The diagnosis proximal suspensory ligament desmopathy encompasses several different disease manifestations ranging from a simple desmitis of the high suspensory ligament to complicated involvement of bone tissue with avulsion fractures, bony additions, fissures or lytic, degenerative processes. Standard imaging techniques, such as radiology and sonography, are insufficient for a detailed differentiation. This study presents the results of a surgical combination therapy adapted to the respective disease manifestation in chronic desmopathies of the proximal suspensory ligament at the front and hind leg performed on 322 horses. The horses were of different breeds and ranged from hobby to international competition horses for different disciplines. Their age ranged between 3 and 19 years (average age 9.4 years). All horses underwent a standardized protocol with clinical and X-ray examination and sonography. Immediately prior to the surgery, the affected leg was examined by computer tomography to identify the exact manifestation and adapt the surgical approach. When only the soft tissue structures were involved, a desmoplasty of the origin of the suspensory ligament, fasciotomy of the superficial and deep metacarpal or metatarsal fascia, and bone marrow transplantation from the sternum to the high suspensory ligament were performed. Additionally, a tenotomy of the medial part of the tibialis anterior tendon (cunean tendon) was done on the hind leg. In the case where there was a clear involvement of the bony tissue, as visualized by computer tomography, several fine holes (osteostixis) were also drilled into the proximal metacarpal or metatarsal bone. The horses went through a detailed programme of movement exercises for 4 to 6 months post surgery. After a median observation period of 24 months, 89.1 % of the horses (91.0 % with surgery on the front leg and 87.8 % with surgery on the hind leg) were able to return to their original use. This study was able to show that, after carrying out an exact diagnosis and a surgical procedure adapted to the respective extent of the disease, a very good result can be achieved in the healing of chronic diseases in the area of the origin of the suspensory ligament without performing a neurectomy of the innervating nerves. The surgical procedure shown can be used in the case of chronic changes in the suspensory ligament both on the front and hind leg of the horse.
