Tendon and Ligament Injuries: Improving the Outcome

Tendon and ligament injury in horses causes both economic and personal hardship for horse owners and industry professionals. A prolonged period of layup and rehabilitation is necessary, but whether the horse will be sound at the end of the rehabilitation period is uncertain.
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Tendon and ligament injury in horses causes both economic and personal hardship for horse owners and industry professionals. A prolonged period of layup and rehabilitation is necessary, but whether the horse will be sound at the end of the rehabilitation period is uncertain. Lameness due to tendon and ligament injury is common in performance horses, affecting up to 25% of racehorses over a career and accounting for up to 43% of injuries in event horses, but it is also common to companion horses. Chronic lameness often follows the initial injury, with recurrence as high as 80% of racehorses with tendinitis.

Tendons connect muscle to bone, providing elasticity and increasing both gait efficiency and support to the lower limb alignment. Ligaments connect bone to bone, giving structural support for joints and maintaining suspension of the fetlock joint as part of the suspensory apparatus in the horse. Tendon and ligament injury can be classified into three categories: traumatic laceration or rupture; acute inflammation with swelling and pain (tendinitis); and a more subtle degenerative injury due to a failure to heal due to repetitive damage.

The connective tissues from which tendons and ligaments are made are closely related. The highly organized structure of tendon enables it to be both strong and elastic. The cells within tendon produce the extracellular matrix that is organized into the fibers responsible for tendon’s unique mechanical properties. The tendon fibers are made of the protein collagen (predominately type I). The collagen forms long interlaced fibers in the same alignment with the tendon length, but the fibers also have a pleated pattern termed “crimp” that, like a spring, gives elasticity to the tendon.

When a tendon is injured, tendon fibers are ruptured or degraded by the inflammation. Attempts at healing frequently fall short of the exact structure of normal tendon. Abnormal orientation, size and organization of the collagen fibers that replace the original structure have less strength and elasticity. This is thought to increase the risk of re-injury once the healing process is over

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