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Home / Equine Research Bank / Vet Surg / Macroscopic comparison of open Metzenbaum and ultrasound-gui...
Veterinary surgery : VS2026; doi: 10.1111/vsu.70102

Macroscopic comparison of open Metzenbaum and ultrasound-guided fasciotomy techniques for surgical treatment of the hindlimb proximal suspensory ligament desmopathy in horses: A cadaveric anatomical study.

Abstract: To macroscopically characterize and compare the open Metzenbaum (FOM) and ultrasound-guided (FUG) plantar fasciotomy techniques for decompression of the hindlimb proximal suspensory ligament (PSL), and to determine whether either approach induces intraligamentous splitting (ILS). Methods: Cadaveric experimental study. Methods: Paired hindlimbs from 10 adult horses with no history of hindlimb lameness. Methods: Each horse contributed one limb to FOM and the contralateral to FUG. All procedures were performed by a single surgeon, and incision measurements were obtained by a blinded examiner. Skin, fascia, and ILS lengths were recorded after dissection. Integrity of the deep branch of the lateral plantar nerve (DBLPN) was evaluated macroscopically. Paired t-tests compared FOM and FUG values (p < .05). Results: Both techniques induced PSL ILS. Mean ± SD incision lengths (cm) for FOM versus FUG were: skin 5.02 ± 0.41 versus 1.28 ± 0.18; fascia 5.54 ± 0.44 versus 4.39 ± 0.22; and ILS 5.33 ± 0.42 versus 4.37 ± 0.24. The FUG technique produced 74% shorter skin, 21% shorter fasciotomy, and 18% shorter ILS incisions compared to FOM (all p < .0001). No macroscopic evidence of DBLPN injury was observed. Conclusions: Both FOM and FUG plantar fasciotomy techniques produced ILS while achieving PSL decompression. FUG required smaller incisions, confirming comparable anatomical efficacy with reduced invasiveness. Conclusions: Intraligamentous splitting appears unavoidable during plantar fasciotomy, but the FUG technique limits its extent and associated soft-tissue disruption, supporting its use as a safer, less invasive alternative in clinical cases of chronic PSL desmopathy.
© 2026 The Author(s). Veterinary Surgery published by Wiley Periodicals LLC on behalf of American College of Veterinary Surgeons.
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Publication Date: 2026-03-26 PubMed ID: 41883235DOI: 10.1111/vsu.70102Google Scholar: Lookup
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Summary

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Overview

  • This study compares two surgical techniques, open Metzenbaum (FOM) and ultrasound-guided (FUG) fasciotomy, used to treat proximal suspensory ligament (PSL) injury in the hindlimbs of horses.
  • The research evaluates incision sizes, ligament splitting, and nerve integrity in cadaver limbs to determine which technique is less invasive while effectively decompressing the PSL.

Background and Purpose

  • The proximal suspensory ligament (PSL) is an important structure in the horse’s hindlimb often prone to injury causing lameness.
  • Plantar fasciotomy is a surgical procedure used to relieve pressure in the PSL by making incisions through surrounding tissues.
  • The traditional open Metzenbaum (FOM) technique involves larger incisions, while the ultrasound-guided (FUG) approach uses smaller incisions aided by imaging.
  • The study aims to macroscopically characterize and compare both techniques to see if one is less invasive without compromising efficacy or causing nerve damage.
  • A specific concern is whether either technique causes intraligamentous splitting (ILS), which is splitting within the ligament tissue.

Methods

  • Cadaveric study with paired hindlimbs from 10 adult horses without previous hindlimb lameness.
  • Each horse provided one limb for the FOM technique and the contralateral limb for the FUG technique to control for individual variation.
  • All surgeries were performed by a single surgeon to maintain consistency.
  • Incision sizes for skin and fascia layers were measured by an examiner blinded to the technique used.
  • After dissection, the lengths of the skin incision, fascial incision, and intraligamentous splitting (ILS) in the PSL were recorded.
  • Macroscopic examination was performed to assess the integrity of the deep branch of the lateral plantar nerve (DBLPN) to check for surgical damage.
  • Statistical comparison between FOM and FUG values was conducted using paired t-tests with significance set at p < 0.05.

Results

  • Both FOM and FUG techniques resulted in intraligamentous splitting (ILS) within the proximal suspensory ligament, indicating that some ligament splitting is unavoidable.
  • Mean incision lengths (with standard deviations) for FOM versus FUG were:
    • Skin incision: 5.02 ± 0.41 cm (FOM) vs. 1.28 ± 0.18 cm (FUG)
    • Fascial incision: 5.54 ± 0.44 cm (FOM) vs. 4.39 ± 0.22 cm (FUG)
    • Intraligamentous splitting: 5.33 ± 0.42 cm (FOM) vs. 4.37 ± 0.24 cm (FUG)
  • The FUG technique significantly reduced incision lengths compared to the FOM technique:
    • 74% shorter skin incisions
    • 21% shorter fascial incisions
    • 18% shorter intraligamentous splitting
  • No visible damage to the deep branch of the lateral plantar nerve was observed with either technique, suggesting both are safe with respect to nerve preservation.

Conclusions and Implications

  • Both surgical approaches effectively decompress the proximal suspensory ligament but cause some unavoidable splitting within the ligament structure.
  • The ultrasound-guided fasciotomy (FUG) technique is less invasive, requiring much smaller skin and tissue incisions compared to the open Metzenbaum (FOM) approach.
  • Reduced incision size with FUG likely translates to less soft tissue disruption, potentially improving recovery time and reducing surgical risks.
  • Neither technique damaged critical nerve structures macroscopically, supporting the safety profile of both methods when performed carefully.
  • The findings endorse the ultrasound-guided technique as a safer, less invasive alternative for treating chronic proximal suspensory ligament desmopathy in clinical settings.

Cite This Article

APA
Maleas G, Hargitaiova K. (2026). Macroscopic comparison of open Metzenbaum and ultrasound-guided fasciotomy techniques for surgical treatment of the hindlimb proximal suspensory ligament desmopathy in horses: A cadaveric anatomical study. Vet Surg. https://doi.org/10.1111/vsu.70102

Publication

Veterinary surgery : VS
ISSN: 1532-950X
NlmUniqueID: 8113214
Country: United States
Language: English

Researcher Affiliations

Maleas, Grigorios
  • Equuria Orthopedics GbR, Emstek, Germany.
Hargitaiova, Kristyna
  • Department of Biomedical Sciences, Cornell University, Ithaca, New York, USA.

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