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