Four-step tenoscopic technique to resect a torn proximal manica flexoria

Four-step tenoscopic technique to resect a torn proximal manica flexoria while sparing the mesotendons of the deep digital flexor tendon in 30 horses

Vet Surg. 2025 Nov 14. doi: 10.1111/vsu.70057. Online ahead of print.
Authors
Julien Racine 1 , Alexander Ungermann 1 , Marlis Blatter 1 , Guido von Plato 1 , Astrid B M Rijkenhuizen 1
Affiliation

1 Department of Equine Surgery, Pferdeklinik Leichlingen, Leichlingen, Germany.

PMID: 41239776
DOI: 10.1111/vsu.70057

Abstract

Objective: To describe a modified two-portal tenoscopic technique for proximal manica flexoria (MF) resection designed to preserve the mesotendons (MTs) of the deep digital flexor tendon (DDFT).

Study design: Prospective clinical study.

Animals: Client-owned horses (n = 30).

Methods: MF resection was performed in four steps: (1) Transection of the lateral attachment of the MF to the superficial digital flexor tendon (SDFT), staying abaxial to the lateral MT; (2) transection of the medial attachment of the MF to the SDFT between the flexor tendons from distal to proximal until reaching the level of the medial MT; (3) transection of the proximal medial attachment of the MF to the SDFT dorsal to the DDFT; and (4) fixation with a Kocher-Ochsner clamp, followed by rotation to disrupt the areolar tissue and extract the MF. Long-term follow-up (>6 months) was assessed by telephone interview.

Results: Proximal MF tears were located medially in 20/30 (66.7%), laterally in 7/30 (23.3%), and both medially and laterally in 3/30 (10.0%) cases. Hindlimbs were affected in 27/30 (90.0%), and forelimbs in 3/30 (10.0%). Nine of 11 sport horses (81.8%) and 12 of 17 leisure horses (70.6%) returned to the same or a higher level of work.

Conclusion: The MF was successfully resected in all horses irrespective of tear localization.

Clinical significance: This two-portal MF resection technique, described step by step, was developed to further limit surgical trauma with a specific focus on preserving the MTs and thereby maintaining the extrinsic blood supply to the flexor tendons.

© 2025 American College of Veterinary Surgeons.