Diagnosis and prognosis of sesamoidean ligament desmitis

Excellent information on the diagnosis of sesmoidean ligament desmitis and reviewing the prognosis. An important general principle here is that often the proper conduction and reading of ultrasounds is best done by experienced ultrasonographers. Yes, many common US procedures of easily and routinely accessed structures can be done by occasional users of a US machine. But many examinations are done on structures not routinely examined and these should be referred to a specialist for confirmation.
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Retrospective analysis of oblique and straight distal sesamoidean ligament desmitis in 52 horses
Equine Vet J. 2021 Feb 10. doi: 10.1111/evj.13438. Online ahead of print.
Authors
Alex Hawkins 1 , Lauren O’Leary 1 , David Bolt 1 , Andrew Fiske-Jackson 1 , Dagmar Berner 1 , Roger Smith 1
Affiliation

1 Department of Clinical Sciences and Services, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire, AL9 7TA, UK.

PMID: 33567104
DOI: 10.1111/evj.13438

Abstract

Background: Injuries to the oblique (ODSL) or straight (SDSL) distal sesamoidean ligaments are a recognised cause of distal limb lameness in the horse. However, there are only limited publications addressing common diagnostic features and prognosis.

Objectives: 1) Report findings on ultrasonography and standing low-field magnetic resonance imaging (sMRI) in horses with ODSL or SDSL injury; 2) Identify clinical variables associated with lesion type; 3) Identify factors associated with return to soundness in horses with ODSL or SDSL injury.

Study design: Retrospective case series.

Methods: Horses with a primary diagnosis of ODSL or SDSL injury confirmed with a combination of diagnostic analgesia and detection of a lesion on imaging (ultrasonographic +/- advanced imaging) were included. Return to soundness and performance follow-up data were obtained.

Results: Fifty-one horses were included. SDSL injuries were more common in the forelimb (13/21, 62%) while ODSL injuries had equal frequency in fore- (15/30, 50%) and hindlimbs (15/30, 50%). ODSL injuries were more likely than SDSL injuries in the proximal third of the ligament (OR 13, 95% CI 2.3-74.3; p=0.004) and often presented with periligamentar swelling (20/30;67%) and focal pain (22/28;79%). Lesions were frequently detected using ultrasonography (35/42;83%) and sMRI examination (18/25;72%). Only 27/49 cases (55%) returned to soundness, with only 15/49 (31%) returning to intended use. There were no significant associations between outcome and clinical features or treatment.

Main limitations: There was no comparative “gold standard” to validate lesions such as high-field MRI or histopathology.

Conclusions: In contrast to previous studies, ODSL and SDSL injuries were readily identified ultrasonographically using appropriate views, and with sMRI. Given the limited availability, cost and general anaesthetic risks associated with high-field MRI, more focus should be placed on optimising the ultrasonographic examination. Owners of affected horses should be informed of the guarded prognosis for return to full use.