New Surgical Treatment for Suspensory Injury

Suspensory injuries are common in athletic horses. The suspensory ligament extends down the back of the lower leg from the knee or the hock and lies between the flexor tendons and the cannon bone. There are a number of treatments for injured suspensory ligaments including shock wave therapy, therapeutic ultrasound, injections of corticosteroids or hyaluronic acid into the area surrounding the injured ligament, electromagnetic stimulation, bone marrow injections, and magnetic therapy. Surgery has been used, but generally has not been considered very successful. Enter a new surgical technique called fasciotomy (fascial release or ligament splitting).

Nathaniel White II, DVM, MS, Dipl. ACVS, Chief of Surgery at the Marion DuPont Scott Equine Center in Leesburg, Va., has been doing this surgery on suspensory ligament injuries for a couple of years. His technique is similar to tendon splitting. In most cases, front limb suspensory injuries or injuries of the suspensory ligament branches in the front and rear limbs will heal with rest and rehabilitation, but in the region of the suspensory attachment to the cannon bone or suspensory ligament, surgery might be beneficial.

If you look at these lesions under the microscope, they have dense scars. These either lack blood vessels and have no healing of the damaged ligament fibers, or they have areas of proliferating cells attempting to heal the injury, he explains.

"When the injury occurs where the suspensory attaches to the sesamoid bone in either the front or rear limb, the damage is resistant to healing," he says. "We've been able to treat horses with chronic problems (that would not heal, sometimes for more than a year) with the splitting technique, and have the suspensory heal. We use ultrasound to guide the blade directly into the damaged ligament, and we also scrape or puncture along the bone where it attaches. This stimulates the growth of blood vessels into the tissue by opening up that area and stimulating new cells from the ligament to form new fibers.

"Since the horses do well afterward, we assume that we've been able to get new blood supply and new healing," adds White. "It also appears as if there is new attachment of the tendon back to the sesamoid bone during the healing process.

"We've also done this on cases of high suspensory injury in the rear leg, where it attaches to the cannon bone just beneath the hock. We don't have the results from all the treated horses in yet, but we started doing this about two years ago and have had horses return to complete soundness. We've had horses back in Grand Prix jumping competition, so we feel the technique is valid," says White.

This surgical technique often is used with older injuries--the cases that have not healed with rest. "We have done some that were a couple of months old to as long as a year after their initial injury, and have had success. I think this technique can be an alternative to some of the other treatments. We are following these horses carefully, and hope we have some final results soon. We haven't had any re-injuries on the ones we've done, so this is pretty encouraging," he says.

He stresses that this does not speed up healing. "When people read about a new technique, they often think that it will make the injury heal faster. This technique does not speed it up; it still takes just as long to have these horses heal and get back into work--usually at least six months and sometimes longer. But we feel the end result is better."

About the Author

Heather Smith Thomas

Heather Smith Thomas ranches with her husband near Salmon, Idaho, raising cattle and a few horses. She has a B.A. in English and history from University of Puget Sound (1966). She has raised and trained horses for 50 years, and has been writing freelance articles and books nearly that long, publishing 20 books and more than 9,000 articles for horse and livestock publications. Some of her books include Understanding Equine Hoof Care, The Horse Conformation Handbook, Care and Management of Horses, Storey's Guide to Raising Horses and Storey's Guide to Training Horses. Besides having her own blog,, she writes a biweekly blog at that comes out on Tuesdays.

Stay on top of the most recent Horse Health news with FREE weekly newsletters from Learn More