Use of a radiofrequency probe for tenoscopic‐guided annular ligament desmotomy

Abstract

Annular ligament desmotomy is commonly performed in horses with chronic tenosynovitis. Previously reported tenoscopic techniques have limitations related to haemorrhage and awkward instrumentation. Radiofrequency (RF) energy affords precision and excellent haemostasis and may be a good alternative to sharp transection of the annular ligament in horses. To describe a technique for using a RF probe for tenoscopic-guided annular ligament desmotomy and to report the clinical outcome of horses in which it was performed. Cadaver specimens (n = 14) and live horses undergoing unrelated terminal procedures (n = 2) were used to optimise the tenoscopic-guided RF annular ligament desmotomy technique. Records were examined for all horses undergoing annular ligament desmotomy with an RF probe from 2003 to 2008 for which follow-up of >1 year post operatively was available. The annular ligament was successfully transected in the cadaver and live horse model limbs using 2 different commercially available RF probes. Complete transection was achieved with practice and confirmed on gross dissection. Histopathology did not reveal any collateral damage to surrounding tissue. Follow-up of >1 year was available for 6 of 7 clinical cases. Four of 6 horses returned to work. Owners were satisfied with the outcome in all cases. Desmotomy using a RF probe allows precise tissue transection under tenoscopic guidance without damage to surrounding structures or haemorrhage. With experience, it is an easily performed technique. In clinical patients, an acceptable outcome may be expected. Tenoscopic-guided RF annular ligament desmotomy offers advantages, including reliable haemostasis and precise tissue transection, over previously reported techniques and is a viable surgical alternative for treating horses with annular ligament desmitis and other complex pathology within the tendon sheath.