Suspensory ligament size does not change after plantar fasciotomy and neurectomy of the deep branch of the lateral plantar nerve by ultrasonographic assessment.
Abstract: To determine the short-term effect of plantar fasciotomy and neurectomy (PFN) of the deep branch of the lateral plantar nerve on the proximal suspensory ligament (PSL) cross-sectional area (CSA) in horses with hindlimb proximal suspensory desmopathy (PSD). Methods: Analytical, observational, cohort study. Methods: Twenty-one horses. Methods: Records of horses with chronic PSD treated by PFN were included if a preoperative ultrasonographic examination was available and at least one postoperative ultrasonographic examination. One masked observer measured the ultrasonographic cross-sectional area (CSA) of the PSL. Intraobserver reliability was determined by repeatedly measuring a subset of ultrasonographic images (n = 127). Two masked observers measured the cross-sectional area of the proximal suspensory ligament (PSL-CSA) on preoperative proton density (PD)-weighted transverse high field magnetic resonance images (n = 19 horses) . Agreements for PSL-CSA between preoperative ultrasonographic and MRI measures and between the two magnetic resonance imaging (MRI) observers were assessed. Follow up considered the horses' ability to return to exercise and their owners' satisfaction. Results: The reliability of the ultrasonographic measurement of the PSL-CSA was excellent. Agreement between ultrasonographic assessment and MRI assessment of PSL-CSA was good. No difference was detected between preoperative (median, interquartile range; oblique-incidence, 2.07, 1.72-2.55; on-incidence, 2.23, 1.98-2.65) and postoperative (oblique-incidence, 2.08, 1.80-2.74; on-incidence, 2.28, 2.01-2.74) PSL-CSAs. At a median of 12 months (4-33 months), 16/20 (80%) owners reported the horse was "better" and 15/20 (75%) functioned at or above preoperative levels. Conclusions: Ultrasonographic measurement of the PSL-CSA was reproducible and in good agreement with MRI measurement. The PSL-CSA was not influenced by PFN. Conclusions: The PSL-CSA cannot be used to guide return to function.
© 2021 The Authors. Veterinary Surgery published by Wiley Periodicals LLC on behalf of American College of Veterinary Surgeons.
Publication Date: 2021-12-31 PubMed ID: 34970755PubMed Central: PMC9306907DOI: 10.1111/vsu.13757Google Scholar: Lookup
The Equine Research Bank provides access to a large database of publicly available scientific literature. Inclusion in the Research Bank does not imply endorsement of study methods or findings by Mad Barn.
- Journal Article
Summary
This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.
The research investigates the effect of plantar fasciotomy and neurectomy on the size of the suspensory ligament in horses suffering from hindlimb proximal suspensory desmopathy, finding that this procedure does not change the ligament’s size. The assessment was carried out by ultrasound and MRI, the results of which were found to be in strong agreement, but showed no influence on the ligament’s size from the surgical intervention.
Study Design and Methodology
- The study is an analytical, observational, and cohort type, centered around 21 horses with chronic proximal suspensory desmopathy treated by plantar fasciotomy and neurectomy.
- Horses with available preoperative ultrasound examinations and at least one postoperative exam were included in the study.
- A single observer, masked to the condition of the horses, conducted measurements of the proximal suspensory ligament’s cross-sectional area using ultrasound. This observer’s reliability was tested by repeating measures on a set of ultrasound images.
- In addition, two masked observers performed measurements of the ligament using preoperative proton-density-weighted transverse high field magnetic resonance imaging.
- The study then calculated agreements of results between ultrasound and MRI measures, and also among the two MRI observers.
- A follow-up on the recovering horses evaluated their capacity to resume exercise and gauged owners’ satisfaction levels.
Findings and Conclusion
- Results showed that the ultrasound measurement of the proximal suspensory ligament’s cross-sectional area was highly reliable and had good conformity with MRI measures.
- No significant changes were discovered in the ligament’s size pre and post the surgery.
- After a median period of 12 months, 80% of horse owners reported an improvement in their horse’s condition, with 75% noting their horses performing at, or surpassing preoperative levels.
- The study concluded that the ultrasound measurement of the suspensory ligament’s cross-sectional area can be reliably reproduced and corresponds well with MRI measurements.
- Notwithstanding, the size of the suspensory ligament, gauged via ultrasound, was not affected by the plantar fasciotomy and neurectomy procedure, suggesting that the cross-sectional area of the ligament cannot be used as a reference for recovery or return to function.
Cite This Article
APA
Scharf A, de Solis CN, Sampson SN, Glass K, Watts AE.
(2021).
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, 51(2), 259-269.
https://doi.org/10.1111/vsu.13757 Publication
Researcher Affiliations
- Department of Large Animal Clinical Sciences, Texas A&M University, College Station, Texas, USA.
- Department of Large Animal Clinical Sciences, Texas A&M University, College Station, Texas, USA.
- Department of Large Animal Clinical Sciences, Texas A&M University, College Station, Texas, USA.
- Department of Large Animal Clinical Sciences, Texas A&M University, College Station, Texas, USA.
- Department of Large Animal Clinical Sciences, Texas A&M University, College Station, Texas, USA.
MeSH Terms
- Animals
- Cohort Studies
- Denervation / veterinary
- Fasciotomy / veterinary
- Horse Diseases / diagnostic imaging
- Horse Diseases / surgery
- Horses
- Ligaments / diagnostic imaging
- Ligaments / surgery
- Reproducibility of Results
Conflict of Interest Statement
The authors declare no conflicts of interest related to this report.
References
This article includes 20 references
- 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.
- Dyson S. Diagnosis and management of common suspensory lesions in the forelimbs and hindlimbs of sport horses. Clin Tech Equine Pract 2007;6(3):179‐188.
- Dyson S. Proximal suspensory desmitis in the hindlimb: 42 cases. Br Vet J 1994;150(3):279‐291.
- Toth 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.
- Dyson S. Proximal suspensory desmitis in the hindlimb. Equine Vet Educ 1995;7(5):275‐278.
- Bathe A. Neurectomy and fasciotomy for the surgical treatment of hindlimb proximal suspensory desmitis. In: 2001 Newmarket, UK, p. 118. 2001.
- 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.
- Toth F, Schumacher J, Schramme MC, Kelly G. Proximal suspensory desmitis of the hindlimbs. Compendium Equine 2009. September;308‐316.
- 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.
- Dyson S. Proximal suspensory desmitis: clinical, ultrasonographic and radiographic features. Equine Vet J 1991;23(1):25‐31.
- Lopez‐Navarro G, Trigo‐Tavera FJ, Rodriguez‐Monterde A. 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.
- Koo TK, Li MY. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med 2016;15(2):155‐163.
- Bland JM, Altman DG. Measurement error. BMJ 1996;313(7059):744.
- 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.
- van der Vlugt‐Meijer RH, Meij BP, Voorhout G. Intraobserver and interobserver agreement, reproducibility, and accuracy of computed tomographic measurements of pituitary gland dimensions in healthy dogs. Am J Vet Res 2006;67(10):1750‐1755.
- Werpy NM, Denoix J. Imaging of the equine proximal suspensory ligament. Vet Clin North Am Equine Pract 2012;28(3):507‐525.
- de Vet HCW, Terwee CB, Knol DL, Bouter LM. When to use agreement versus reliability measures. J Clin Epidemiol 2006;59(10):1033‐1039.
- Bischofberger AS, Konar M, Ohlerth S. 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.
- 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.
- 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.
Use Nutrition Calculator
Check if your horse's diet meets their nutrition requirements with our easy-to-use tool Check your horse's diet with our easy-to-use tool
Talk to a Nutritionist
Discuss your horse's feeding plan with our experts over a free phone consultation Discuss your horse's diet over a phone consultation
Submit Diet Evaluation
Get a customized feeding plan for your horse formulated by our equine nutritionists Get a custom feeding plan formulated by our nutritionists
