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  Discussion on Annular Ligament Desmotomy
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New Member:
Chicnini

Posted on Wednesday, Sep 20, 2006 - 3:09 pm:

Dear Dr. O,

My 16 year old mare was operated on 4 and a half weeks ago. She was a bit lame after surgery and every day she was a little better. One week after surgery she was getting worse. I finally had the surgeon come out two weeks after surgery and of course my horse was sound. He was extremely happy with what he saw and I was given the go ahead to start handgrazing. Shortly after I started hand grazing she was a bit "Gimpy" again. I was advised by the surgeon to confine her to the stall for three days with no hand grazing. I did so and she was doing wonderfully after three days. This was one week ago. Today she is gimpy again. All of these ups and downs are really confusing me. I do not know if this is to be expected with this type of surgery. Originally the surgeon told me that she should not be lame at all. But on the other hand he said "Janine, I just cut a major ligament", when I asked why she was limping. When I asked him about complications, he said worst case senerio is infection. He said that the surgery went so smoothly and there really wasnt any reason to worry about adhesion in her case. I am going for a follow up scan on Mon. I know that should tell me a lot, but my question for you is, if adhesion is not a concern and there is no infection, what other complications could I possibly expect with this type of surgery? In your opinion, 4 and a half weeks after surgery, is it normal for a horse to be "gimpy" on and off?

I previously posted under someone else's discussion and I apologize, It was under Palmer Annular Ligament Constriction: Who is at risk?

Thanks
Janine
Moderator:
DrO

Posted on Thursday, Sep 21, 2006 - 5:55 am:

Welcome Janine,
The surgery is not going to fix 100 % of the problems but it is still too early to be concerned. I can only guess, but the cut ligament itself will be painful for a time but also you may be seeing unresolved issues from prior to the surgery. The prognosis for a surgery of this type depends heavily upon the preexisting conditions and severity that necessitates the operation.
DrO
New Member:
Chicnini

Posted on Saturday, Sep 23, 2006 - 7:12 pm:

Dear Dr. O,

I was wondering, if my horse had a pr-existing condition that would have contributed to the annular ligament problem, would that have been seen on an ultrasound? Unfortunately she is still pretty gimpy. I know she does have some arthritis in her fetlock, according to her sergeon she has "very mild changes consistent with osteoarthritis". Her ultrasound prior to surgery revealed that she had "marked thickening, 9cm, of the digital annular ligament with hypoechoic ares within the ligament and digital sheath effusion. The flexor tendons appeared normal". Is it possible that being in the stall for 5 weeks(post surgery today)can be causing her arthritis to flare up and that is why she is "gimpy"? I know I will not know for sure until her ultrasound on Mon., but any information that you can give me is greatly appreciated. With all the research that I have done on this online, I can not find even a little piece of info on what I may expect during a recovery from this type of surgery. I was also curious about what I may expect to hear about an exercise program.


Thank You,
Janine
New Member:
Chicnini

Posted on Saturday, Sep 23, 2006 - 7:13 pm:

If anyone else has had any experience with annular ligament desmotomy I would really appreciate any information that you would share with me.
Moderator:
DrO

Posted on Sunday, Sep 24, 2006 - 8:48 am:

It is problematic describing a typical outcome with this surgery Janine. First there are frequently complications do to damage to other and surrounding structures. The surgery itself is difficult and can result in damage to peripheral structures. As a result there are no "typical" recoveries and prognosis depends on taking all these factors into account.

Janine some of your questions you already know the answer to (can there be...?) and none of the answers to any of these questions answer the important question of, "why your horse is still lame and what can be done about it".

Since this latest bout of lameness has gone on for more than a few days now that you are well over a month out of surgery I would say it does represent a complication of some sort and not part of the regular healing process but the question is what? It sounds like you have a exam scheduled for this coming monday that may answer these questions. But be careful of US lesion interpretation alone, they don't always readily tell you if this is the source and never whether it is the only source of pain. I strongly suggest this be used in combination of regional anesthesia to accurately define where the pain is coming from. For more on this see, Diseases of Horses » Lameness » First Aid for the Lame Horse.
DrO
I do sense your worry and concern and it seems to be coming from uncertainty about the current lameness
New Member:
Chicnini

Posted on Monday, Sep 25, 2006 - 9:31 pm:

Dear Dr. O,

We went to see the surgeon today and I received the following information: "walking sound today (it figures shes been limping for 4 days at the walk and makes a miraculous recovery in a matter of hours, as usual) mildly resents flexion of the LF lower limb, grade 2/5 lame at the trot in a straight line. THere is a hypoechoic area on the lateral aspect of the SDFT with a poor fiber pattern. The annular ligament has been completely transsected."
I was instructed to keep her confined for another 6-8 weeks and then we will re-scan it. I was also told to hand graze her as much as possible, even if she is limping.
My question is, based on the above findings where do you think she falls on the rehab program that you have under Flexor Tendonitis Table 1 Exercise protocol following first exam?
Would this be considered tendonitis? I should have asked her surgeon this, but I always have a hard time remembering these types of questions. I am assuming that based on the US findings in 8 weeks and her lameness at that point, then he will consider blocking her, hopefully her lameness will greatly improve and that will not have to be done.Thank you for all of your help..

Janine
Moderator:
DrO

Posted on Tuesday, Sep 26, 2006 - 7:40 am:

From the information you provide above I would put you in the moderate category after the first exam. But this is after several assumptions including most importantly that the lameness comes from the observed tendon lesion, something we don't know for sure. I am just guessing at the severity from your comments also, helpful would be to know how big this lesion is and how severe the disruption is.

The chart was designed to rehab acute injuries of the flexor tendons, though we do use it for other types of injuries. Your injury is more chronic in nature Janine and complicated by other changes.
DrO
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