ISSN 2398-2977      

Accessory ligament SDFT: desmotomy

pequis

Synonym(s): Accessory desmotomy, desmotomy of the accessory ligament of the SDFT, superior or inferior check ligament desmotomy


Introduction

  • The superficial digital flexor tendon (SDFT) inserts in the palmar aspect of P2 and has 2 origins. The muscular part originates from the medial epicondyle of the humerus and the fibrous part or the accessory ligament of the SDFT (ALSDFT, superior/proximal check ligament) which originates from the distal medial aspect of the radius. This latter bone-tendon-bone segment bears most of the load of the entire musculotendinous unit, prevents over-stretching during extension of the fetlock, and contributes to the support of the metacarpophalangeal joint.
  • Desmotomy permits lengthening of the SDF muscle/tendon unit and/or allows the belly of the SDF muscle to take a greater proportion of the load, serving to protect a repaired SDFT.
  • Transection of the ALSDFT can be performed via a standard surgical approach or tenoscopically via the carpal sheath.

Uses

Advantages

  • Established surgical technique.
  • A tenoscopic approach significantly reduces wound healing time and post-surgical complications Tenosynovioscopy.

Disadvantages

Requirements

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Preparation

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Procedure

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Aftercare

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Outcomes

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Prognosis

  • The results of this surgery are clearly more beneficial in the Standardbred racehorse Standardbred compared to the Thoroughbred Thoroughbred. In the latter some clinicians are unsure as to the benefit of surgery over rest followed by controlled exercise.
  • Fair for mild - moderate deformity cases.
  • Guarded - for severe deformity cases.

Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Nelson B B et al (2015) Radiofrequency probe and sharp transection for tenoscopic-guided desmotomy of the accessory ligament of the superficial digital flexor tendon. Vet Surg 44 (6), 713-722 PubMed.
  • Hu A J & Bramlage L R (2014) Racing performance of Thoroughbreds with superficial digital flexor tendonitis treated with desmotomy of the accessory ligament of the superficial digital flexor tendon: 332 cases (1989-2003). J Am Vet Med Assoc 244 (12), 1441-1448 PubMed.
  • David F et al (2011) Electrosurgical tenoscopic desmotomy of the accessory ligament of the superficial digital flexor muscle (proximal check ligament) in horses. Vet Surg 40 (1), 46-53 PubMed.
  • Alexander G R et al (2001) Effects of superior check desmotomy on flexor tendon and suspensory ligament strain in equine cadaver limbs. Vet Surg 30 (6), 522-527 PubMed.
  • Southwood L L et al (1999) Desmotomy of the accessory ligament of the superior digital flexor tendon in the horse with the use of a tenoscopic approach to the carpal sheath. Vet Surg 28 (2), 99-105 PubMed.
  • Gibson K T et al (1997) Superficial digital tendonitis in thoroughbred race horses outcome following non-surgical treatment and superior check desmotomy. Aust Vet J 75, 631 PubMed.
  • Hogan P M & Bramlage L R (1995) Transection of the accessory ligament of the superficial digital flexor tendon for treatment of tendinitis - long-term results in 61 Standardbred racehorses (1985-1992). Equine Vet J 27, 221-226 PubMed.
  • Shoemaker R S, Bertone A L, Mohammad L N & Arms S W (1991) Desmotomy of the accessory ligament of the superficial digital flexor muscle in equine cadaver limbs. Vet Surg 20 (4), 245-252 PubMed.

Other sources of information

  • McIlwraith C W, Nixon A J & Wright I W (2005) Desmotomy of the Accessory Ligament of the Superficial Digital Flexor (Proximal Check Ligament). In: Diagnostic and Surgical Arthroscopy in the Horse. 3rd edn. Elsevier, UK. pp 368-370.

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