleton L, Dakin S, Brown R. Multi‐omic single cell analysis resolves novel stromal cell populations in healthy and diseased human tendon. Sci Rep 2020;10(1):13939.
- De Micheli AJ, Swanson JB, Disser NP, Martinez LM, Walker NR, Oliver DJ. Single‐cell transcriptomic analysis identifies extensive heterogeneity in the cellular composition of mouse achilles tendons. Am J Physiol Cell Physiol 2020;319(5):C885–C894.
- Lavagnino M, Madison J, Williams MR, Arnoczky SP. The equine forelimb suspensory ligament exhibits a heterogeneous strain pattern under tensile load. Vet Comp Orthop Traumatol 2015;28(5):306–311.
- Riemersma DJ, Van Den Bogert AJ, Jansen MO, Schamhardt HC. Tendon strain in the forelimbs as a function of gait and ground characteristics and in vitro limb loading in ponies. Equine Vet J 1996;28(2):133–138.
- Riemersma DJ, Van Den Bogert AJ, Jansen MO, Schamhardt HC. Influence of shoeing on ground reaction forces and tendon strains in the forelimbs of ponies. Equine Vet J 1996;28(2):126–132.
- Jansen MO, Schamhardt HC, Van Den Bogert AJ, Hartman W. Mechanical properties of the tendinous equine interosseus muscle are affected by in vivo transducer implantation. J Biomech 1998;31(5):485–490.
- Bardin AL, Tang L, Panizzi L, Rogers CW, Colborne GR. Development of an anybody musculoskeletal model of the Thoroughbred forelimb. J Equine Vet Sci 2021;103:103666.
- Takahashi T, Mukai K, Ohmura H, Aida H, Hiraga A. In vivo measurements of flexor tendon and suspensory ligament forces during trotting using the Thoroughbred forelimb model. J Equine Sci 2014;25(1):15–22.
- Meershoek LS, Lanovaz JL. Sensitivity analysis and application to trotting of a noninvasive method to calculate flexor tendon forces in the equine forelimb. Am J Vet Res 2001;62(10):1594–1598.
- Walker VA, Walters JM, Griffith L, Murray RC. The effect of collection and extension on tarsal flexion and fetlock extension at trot. Equine Vet J 2013;45(2):245–248.
- Bardin AL, Taylor NC, Colborne GR. Response of the Thoroughbred forelimb to perturbations caused by a change in ground surface. J Equine Vet Sci 2022;112:103897.
- Firth EC, Rogers CW, Anderson BH. Musculoskeletal responses of 2‐year‐old Thoroughbred horses to early training. 4. Morphometric, microscopic and biomechanical properties of the digital tendons of the forelimb. N Z Vet J 2004;52(5):285–292.
- Birch HL, Mclaughlin L, Smith RK, Goodship AE. Treadmill exercise‐induced tendon hypertrophy: assessment of tendons with different mechanical functions. Equine Vet J 1999;31(S30):222–226.
- Johnston AS, Riggs CM, Cogger N, Benschop J, Rogers CW, Rosanowski SM. Using time‐series analysis techniques to enhance the understanding of musculoskeletal injury in Thoroughbred racehorses. Equine Vet J 2020;52(5):699–708.
- Welsh CE, Lewis TW, Blott SC, Mellor DJ, Lam KH, Stewart BD. Preliminary genetic analyses of important musculoskeletal conditions of Thoroughbred racehorses in Hong Kong. Vet J 2013;198(3):611–615.
- Kasashima Y, Takahashi T, Smith RK, Goodship AE, Kuwano A, Ueno T. Prevalence of superficial digital flexor tendonitis and suspensory desmitis in Japanese Thoroughbred flat racehorses in 1999. Equine Vet J 2004;36(4):346–350.
- Plevin S, Mclellan J. The effect of insertional suspensory branch desmitis on racing performance in juvenile Thoroughbred racehorses. Equine Vet J 2014;46(4):451–457.
- Hill AE, Blea JA, Arthur RM, Mcilwraith CW. Non‐fatal injury occurrence in southern California Thoroughbred racehorses 2009–2010. Vet J 2015;205(1):98–100.
- Ely ER, Avella CS, Price JS, Smith RK, Wood JL, Verheyen KL. Descriptive epidemiology of fracture, tendon and suspensory ligament injuries in national hunt racehorses in training. Equine Vet J 2009;41(4):372–378.
- Hill AE, Stover SM, Gardner IA, Kane AJ, Whitcomb MB, Emerson AG. Risk factors for and outcomes of noncatastrophic suspensory apparatus injury in Thoroughbred racehorses. J Am Vet Med Assoc 2001;218(7):1136–1144.
- Cohen ND, Mundy GD, Peloso JG, Carey VJ, Amend NK. Results of physical inspection before races and race‐related characteristics and their association with musculoskeletal injuries in Thoroughbreds during races. J Am Vet Med Assoc 1999;215(5):654–661.
- Cohen ND, Peloso JG, Mundy GD, Fisher M, Holland RE, Little TV. Racing‐related factors and results of prerace physical inspection and their association with musculoskeletal injuries incurred in Thoroughbreds during races. J Am Vet Med Assoc 1997;211(4):454–463.
- Crawford KL, Finnane A, Greer RM, Phillips CJC, Woldeyohannes SM, Perkins NR. Appraising the welfare of Thoroughbred racehorses in training in Queensland, Australia: the incidence and type of musculoskeletal injuries vary between two‐year‐old and older Thoroughbred racehorses. Animals 2020;10(11):2046.
- Williams RB, Harkins LS, Wood JLN. Racehorse injuries, clinical problems and fatalities recorded on British racecourses from flat racing and national hunt racing during 1996, 1997 and 1998. Equine Vet J 2001;33(5):478–486.
- Gibson KT, Burbidge HM, Pfeiffer DU. Superficial digital flexor tendonitis in Thoroughbred racehorses: outcome following non‐surgical treatment and superior check desmotomy. Aust Vet J 1997;75:631–635.
- Bertuglia A, Bullone M, Rossotto F, Gasparini M. Epidemiology of musculoskeletal injuries in a population of harness standardbred racehorses in training. BMC Vet Res 2014;10(1):11.
- Kalisiak O. Parameters influencing prevalence and outcome of tendonitis in Thoroughbred and Arabian racehorses. Pol J Vet Sci 2012;15(1):111–118.
- Dabareiner RM, Cohen ND, Carter GK, Nunn S, Moyer W. Musculoskeletal problems associated with lameness and poor performance among horses used for barrel racing: 118 cases (2000–2003). J Am Vet Med Assoc 2005;227(10):1646–1650.
- Murray RC, Dyson SJ, Tranquille C, Adams V. Association of type of sport and performance level with anatomical site of orthopaedic injury diagnosis. Equine Vet J 2006;38(S36):411–416.
- Singer ER, Barnes J, Saxby F, Murray JK. Injuries in the event horse: training versus competition. Vet J 2008;175(1):76–81.
- Murray RC, Tranquille CA, Walker VA, Milmine RC, Bak L, Tacey JB. Magnetic resonance imaging findings in the proximal metacarpal region of 359 horses and proximal metatarsal region of 64 horses acquired under standing sedation. J Equine Vet Sci 2020;94:103268.
- Van Den Belt AJ, Dik KJ, Barneveld A. Ultrasonographic evaluation and long‐term follow‐up of flexor tendonitis/desmitis in the metacarpal/metatarsal region in Dutch warmblood horses and standardbred racehorses. Vet Q 1994;16(Suppl 2):S76–S80.
- Woodie JB, Ruggles AJ, Bertone AL, Hardy J, Schneider RK. Apical fracture of the proximal sesamoid bone in standardbred horses: 43 cases (1990–1996). J Am Vet Med Assoc 1999;214(11):1653–1656.
- Auth AK, Hinnigan GJ, Smith MA, Owen KR. Low‐field magnetic resonance imaging findings of the fetlock region of nonracehorses. J Equine Vet Sci 2024;132:104938.
- Dyson S, Pinilla MJ, Bolas N, Murray R. Proximal suspensory desmopathy in hindlimbs: magnetic resonance imaging, gross post‐mortem and histological study. Equine Vet J 2018;50(2):159–165.
- Dyson S, Murray R, Pinilla M‐J. Proximal suspensory desmopathy in hindlimbs: a correlative clinical, ultrasonographic, gross post mortem and histological study. Equine Vet J 2017;49(1):65–72.
- O'Brien EJO, Smith RKW. Mineralization can be an incidental ultrasonographic finding in equine tendons and ligaments. Vet Radiol Ultrasound 2018;59(5):613–623.
- Bowser JE, Elder SH, Pasquali M, Grady JG, Rashmir‐Raven AM, Wills R. Tensile properties in collagen‐rich tissues of quarter horses with hereditary equine regional dermal asthenia (herda). Equine Vet J 2014;46(2):216–222.
- Mero JL, Scarlett JM. Diagnostic criteria for degenerative suspensory ligament desmitis in Peruvian Paso horses. J Equine Vet Sci 2005;25(5):224–228.
- Momen M, Brauer K, Patterson MM, Sample SJ, Binversie EE, Davis BW. Genetic architecture and polygenic risk score prediction of degenerative suspensory ligament desmitis (DSLD) in the Peruvian horse. Front Genet 2023;14:1201628.
- Xie L, Spencer ND, Beadle RE, Gaschen L, Buchert MR, Lopez MJ. Effects of athletic conditioning on horses with degenerative suspensory ligament desmitis: a preliminary report. Vet J 2011;189(1):49–57.
- Halper J, Kim B, Khan A, Yoon JH, Mueller POE. Degenerative suspensory ligament desmitis as a systemic disorder characterized by proteoglycan accumulation. BMC Vet Res 2006;2(1):12.
- Kim B, Yoon JH, Zhang J, Eric Mueller PO, Halper J. Glycan profiling of a defect in decorin glycosylation in equine systemic proteoglycan accumulation, a potential model of progeroid form of Ehlers–Danlos syndrome. Arch Biochem Biophys 2010;501(2):221–231.
- Plaas A, Sandy JD, Liu H, Diaz MA, Schenkman D, Magnus RP. Biochemical identification and immunolocalizaton of aggrecan, ADAMTS5 and inter‐alpha‐trypsin‐inhibitor in equine degenerative suspensory ligament desmitis. J Orthop Res 2011;29(6):900–906.
- Luo W, Sandy J, Trella K, Gorski D, Gao S, Li J. Degenerative suspensory ligament desmitis (DSLD) in Peruvian Paso horses is characterized by altered expression of TGFΒ signaling components in adipose‐derived stromal fibroblasts. PLoS One 2016;11(11):e0167069.
- Young M, Moshood O, Zhang J, Sarbacher CA, Mueller POE, Halper J. Does bmp2 play a role in the pathogenesis of equine degenerative suspensory ligament desmitis?. BMC Res Notes 2018;11(1):672.
- Haythorn A, Young M, Stanton J, Zhang J, Mueller POE, Halper J. Differential gene expression in skin RNA of horses affected with degenerative suspensory ligament desmitis. J Orthop Surg Res 2020;15(1):460.
- Momen M, Brounts SH, Binversie EE, Sample SJ, Rosa GJM, Davis BW. Selection signature analyses and genome‐wide association reveal genomic hotspot regions that reflect differences between breeds of horse with contrasting risk of degenerative suspensory ligament desmitis. G3 Genes Genom Genet 2022;12(10):jkac179.
- Hofberger S, Gauff F, Licka T. Suspensory ligament degeneration associated with pituitary pars intermedia dysfunction in horses. Vet J 2015;203(3):348–350.
- Hofberger SC, Gauff F, Thaller D, Morgan R, Keen JA, Licka TF. Assessment of tissue‐specific cortisol activity with regard to degeneration of the suspensory ligaments in horses with pituitary pars intermedia dysfunction. Am J Vet Res 2018;79(2):199–210.
- Manfredi JM, Jacob S, Norton E. A one‐health lens offers new perspectives on the importance of endocrine disorders in the equine athlete. J Am Vet Med Assoc 2023;261(2):153–164.
- Le Jeune SS, Macdonald MH, Stover SM, Taylor KT, Gerdes M. Biomechanical investigation of the association between suspensory ligament injury and lateral condylar fracture in Thoroughbred racehorses. Vet Surg 2003;32(6):585–597.
- Hill AE, Gardner IA, Carpenter TE, Lee CM, Hitchens PL, Stover SM. Prevalence, location and symmetry of noncatastrophic ligamentous suspensory apparatus lesions in California Thoroughbred racehorses, and association of these lesions with catastrophic injuries. Equine Vet J 2016;48(1):27–32.
- Spargo KE, Rubio‐Martinez LM, Wheeler DP, Fletcher L, Carstens A. Catastrophic musculoskeletal injuries in Thoroughbred racehorses on racetracks in Gauteng, South Africa. J S Afr Vet Assoc 2019;90:e1–e5.
- Verschooten F, Gasthuys F, De Moor A. Distal splint bone fractures in the horse: an experimental and clinical study. Equine Vet J 1984;16(6):532–536.
- McLellan J, Plevin S. Do radiographic signs of sesamoiditis in yearling Thoroughbreds predispose the development of suspensory ligament branch injury?. Equine Vet J 2014;46(4):446–450.
- Plevin S, McLellan J, O'Keeffe T. Association between sesamoiditis, subclinical ultrasonographic suspensory ligament branch change and subsequent clinical injury in yearling Thoroughbreds. Equine Vet J 2016;48(5):543–547.
- Bertoni L, Forresu D, Coudry V, Audigie F, Denoix J‐M. Exostoses on the palmar or plantar aspect of the diaphysis of the third metacarpal or metatarsal bone in horses: 16 cases (2001–2010). J Am Vet Med Assoc 2012;240(6):740–747.
- Fairburn A, Dyson S, Murray R. Clinical significance of osseous spurs on the dorsoproximal aspect of the third metatarsal bone. Equine Vet J 2010;42(7):591–599.
- Dyson S. Proximal suspensory desmitis: clinical, ultrasonographic and radiographic features. Equine Vet J 1991;23(1):25–31.
- Ford TS, Ross MW, Orsini PG. A comparison of methods for proximal palmar metacarpal analgesia in horses. Vet Surg 1989;18(2):146–150.
- Gayle J, Redding R. Comparison of diagnostic anaesthetic techniques of the proximal plantar metatarsus in the horse. Equine Vet Educ 2007;19:222–224.
- Dyson SJ, Romero JM. An investigation of injection techniques for local analgesia of the equine distal tarsus and proximal metatarsus. Equine Vet J 1993;25(1):30–35.
- Labens R, Schramme MC, Robertson ID, Thrall DE, Redding WR. Clinical, magnetic resonance, and sonographic imaging findings in horses with proximal plantar metatarsal pain. Vet Radiol Ultrasound 2010;51(1):11–18.
- Hughes TK, Eliashar E, Smith RK. In vitro evaluation of a single injection technique for diagnostic analgesia of the proximal suspensory ligament of the equine pelvic limb. Vet Surg 2007;36(8):760–764.
- Contino EK, King MR, Valdés‐Martínez A, Mcilwraith CW. In vivo diffusion characteristics following perineural injection of the deep branch of the lateral plantar nerve with mepivacaine or iohexol in horses. Equine Vet J 2015;47(2):230–234.
- Gerdes C, Morgan R, Terry R, Foote A, Smith R. Computed tomographic arthrography, gross anatomy and histology demonstrate a communication between synovial invaginations in the proximal aspect of the third interosseous muscle and the carpometacarpal joint in horses. Front Vet Sci 2022;9:958598.
- Gaschen L, Burba DJ. Musculoskeletal injury in Thoroughbred racehorses: correlation of findings using multiple imaging modalities. Vet Clin North Am Equine Pract 2012;28(3):539–561.
- Werpy N, Chapman K, Griffith L. Non‐weight bearing ultrasonographic examination allows the diagnosis of longitudinal fiber disruption (split) in equine suspensory ligament branches not visible on weight bearing examination. Vet Radiol Ultrasound 2021;62(1):84–97.
- Dyson S. Proximal suspensory desmitis in the hindlimb: 42 cases. Br Vet J 1994;150(3):279–291.
- Minshall GJ, Wright IM. Arthroscopic diagnosis and treatment of intra‐articular insertional injuries of the suspensory ligament branches in 18 horses. Equine Vet J 2006;38(1):10–14.
- Dyson SJ, Arthur RM, Palmer SE, Richardson D. Suspensory ligament desmitis. Vet Clin North Am Equine Pract 1995;11(2):177–215.
- Ramzan PHL, Palmer L, Dallas RS, Shepherd MC. Subclinical ultrasonographic abnormalities of the suspensory ligament branch of the athletic horse: a survey of 60 Thoroughbred racehorses. Equine Vet J 2013;45(2):159–163.
- Fairburn AJ, Busschers E, Barr ARS. Subclinical ultrasonographic abnormalities of the suspensory ligament branches in national hunt racehorses. Equine Vet J 2017;49(4):475–479.
- Read RM, Boys‐Smith S, Bathe AP. Subclinical ultrasonographic abnormalities of the suspensory ligament branches are common in elite showjumping warmblood horses. Front Vet Sci 2020;7:117.
- Rabba S, Petrucci V, Petrizzi L, Giommi DW, Busoni V. B‐mode ultrasonographic abnormalities and power Doppler signal in suspensory ligament branches of nonlame working quarter horses. J Equine Vet Sci 2020;94:103254.
- Zauscher JM, Estrada R, Edinger J, Lischer CJ. The proximal aspect of the suspensory ligament in the horse: how precise are ultrasonographic measurements?. Equine Vet J 2013;45(2):164–169.
- Werpy NM, Denoix JM, Mcilwraith CW, Frisbie DD. Comparison between standard ultrasonography, angle contrast ultrasonography, and magnetic resonance imaging characteristics of the normal equine proximal suspensory ligament. Vet Radiol Ultrasound 2013;54(5):536–547.
- Sullivan HM, Barrett MF, Zhou T, Kawcak CE. Ultrasonographic evaluation of the suspensory ligament in quarter horses used for cutting. J Equine Vet Sci 2022;119:104139.
- Rabba S, Grulke S, Verwilghen D, Evrard L, Busoni V. B‐mode and power Doppler ultrasonography of the equine suspensory ligament branches: a descriptive study on 13 horses. Vet Radiol Ultrasound 2018;59(4):453–460.
- Lustgarten M, Redding WR, Labens R, Morgan M, Davis W, Seiler GS. Elastographic characteristics of the metacarpal tendons in horses without clinical evidence of tendon injury. Vet Radiol Ultrasound 2014;55(1):92–101.
- Lustgarten M, Redding WR, Labens R, Davis W, Daniel TM, Griffith E. Elastographic evaluation of naturally occurring tendon and ligament injuries of the equine distal limb. Vet Radiol Ultrasound 2015;56(6):670–679.
- Kleiter M, Kneissl S, Stanek C, Mayrhofer E, Baulain U, Deegen E. Evaluation of magnetic resonance imaging techniques in the equine digit. Vet Radiol Ultrasound 1999;40(1):15–22.
- Nagy A, Dyson S. Magnetic resonance imaging and histological findings in the proximal aspect of the suspensory ligament of forelimbs in nonlame horses. Equine Vet J 2012;44(1):43–50.
- Zubrod CJ, Barrett MF. Magnetic resonance imaging of tendon and ligament injuries. Clin Tech Equine Pract 2007;6(3):217–229.
- Brokken MT, Schneider RK, Sampson SN, Tucker RL, Gavin PR, Ho CP. Magnetic resonance imaging features of proximal metacarpal and metatarsal injuries in the horse. Vet Radiol Ultrasound 2007;48(6):507–517.
- Nagy A, Dyson S. Magnetic resonance imaging findings in the carpus and proximal metacarpal region of 50 lame horses. Equine Vet J 2012;44(2):163–168.
- Nagy A, Dyson S. Magnetic resonance anatomy of the proximal metacarpal region of the horse described from images acquired from low‐ and high‐field magnets. Vet Radiol Ultrasound 2009;50(6):595–605.
- Gonzalez LM, Schramme MC, Robertson ID, Thrall DE, Redding RW. MRI features of metacarpo(tarso)phalangeal region lameness in 40 horses. Vet Radiol Ultrasound 2010;51(4):404–414.
- King JN, Zubrod CJ, Schneider RK, Sampson SN, Roberts G. MRI findings in 232 horses with lameness localized to the metacarpo(tarso)phalangeal region and without a radiographic diagnosis. Vet Radiol Ultrasound 2013;54(1):36–47.
- Labens R, Schramme MC, Murray RC, Bolas N. Standing low‐field MRI of the equine proximal metacarpal/metatarsal region is considered useful for diagnosing primary bone pathology and makes a positive contribution to case management: a prospective survey study. Vet Radiol Ultrasound 2020;61(2):197–205.
- Barrett MF, Manchon PT, Hersman J, Kawcak CE. Magnetic resonance imaging findings of the proximal metacarpus in quarter horses used for cutting: retrospective analysis of 32 horses 2009–2012. Equine Vet J 2018;50(2):172–178.
- Zubrod CJ, Schneider RK, Tucker RL. Use of magnetic resonance imaging identify suspensory desmitis and adhesions between exostoses of the second metacarpal bone and the suspensory ligament in four horses. J Am Vet Med Assoc 2004;224(11):1815–1820, 1789.
- Barrett MF, Selberg KT, Johnson SA, Hersman J, Frisbie DD. High field magnetic resonance imaging contributes to diagnosis of equine distal tarsus and proximal metatarsus lesions: 103 horses. Vet Radiol Ultrasound 2018;59(5):587–596.
- Hinkle FE, Selberg KT, Frisbie DD, Barrett MF. Radiographic changes of the proximal third metatarsal bone do not predict presence or severity of proximal suspensory desmopathy in a predominately quarter horse population. Equine Vet J 2023;55(1):24–32.
- Van Veggel E, Selberg K, Van Der Velde‐Hoogelander B, Bolas N, Vanderperren K, Bergman HJ. Magnetic resonance imaging findings of the proximal metacarpal region in warmblood horses: 36 lame and 26 control limbs (2015–2021). Front Vet Sci 2021;8:714423.
- Launois MT, Vandeweerd J‐MEF, RaR P, Brogniez L, Desbrosse FG, Clegg PD. Use of computed tomography to diagnose new bone formation associated with desmitis of the proximal aspect of the suspensory ligament in third metacarpal or third metatarsal bones of three horses. J Am Vet Med Assoc 2009;234(4):514–518.
- Lin S‐T, Peter VG, Schiavo S, Pokora R, Patrick H, Bolas N. Identification of heterotopic mineralization and adjacent pathology in the equine fetlock region by low‐field magnetic resonance imaging, cone‐beam and fan‐beam computed tomography. J Equine Vet Sci 2023;126:104252.
- Müller EMT, Vanderperren K, Merle R, Rheinfeld S, Leelamankong P, Lischer CJ. Findings consistent with equine proximal suspensory desmitis can be reliably detected using computed tomography and differ between affected horses and controls. Vet Radiol Ultrasound 2023;64(6):E64–E96.
- Edwards RB 3rd, Ducharme NG, Fubini SL, Yeager AE, Kallfelz FA. Scintigraphy for diagnosis of avulsions of the origin of the suspensory ligament in horses: 51 cases (1980–1993). J Am Vet Med Assoc 1995;207(5):608–611.
- Williams J, Miyabayashi T, Ruggles A, Yamamoto J, Takiguchi M. Scintigraphic and ultrasonographic diagnosis of soft tissue injury in a Thoroughbred horse. J Vet Med Sci 1994;56(1):169–172.
- Dyson SJ, Weekes JS, Murray RC. Scintigraphic evaluation of the proximal metacarpal and metatarsal regions of horses with proximal suspensory desmitis. Vet Radiol Ultrasound 2007;48(1):78–85.
- Oomen AM, Oosterlinck M, Pille F, Sonneveld DC, Gasthuys F, Back W. Use of a pressure plate to analyse the toe–heel load redistribution underneath a normal shoe and a shoe with a wide toe in sound warmblood horses at the walk and trot. Res Vet Sci 2012;93(2):1026–1031.
- Lawson SE, Chateau H, Pourcelot P, Denoix JM, Crevier‐Denoix N. Effect of toe and heel elevation on calculated tendon strains in the horse and the influence of the proximal interphalangeal joint. J Anat 2007;210(5):583–591.
- Kadic DTN, Minshall GJ, Wright IM. Surgical management of marginal tears/avulsions of the suspensory ligament branches in 29 Thoroughbred racehorses. Equine Vet J 2019;51(3):310–315.
- Hewes CA, White NA. Outcome of desmoplasty and fasciotomy for desmitis involving the origin of the suspensory ligament in horses: 27 cases (1995–2004). J Am Vet Med Assoc 2006;229(3):407–412.
- Brokken MT, Schneider RK, Roberts GD, Holmes SP, Gavin PR, Sampson SN. Evaluation of a new surgical treatment for equine hind limb proximal suspensory desmitis. Vet Surg 2016;45(7):868–878.
- Tóth F, Schumacher J, Schramme M, Holder T, Adair HS, Donnell RL. Compressive damage to the deep branch of the lateral plantar nerve associated with lameness caused by proximal suspensory desmitis. Vet Surg 2008;37(4):328–335.
- Guasco PG, Kelly G, Schumacher J, Henry RW. Excision of the deep branch of the lateral palmar nerve of horses to resolve lameness caused by proximal suspensory desmitis. Vet Surg 2013;42(3):296–301.
- Scharf A, De Solis CN, Sampson SN, Glass K, Watts AE. Suspensory ligament size does not change after plantar fasciotomy and neurectomy of the deep branch of the lateral plantar nerve by ultrasonographic assessment. Vet Surg 2022;51(2):259–269.
- Tatarniuk DM, Hill JA, Modesto RB, Swor TM, Caston SS, Kersh KD. Outcome following neurectomy of the deep branch lateral plantar nerve and plantar fasciotomy for hindlimb proximal suspensory desmopathy in western performance horses: 21 cases. Vet Surg 2021;50(2):273–282.
- Dyson S, Murray R. Management of hindlimb proximal suspensory desmopathy by neurectomy of the deep branch of the lateral plantar nerve and plantar fasciotomy: 155 horses (2003–2008). Equine Vet J 2012;44(3):361–367.
- José Antonio G, Jim S, Ramés SJ, Rohrbach BW, Alejandro Rodríguez M, Laura Romero R. Denervating the pelvic suspensory ligaments of horses causes morphological and histological changes in the ligaments. Am J Vet Res 2022;83(5):399–404.
- Lopez‐Navarro G, Trigo‐Tavera FJ, Rodriguez‐Monterde A, Gutierrez‐Ospina G, Arechavaleta‐Velasco M, Schumacher J. Histological changes in the proximal suspensory ligament after neurectomy of the deep branch of the lateral palmar nerve of horses with induced proximal suspensory desmitis. Vet J 2017;227:46–48.
- Pauwels FE, Schumacher J, Mayhew IG, Van Sickle DC. Neurectomy of the deep branch of the lateral plantar nerve can cause neurogenic atrophy of the muscle fibres in the proximal part of the suspensory ligament (M. Interosseous III). Equine Vet J 2009;41(5):508–510.
- Crowe OM, Dyson SJ, Wright IM, Schramme MC, Smith RKW. Treatment of chronic or recurrent proximal suspensory desmitis using radial pressure wave therapy in the horse. Equine Vet J 2004;36(4):313–316.
- Lischer CJ, Ringer SK, Schnewlin M, Imboden I, Fürst A, Stöckli M. Treatment of chronic proximal suspensory desmitis in horses using focused electrohydraulic shockwave therapy. Schweiz Arch Tierheilkd 2006;148(10):561–568.
- Giunta K, Donnell JR, Donnell AD, Frisbie DD. Prospective randomized comparison of platelet rich plasma to extracorporeal shockwave therapy for treatment of proximal suspensory pain in western performance horses. Res Vet Sci 2019;126:38–44.
- Imboden I, Waldern NM, Wiestner T, Lischer CJ, Ueltschi G, Weishaupt MA. Short term analgesic effect of extracorporeal shock wave therapy in horses with proximal palmar metacarpal/plantar metatarsal pain. Vet J 2009;179(1):50–59.
- McClure SR, Vansickle D, Evans R, Reinertson EL, Moran L. The effects of extracorporeal shock‐wave therapy on the ultrasonographic and histologic appearance of collagenase‐induced equine forelimb suspensory ligament desmitis. Ultrasound Med Biol 2004;30(4):461–467.
- Caminoto EH, Alves AL, Amorim RL, Thomassian A, Hussni CA, Nicoletti JL. Ultrastructural and immunocytochemical evaluation of the effects of extracorporeal shock wave treatment in the hind limbs of horses with experimentally induced suspensory ligament desmitis. Am J Vet Res 2005;66(5):892–896.
- Bosch G, Lin YL, Van Schie HTM, Van De Lest CHA, Barneveld A, Van Weeren PR. Effect of extracorporeal shock wave therapy on the biochemical composition and metabolic activity of tenocytes in normal tendinous structures in ponies. Equine Vet J 2007;39(3):226–231.
- Bosch G, De Mos M, Van Binsbergen R, Van Schie HTM, Van De Lest CHA, Van Weeren PR. The effect of focussed extracorporeal shock wave therapy on collagen matrix and gene expression in normal tendons and ligaments. Equine Vet J 2009;41(4):335–341.
- Pluim M, Martens A, Vanderperren K, Sarrazin S, Koene M, Luciani A. Short‐ and long term follow‐up of 150 sports horses diagnosed with tendinopathy or desmopathy by ultrasonographic examination and treated with high‐power laser therapy. Res Vet Sci 2018;119:232–238.
- Pluim M, Martens A, Vanderperren K, Van Weeren R, Oosterlinck M, Dewulf J. High‐power laser therapy improves healing of the equine suspensory branch in a standardized lesion model. Front Vet Sci 2020;7:600.
- Pluim M, Heier A, Plomp S, Boshuizen B, Gröne A, Van Weeren R. Histological tissue healing following high‐power laser treatment in a model of suspensory ligament branch injury. Equine Vet J 2022;54(6):1114–1122.
- Carrozzo U, Toniato M, Harrison A. Assessment of noninvasive low‐frequency ultrasound as a means of treating injuries to suspensory ligaments in horses: a research paper. J Equine Vet Sci 2019;80:80–89.
- Vlahos TP. Percutaneous ultrasonic debridement of equine tendinopathy and desmopathy: a report of 10 cases. Open Vet J 2023;13(9):1141–1149.
- Argüelles D, Carmona JU, Climent F, Muñoz E, Prades M. Autologous platelet concentrates as a treatment for musculoskeletal lesions in five horses. Vet Rec 2008;162(7):208–211.
- Castelijns G, Crawford A, Schaffer J, Ortolano GA, Beauregard T, Smith RK. Evaluation of a filter‐prepared platelet concentrate for the treatment of suspensory branch injuries in horses. Vet Comp Orthop Traumatol 2011;24(5):363–369.
- Waselau M, Sutter W, Genovese RL, Bertone AL. Intralesional injection of platelet‐rich plasma followed by controlled exercise for treatment of midbody suspensory ligament desmitis in standardbred racehorses. J Am Vet Med Assoc 2008;232(10):1515–1520.
- Garrett KS, Bramlage LR, Spike‐Pierce DL, Cohen ND. Injection of platelet‐ and leukocyte‐rich plasma at the junction of the proximal sesamoid bone and the suspensory ligament branch for treatment of yearling Thoroughbreds with proximal sesamoid bone inflammation and associated suspensory ligament branch desmitis. J Am Vet Med Assoc 2013;243(1):120–125.
- Maleas G, Mageed M. Effectiveness of platelet‐rich plasma and bone marrow aspirate concentrate as treatments for chronic hindlimb proximal suspensory desmopathy. Front Vet Sci 2021;8:678453.
- Hall M, Vasey J, Russell J, Russell T. Use of ultrasound‐guided autologous bone marrow transfer for treatment of suspensory ligament desmitis in 30 race horses (2003–2010). Aust Vet J 2013;91(3):102–107.
- Torricelli P, Fini M, Filardo G, Tschon M, Pischedda M, Pacorini A. Regenerative medicine for the treatment of musculoskeletal overuse injuries in competition horses. Int Orthop 2011;35(10):1569–1576.
- Van Loon VJ, Scheffer CJ, Genn HJ, Hoogendoorn AC, Greve JW. Clinical follow‐up of horses treated with allogeneic equine mesenchymal stem cells derived from umbilical cord blood for different tendon and ligament disorders. Vet Q 2014;34(2):92–97.
- Hansen SH, Bramlage LR, Moore GE. Racing performance of Thoroughbred racehorses with suspensory ligament branch desmitis treated with mesenchymal stem cells (2010–2019). Equine Vet J 2023;56(3):503–513.
- Depuydt E, Chiers K, Van Hecke L, Saunders J, Martens A, Pille F. Assessing the functional properties of tenogenic primed mesenchymal stem cells in ex vivo equine tendon and ligament explants: a preliminary study. Stem Cell Res 2022;65:102963.
- Vandenberghe A, Broeckx SY, Beerts C, Seys B, Zimmerman M, Verweire I. Tenogenically induced allogeneic mesenchymal stem cells for the treatment of proximal suspensory ligament desmitis in a horse. Front Vet Sci 2015;2:49.
- Beerts C, Suls M, Broeckx SY, Seys B, Vandenberghe A, Declercq J. Tenogenically induced allogeneic peripheral blood mesenchymal stem cells in allogeneic platelet‐rich plasma: 2‐year follow‐up after tendon or ligament treatment in horses. Front Vet Sci 2017;4:158.
- Carlier S, Depuydt E, Suls M, Bocqué C, Thys J, Vandenberghe A. Equine allogeneic tenogenic primed mesenchymal stem cells: a clinical field study in horses suffering from naturally occurring superficial digital flexor tendon and suspensory ligament injuries. Equine Vet J 2023;56(5):924–935.
- Kornicka‐Garbowska K, Pędziwiatr R, Woźniak P, Kucharczyk K, Marycz K. Microvesicles isolated from 5‐azacytidine‐and‐resveratrol‐treated mesenchymal stem cells for the treatment of suspensory ligament injury in horse—a case report. Stem Cell Res Ther 2019;10(1):394.
- Kovac M, Litvin YA, Aliev RO, Zakirova EY, Rutland CS, Kiyasov AP. Gene therapy using plasmid DNA encoding VEGF164 and FGF2 genes: a novel treatment of naturally occurring tendinitis and desmitis in horses. Front Pharmacol 2018;9:978.
- Kovac M, Litvin YA, Aliev RO, Zakirova EY, Rutland CS, Kiyasov AP. Gene therapy using plasmid DNA encoding vascular endothelial growth factor 164 and fibroblast growth factor 2 genes for the treatment of horse tendinitis and desmitis: case reports. Front Vet Sci 2017;4:168.