Abstract
<strong>PICO question</strong><br /><p>In horses with longitudinal tears of the deep digital flexor tendon within the digital flexor tendon sheath, is surgical repair as effective as tenoscopic debridement alone for returning to previous level of performance?</p><strong>Clinical bottom line</strong><br /><p>Current literature on the efficacy of surgical repair or tenoscopic debridement is limited. Criteria to define and evaluate performance outcomes is not uniform and confounded with multiple variables, merely representing low quality evidence that is difficult to draw meaningful conclusions from. However, the literature suggests tenoscopic debridement alone has been associated with improved outcomes. A more definitive conclusion cannot be made until higher quality evidence is made available on this topic.</p><p> </p><img src="https://www.veterinaryevidence.org/rcvskmod/icons/oa-icon.jpg" alt="Open Access" /> <img src="https://www.veterinaryevidence.org/rcvskmod/icons/pr-icon.jpg" alt="Peer Reviewed" />
Highlights
Palmar annular ligament desmotomy was performed on cases with evidence of chronicity or obvious thickening of the ligament
Before 2003, desmotomy was performed in all cases
Of 130 horses with chronic tenosynovitis of the digital flexor tendon sheath (DFTS) that had tenoscopic surgery, 101 horses were diagnosed with 115 longitudinal tears (LTs) affecting a digital flexor tendon in 104 digital flexor tendon sheaths
Summary
Population: Horses with non-septic tenosynovitis of the Digital Flexor Tendon Sheath. Palmar annular ligament desmotomy was performed on cases with evidence of chronicity or obvious thickening of the ligament. In some cases further debridement and smoothing of the fibrillated edge was achieved using a coblation probe on a low energy setting and in no contact mode. Main findings: (relevant to PICO question): Of 130 horses with chronic tenosynovitis of the digital flexor tendon sheath (DFTS) that had tenoscopic surgery, 101 horses were diagnosed with 115 longitudinal tears (LTs) affecting a digital flexor tendon in 104 digital flexor tendon sheaths. Palmar-plantar annular ligament (PAL) desmotomy was performed in 71/104 DFTS (68%). 27 horses (27%) returned to a lower level of work and 34 horses (35%) remained lame. Coblation was associated with a lower level of performance and cosmetic outcome (increased distension). Manual debridement of LTs (no resector or coblation) was associated with a better functional outcome
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