Tenoscopic surgery for treatment of lacerations of the digital flexor tendon sheath

Abstract

Reasons for performing study: Lacerations to the digital flexor tendon sheath (DFTS) are a common injury in the horse, but little information is available in the literature regarding prognostic indicators.

Objective: To ascertain whether laceration of the DFTS carried a better prognosis if treated by tenoscopic lavage, debridement and repair within 36 h of the original injury.

Methods: A retrospective analysis of 39 horses treated surgically for lacerations to the DFTS was performed over a 3 year period. The injury-to-surgery interval was recorded as <36 or >36 h. The structures damaged by the injury were also recorded, as well as age, sex, use and outcome.

Results: Sixteen horses had laceration and contamination of the DFTS alone, of which 15 (94%) returned to their original or intended use. Sixteen horses had lacerations involving the superficial digital flexor tendon, of which 12 (75%) made a full recovery. Six horses had lacerations to both superficial and deep digital flexor tendons, 5 were subjected to euthanasia intraoperatively and one is paddock sound. Treatment within 36 h of initial laceration carried a significantly better prognosis for return to intended athletic use (25 of 28 horses allowed to recover from anaesthesia) than treatment after 36 h (2 of 5 P = 0.03; Fisher's Exact Test).

Conclusions: If sepsis is treated early using tenoscopic visualisation, lavage and repositol antibiotics, the limiting factor in return to athletic function is tendon damage.

Potential relevance: This study supports anecdotal evidence that early treatment of synovial sepsis improves the prognosis for return to intended use. It also provides information on prognostic indicators including extent of damage to collateral structures.