LA Orthopedic Emergencies

Tendon and ligament lacerations

Extensor tendon lacerations heal well without significant intervention.

Flexor tendon lacerations can be career ending due to poor healing. Tendons do not return to normal structure but maintain variable amounts of scar tissue within the injured area. Scar tissue is unable to stretch properly and often tears, leading to reinjury. Chronic injury may also lead to calcification of the tendon, further minimizing stretch.

Partial lacerations carry the best prognosis. It is important to keep these from becoming complete tendon lacerations. This requires immediate support to prevent full weight bearing. As the flexor tendons are most stretched with weight bearing, the animal is splinted so that it is standing on its toe and with the dorsal cortices aligned. This resembles a ballet dancer on their toes.

http://www.randwickequine.com.au/sites/default/files/publications/injuries_of_the_flexor_tendons_focus_on_the_superficial_digital_flexor_tendon.pdf and https://www.sciencedirect.com/science/article/abs/pii/S1534751604000459

This position can be stabilized with a dorsal splint, casting material or Kimzey leg saver splint.

Complete lacerations should be similarly stabilized for animal comfort. Surgical repair has not been found to change success rates.  Suture repair is difficult and results in significant foreign body reaction. Healing is slow and often regresses as the horse uses the limb. Special shoeing and bandaging are required. In a large retrospective study, only 55% or horses with tendon lacerations were able to return to intended use and 18% were euthanized. Lacerations within the tendon sheath seem to heal particularly poorly, likely related to the poor vascularity.

 

Resources

Tendon and ligament injury chapter

Outcome after Lacerations of the Superficial and Deep Digital Flexor Tendons, Suspensory Ligament and/or Distal Sesamoidean Ligaments in 106 Horses. Jordana M et al. 2011 Veterinary Surgery 40(3):277 Р283

Healing Characteristics of Deep Digital Flexor Tenorrhaphy Within the Digital Sheath of Horses. Jann H et al. 2003 Veterinary Surgery 32(5):421-30.

License

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Large Animal Surgery - Supplemental Notes by Erin Malone, DVM, PhD; Elaine Norton, DVM PhD; Erica Dobbs, DVM; and Ashley Ezzo, DVM is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, except where otherwise noted.