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PubMedDate not supplied

The role of the anterior longitudinal ligament in Harrington rod fixation of unstable thoracolumbar spinal fractures.

This study was carried out to identify the role of the anterior longitudinal ligament in Harrington distraction rod fixation of the unstable spine, and to suggest clinical means of detecting a ruptured ligament when this is not obvious from a preoperative radiogram. In the unstable thoracolumbar spine, a marked difference in force is required for distraction and stabilization when the ligament is intact compared with when the ligament is disrupted. This can be detected by using a force-indicating distractor during the procedure. Furthermore, when the anterior longitudinal ligament is disrupted, the pattern of vertebral movements during distraction is altered. With the ligament intact, the vertebrae adjacent to the unstable segment will angulate around an axis situated ventral to the vertebral bodies, while the vertebrae will move apart in parallel planes when the ligament is severed. This can easily be detected by studying the movements of Kirschner wires inserted into the spinous processess.

Adult↗
PubMed1987

The biomechanical functions of the iliolumbar ligament in maintaining stability of the lumbosacral junction.

The iliolumbar ligament is one of the three lumbopelvic ligaments. Recent study has shown that the ligament is not present at birth and is formed from metaplasia of the quadratus lumborum muscle at the end of the first decade. To study the biomechanical functions of this ligament, an apparatus was developed using linear variable differential transformers. Twenty fresh cadaveric specimens of the lumbosacral pelvis were tested. The flexibility of the intact lumbar segment was studied before and after the ligaments were divided. Flexion of L5 on S1 was mainly controlled by the posterior band and lateral bending by the anterior band of the ligament. When the L5-S1 disc was degenerated, total division of the ligaments reduced extension during loading. Its effect on torsion was not evident from this study.

Adolescent↗
PubMed1990

Histology of the alar and transverse ligaments.

Seven sets of human transverse and alar ligaments, after tensile testing, and eight corresponding ligaments without testing, were examined histologically with respect to their fiber composition and fiber orientation. Various staining techniques were supplemented by polarized light microscopy. Both the transverse and the alar ligaments consist of collagen fibers, with very few elastic fibers in the peripheral layer. In the central portion of the transverse ligament, the collagen fibers cross each other at an angle of approximately 30 degrees. Close to the dens, the transverse ligaments show on their ventral side a transition into fibrocartilage. Except for the immediate site of failure, no differences became evident between tested specimens and controls. The collagen, as the almost exclusive constituent, together with the fiber orientation determine the mechanical properties of these ligaments. This supports the hypothesis that the ligaments could be irreversibly overstretched or even ruptured when the head is rotated and, in addition, flexed by impact trauma, especially in unexpected rear-end collisions.

Aged↗
PubMed1992

Immunohistochemical demonstration of bone morphogenetic protein-2 and transforming growth factor-beta in the ossification of the posterior longitudinal ligament of the cervical spine.

To clarify the mechanism of ossification of the posterior longitudinal ligament, immunohistochemical localization of bone morphogenetic protein-2 and transforming growth factor-beta was examined using surgical specimens of ligament tissues from an affected patient. Two polyclonal antibone morphogenetic protein-2 antibodies and an anti-human transforming growth factor-beta antibody were used as primary antibodies. Bone morphogenetic protein-2 and transforming growth factor-beta were present in ossified matrix and chondrocytes of adjacent cartilaginous areas of ossification of the posterior longitudinal ligament. Although immunostaining with antibone morphogenetic protein-2 antibodies also was observed in mesenchymal cells with fibroblastic features in the immediate vicinity of the cartilaginous areas, no staining could be detected with anti-human transforming growth factor-beta antibody in these cells. The presence of these factors were specific for the ossified ligament because no immunostaining was observed after using antibodies in the posterior longitudinal ligament at unossified levels from the same patient. It is suggested that bone morphogenetic protein-2 and transforming growth factor-beta play important roles in the development of ossification of the posterior longitudinal ligament and that bone morphogenetic protein-2 may act as an initiating factor in the development of ossification of the posterior longitudinal ligament by stimulating differentiation of mesenchymal progenitor cells. Transforming growth factor-beta may stimulate bone formation at a later stage of the process of ectopic ossification.

Aged↗
PubMed1995

The nature and distribution of the innervation of human supraspinal and interspinal ligaments.

STUDY DESIGN: To use fresh, human supraspinal and interspinal ligaments and document their innervation. OBJECTIVES: To characterize the innervation of the human supraspinal and interspinal ligaments. SUMMARY OF BACKGROUND DATA: The nature and distribution of the innervation of spinal ligaments remains unknown. METHODS: Sections of spinal ligaments were labeled with a fluorescent antibody against neurofilament proteins and observed with a confocal microscope. RESULTS: The ligaments were found to be well innervated. Innervation was equally distributed along the ligament, symmetrically distributed between left and right sides, and more densely distributed in the periphery. Pacinian corpuscles were scattered randomly, close to blood vessels, whereas Ruffini corpuscles were in the periphery, close to the collagen bundles. CONCLUSIONS: Human supraspinal and interspinal ligaments are well innervated. This innervation might form the basis of neurologic feedback mechanisms for the protection and stability of the spine. These mechanisms might also be important in the development of diseases such as scoliosis.

Adult↗
PubMed1995

Long-term follow-up evaluation of surgery for ossification of the posterior longitudinal ligament.

STUDY DESIGN: We compared anterior and posterior surgery for cervical myelopathy resulting from ossification of the posterior longitudinal ligament. Surgical techniques, based on shape and distribution of ossification of the posterior longitudinal ligament, were divided into four technical phases. OBJECTIVES: Long-term follow-up data on anterior and posterior surgery were analyzed to establish guidelines for surgical treatment. SUMMARY OF BACKGROUND DATA: Comparison of anterior and posterior surgery is difficult because surgical techniques, ossification of the posterior longitudinal ligament shape classifications, and surgical criteria varied. No reports have accurately assessed spinal changes over a 10-year follow-up period. METHODS: Fifty patients received anterior surgery and 65 received posterior surgery between 1968 and 1993. Assessment after surgery was based on the recovery rate using the scoring system of the Japanese Orthopaedic Association. Spinal changes in the anterior group were assessed radiographically. RESULTS: Recovery and final results improved with phase after anterior, but not posterior, surgery. Neurologic deterioration after initial recovery was lower for the anterior group. One third of patients in the anterior group followed for more than 7 years exhibited neurologic deterioration, with most showing these changes within 10 years. Worsening was attributed to insufficient removal of lateral, superior, or inferior ossification of the posterior longitudinal ligament, reossification at the excision site, kyphotic malalignment, growth of ossification at upper cervical levels, or untreated complicated hypertrophy of the posterior longitudinal ligament. Many patients showed a good outcome after surgery. Accurate alignment and long-range fusion improved results. If the cord was compressed in a canal narrowed to under 3 mm, anterior surgery was considered "too risky." CONCLUSIONS: Complete extirpation of ossification of the posterior longitudinal ligament as confirmed by ultrasonography during surgery and long-range fusion with fibular grafts is advocated in the management of ossification of the posterior longitudinal ligament.

Follow-Up Studies↗
PubMed1996

Iliolumbar ligament insertions. In vivo anatomic study.

STUDY DESIGN: Using magnetic resonance imaging, this study analyzed the anatomic characteristics of the iliolumbar ligament insertion on humans. OBJECTIVES: To resolve certain anatomic questions about the manner of insertion of the iliolumbar ligament. SUMMARY OF BACKGROUND DATA: The data of the postmortem studies of the iliolumbar ligament are controversial because of the number, complexity, and variability of the structures present in the lumbosacral region. METHODS: Twenty-eight iliolumbar ligaments of 14 adult volunteers were analyzed with magnetic resonance imaging. The images were acquired along the transversal planes (from inferior to superior) and coronal planes (from the ventral to the dorsal) of the lumbosacral region. RESULTS: The anterior band of the iliolumbar ligament (broad and flat) originates from the anterior-inferior-lateral part of the L5 transverse process and expands as a wide fan before inserting on the anterior part of the iliac tuberosity below the posterior band. The posterior band of the iliolumbar ligament originates from the apex of the L5 transverse process and is thinner than the anterior with a round section, and it inserts on the iliac crest (from the anterior margin to the apex). CONCLUSIONS: The minor width of the area of insertion on the iliac crest of the posterior band (and therefore its lower resistance with the mechanical overloads) could explain the frequency of the painful syndromes related, by some authors, to an enthesopathy of this ligament.

Adult↗
PubMed1997

Long-term follow-up study of anterior decompression and fusion for thoracic myelopathy resulting from ossification of the posterior longitudinal ligament.

STUDY DESIGN: This was a retrospective study of the results of anterior decompression and fusion in patients with thoracic myelopathy secondary to ossification of the posterior longitudinal ligament with a minimum follow-up time of 5 years. OBJECTIVES: To clarify the effectiveness and limits of anterior decompression and fusion for thoracic ossification of the posterior longitudinal ligament. SUMMARY OF BACKGROUND DATA: Posterior decompression for the surgical management of thoracic ossification of the posterior longitudinal ligament has had an uncertain success record. Anterior decompression and fusion have been considered the treatment of choice however, there are few reports describing the long-term results. METHODS: The participants in this investigation were 33 patients whose cases were followed for an average period of 8 years and 2 months. The factors that were investigated included changes in the Japanese Orthopedic Association score and in recovery rates, postoperative complications, and radiographic findings of bone union and progression of ossification of the posterior longitudinal ligament within the area of anterior decompression. RESULTS: Although the recovery rates were relatively stable from 1-5 years after surgery, the rates declined thereafter. The average recovery rate at the final follow-up visit was 53.2%. Postoperative complications included three cases of deterioration of thoracic myelopathy and four cases of extrapleural cerebrospinal fluid leakage. Except for the one case of deterioration of thoracic myelopathy, the remainder of the complications were transient. CONCLUSIONS: Anterior decompression and fusion is an effective surgical procedure for thoracic ossification of the posterior longitudinal ligament with good, stable, long-term results; when thoracic ossification of the posterior longitudinal ligament was extensive or coincident with ossification of the intraspinal ligament, however, the results were not as predictable.

Adult↗
PubMed2001

Mechanosensitive afferent units in the lumbar posterior longitudinal ligament.

STUDY DESIGN: The mechanosensitive afferent units in the lumbar posterior longitudinal ligament were investigated in an animal model using an electrophysiologic technique. OBJECTIVES: The objectives of this study were to identify the mechanosensitive receptive fields in the lumbar posterior longitudinal ligament and to investigate their distribution and characteristics. SUMMARY OF BACKGROUND DATA: The lumbar posterior longitudinal ligament has a nerve network originating from the sinuvertebral nerve. These fibers are thin, and most of their terminals are free nerve endings. Some immunohistochemical studies have indicated that they are immunoreactive to calcitonin gene-related peptide and/or substance P, suggesting a nociceptive function. Most of these studies investigated morphologic aspects, and there have been few studies employing electrophysiologic techniques to examine mechanosensitive units. METHODS: We used 13 adult cats. They were anesthetized and then laminectomy was performed. The L5 and L6 dorsal rootlets were draped over a recording electrode. To investigate the receptive fields in the posterior longitudinal ligament, afferent impulses were evoked by mechanical stimulation with a glass probe. When the receptive fields were located, they were stimulated electrically to obtain conduction velocity and were stimulated with a set of 17 nylon filaments to determine their mechanical thresholds. RESULTS: Thirteen units were identified in the lumbar posterior longitudinal ligament. The majority of the units were located around the intervertebral disc level of the posterior longitudinal ligament. The mean mechanical threshold was 47.04 +/- 15.25 g. According to the conduction velocities of the units, 12 units were classified into Group III (0.5-2.5 m/sec) and one unit into Group IV (2.5-20 m/sec). CONCLUSION: Mechanosensitive units classified into Group III or Group IV and with a high mechanical threshold (>7.0 g) were thought to act as nociceptive units. All units identified in this study satisfied these criteria. Our result suggests that afferent fibers from the lumbar posterior longitudinal ligament have a principally nociceptive function.

Afferent Pathways↗
PubMed2002

Anterior decompression for myelopathy resulting from thoracic ossification of the posterior longitudinal ligament.

STUDY DESIGN: A retrospective study was conducted to investigate the anterior decompression and fusion of 12 patients with thoracic ossification of the posterior longitudinal ligament. OBJECTIVE: To evaluate the effect of myelopathy management in which the thoracic ossification of the posterior longitudinal ligament is removed. SUMMARY AND BACKGROUND DATA: Very few reports have described operative treatments for thoracic ossification of the posterior longitudinal ligament. The condition is extremely rare, even in Japan. Consequently, operative procedures for myelopathy resulting this disorder have not been established. METHODS: This study involved 12 patients with thoracic ossification of the posterior longitudinal ligament. All the patients underwent direct removal of the ossification and spinal fusion using an anterior approach. A scapula-releasing technique was used in five patients who had major ossification of the posterior longitudinal ligament at Th4. The follow-up period ranged from 2.5 to 10 years (mean, 6.5 years). The clinical effect of the decompression was evaluated with a Japanese Orthopedic Association score for cervical myelopathy. The efficacy of the decompression was determined by postoperative computed tomography scan. RESULTS: Complete removal of the ossification was achieved in eight patients. In four patients, however, residual ossification was noted. The Japanese Orthopedic Association score before the operation ranged from 4 to 7 points (mean, 5.3 +/- 0.4 points). It showed a change 3 months after the operation, ranging from 1 to 8 points (mean, 6.9 +/- 0.5 points). At 1 year after the operation, it had changed to a range of 1 to 10 points (mean, 7.2 +/- 0.6 points). At the final consultation, it had changed further to a range of 1 to 10 points (mean, 6.9 +/- 0.5 points). Patients whose ossification was not completely removed showed severe or minor postoperative deterioration. CONCLUSIONS: Total removal of the ossification might be required to manage severe myelopathy in patients with thoracic ossification of the posterior longitudinal ligament. Complete removal of the ossification gave good results in eight patients. Patients whose ossification of the posterior longitudinal ligament had not been completely removed, however, had a poor outcome.

Adult↗
PubMed2002

Does the morphology of the iliolumbar ligament affect lumbosacral disc degeneration?

STUDY DESIGN: An anatomic study of the iliolumbar ligament was performed in association with lumbosacral disc degeneration. OBJECTIVES: To determine whether the morphology of the iliolumbar ligament contributes to lumbosacral disc degeneration. SUMMARY OF BACKGROUND DATA: There have been few reports concerning the clinical significance of the iliolumbar ligament. METHODS: We dissected 25 male and 27 female cadavers and measured the length and cross-sectional area of the anterior and posterior bands of the iliolumbar ligament. The specimens were classified into three groups based on the grade of L4-L5 and L5-S1 disc degeneration: the L4-L5 disc was more degenerated than the L5-S1 disc (group L), the L4-L5 disc was less degenerated than the L5-S1 disc (group S), and both discs were equally degenerated (group E). The results were statistically compared among the three groups. RESULTS: The length of the posterior bands and the summation of the length of the anterior and posterior bands were significantly shorter in group L than in group S, and the cross-sectional area of the posterior bands and the summation of the cross-sectional area of the anterior and posterior bands were significantly larger in group L than in groups S or E in the male cadaver specimens. CONCLUSION: If the iliolumbar ligaments (especially the posterior band of the ligament) of a male patient are short and have a large cross-sectional area, the lumbosacral junction can be stabilized by the ligaments, with the L5-S1 disc being protected from degeneration. The L4-L5 disc may be prone to degeneration.

Adult↗
PubMed2002

Feasibility of ultrasound examination in posterior ligament complex injury of thoracolumbar spine fracture.

STUDY DESIGN: A prospective study of 12 patients with thoracolumbar spinal fractures was conducted. OBJECTIVE: To assess the feasibility of ultrasound examination for posterior ligament complex injury in thoracolumbar spinal fractures. SUMMARY OF BACKGROUND DATA: In posterior ligament complex injury of thoracolumbar spine fracture, the reliability of magnetic resonance imaging (MRI) for diagnosis has been reported. Nevertheless the usefulness of ultrasound for diagnosis has not been studied, whereas diagnostic ultrasound has been applied in the musculoskeletal system. METHODS: Two healthy volunteers without a history of spinal trauma were recruited for pilot examination of the ultrasound procedure to access normal findings of the posterior ligament complex. This study investigated 12 thoracolumbar spine fractures. Four were flexion distraction injury; six were stable or unstable burst fractures; and two were simple compression fractures. Osteoporotic spine fractures were excluded from this study. Ultrasound was performed over the injured area by an experienced musculoskeletal radiologist in addition to radiography and MRI. Five patients underwent operative procedures to stabilize the fractured spine. Imaging data and operative findings were correlated with ultrasound examination. RESULTS: In the patients who did not undergo surgery, agreement in diagnosis between MRI and ultrasound was moderate (5 of 7). Difficulty evaluating ligament status was encountered when the region of interest was the lower thoracic level (T10, T11, T12) because of long overlapping spinous processes. In the patients who underwent surgery, correlation between MRI, ultrasound, and operative findings was excellent, especially in diagnosing the status of the supraspinous and interspinous ligaments. Nevertheless, it is impossible to visualize deep-seated structures (i.e., ligamentum flavum, deep muscles of the spine, and facet joint) with ultrasound. CONCLUSIONS: This study demonstrated the excellent diagnostic ability of ultrasound to detect the status of the supraspinous and interspinous ligaments, especially in patients who undergo surgery. Although ultrasound examination appears to be less sensitive than MRI in predicting ligament status, the cost effectiveness of ultrasound and its use as an alternative to MRI in special situations (i.e., patients with pacemaker, ferromagnetic implant, or severe claustrophobia) should be emphasized. More clinical data concerning the sensitivity, specificity, and accuracy of ultrasound examination should be addressed in future studies.

Adult↗
PubMed2002

The anterior and superior malleal ligaments in otosclerosis: a histopathologic observation.

HYPOTHESIS: The aim of this study was to assess, in otosclerosis, whether the anterior and superior malleal ligaments show histologic changes that can lead to reduced malleal mobility and eventual fixation, and also to evaluate whether these changes are related to the degree of histologic otosclerosis. BACKGROUND: Fixation of the malleus seems to be one of the most controversial clinical entities in the acquired condition of otosclerosis. It has even been postulated that persistent conductive deafness, or progression of conductive deafness after initial improvement after stapedotomy, could be due to unsuspected malleus fixation. METHODS: Fifty eight temporal bones with known otosclerosis and 43 normal temporal bones were selected. In addition, 10 temporal bones of fetuses and children were also studied. Otosclerosis of the footplate and otic capsule was graded as none, mild, moderate, and severe. The histologic changes in the ligaments also were graded from none to severe. RESULTS: The median ages of patients in the otosclerotic and normal groups were 62 and 60 years, respectively. In the anterior malleal ligament of the otosclerotic bones, 10% mild (+), 60% moderate (++), and 30% severe (+++) degrees of hyalinization were observed. In the anterior malleal ligament of the nonotosclerotic bones, 14% showed no hyalinization, 24% had only a tinge of hyalinization (minimal), 51% had mild (+) hyalinization, and 11% had moderate (++) hyalinization. Superior ligament hyalinization appears to be related to the severity of anterior ligament hyalinization. The severity of otosclerosis in the footplate or the otic capsule did not appear to be related to the severity of hyalinization. CONCLUSION: From this study, it is apparent that otosclerotic bones have a significantly high incidence of hyalinization of the anterior malleal ligament. This seems to be related to the duration rather than the severity of otosclerosis. It is important to properly evaluate malleal mobility during all stapes surgery.

Adult↗
PubMed2003

Significance of bone formation markers in patients with ossification of the posterior longitudinal ligament of the spine.

STUDY DESIGN: Serum concentrations of bone formation markers were correlated with the type, location, and progression of ossification of the posterior longitudinal ligament. OBJECTIVE: To determine the relation between bone formation markers and ossification of the posterior longitudinal ligament. SUMMARY OF BACKGROUND DATA: Few reports have correlated bone formation markers with ossification of the posterior longitudinal ligament. METHODS: In this study, 43 patients with cervical ossification of the posterior longitudinal ligament and myelopathy underwent laminoplasty. The patients were observed for more than 10 years, after which plain radiographs and tomograms of the cervical region were taken. The radiographs were selectively performed to address thoracic and lumbar ossification of the posterior longitudinal ligament. Serum concentrations of bone formation markers (intact osteocalcin, osteocalcin, carboxyterminal propeptide of human type 1 procollagen, and bone-specific alkaline phosphatase) were measured and correlated with these radiographic studies. RESULTS: A positive correlation was observed between intact osteocalcin, osteocalcin, and carboxyterminal propeptide of human type 1 procollagen in patients with combinations of cervical, thoracic, or lumbar ossification of the posterior longitudinal ligament. CONCLUSIONS: Serum concentrations of intact osteocalcin, osteocalcin, and carboxyterminal propeptide of human type 1 procollagen may reflect the activity of general ectopic bone formation in patients with ossification of the posterior longitudinal ligament.

Aged↗
PubMed2006

Simultaneous reconstruction of medial and lateral elbow ligaments for instability using a circumferential graft.

Reconstructing elbow instability remains a challenging problem. Techniques described have included techniques for the lateral ligamentous complex, including the lateral ulnar collateral ligament, and techniques to reconstruct the medial collateral ligament. We describe a new circumferential technique to reconstruct both the lateral and medial ligament complexes, using 1 circular graft. A hole is drilled through the center of rotation of the distal humerus and through the insertion sites of the medial and lateral ligament complexes. A hamstring tendon graft is passed through the humerus twice to reconstruct the anterior and posterior bands of the medial collateral ligament and sutured onto itself. Endobutton fixation is used to fix the graft on either side of the ulna. The graft is tightened on the lateral and medial sides and fixed into the humerus using interference fit screws. Advantages of the technique described include stabilization of both the medial and lateral ligament complexes with 1 graft. The strength of fixation allows for individual tensioning in all limbs of the reconstruction and the multiple passes of the graft through a single humeral tunnel increasing the strength of the reconstruction. Potential complications could include ulnar nerve damage, recurrent instability, elbow stiffness, and wound breakdown. Complications related to the potential use of a hinged external fixator are not specific to this procedure but can be associated. Early active mobilization can be initiated because of the strong stability provided by the circumferential graft and good fixation.

Contraindications↗
PubMed1996

Interleukin-1 beta and tumor necrosis factor-alpha stimulate synergistically the expression of monocyte chemoattractant protein-1 in fibroblastic cells derived from human periodontal ligament.

The present study demonstrates that interleukin-1 beta (IL-1 beta) and tumor necrosis factor-alpha (TNF-alpha) induce and synergistically stimulate monocyte chemoattractant protein-1 (MCP-1) expression in fibroblasts from human periodontal ligament. IL-1 beta and TNF-alpha induced in a dose-dependent manner the expression of the MCP-1 gene in the fibroblasts from the human periodontal ligament. However, such an inducing effect was not observed with IL-6 and interferon-gamma. The peak expression of the MCP-1 gene by IL-1 beta or TNF-alpha was observed at 3 h after initiation of their treatment. Furthermore, IL-1 beta in combination with TNF-alpha synergistically stimulated the MCP-1 gene expression in the cells. We also observed significant chemotactic activity for human monocytes in conditioned medium of fibroblasts from the human periodontal ligament treated with both cytokines. The stimulated chemotactic activity induced by these cytokines depended on both dose and treatment time. The chemotactic activity in conditioned medium of IL-1 beta-treated fibroblasts from the human periodontal ligament was neutralized by antiserum specific for MCP-1 protein. The MCP-1 gene product in conditioned medium of IL-1 beta-treated fibroblasts from the human periodontal ligament was shown to have a molecular mass of 11,000 Da by immunoprecipitation with the specific antiserum, and IL-1 beta also stimulated synergistically MCP-1 protein expression in combination with TNF-alpha. These results suggest that IL-1 beta and TNF-alpha may contribute to the infiltration of monocytes into inflammatory sites of periodontal ligament tissues via the MCP-1 gene product produced by fibroblasts from the human periodontal ligament.

Chemokine CCL2↗
PubMed1992

The apical ligaments of the penis of the goat and sheep.

The penile apical ligaments of 13 goats and 8 sheep were dissected and described. Unlike the single apical ligament of the bull penis, both goats and sheep had one ligament on each side of the apex of the penis with no apparent connection over the dorsal surface. These lateral apical ligaments consisted of substantial connective tissue fibers that arose from the outer layers of the tunica albuginea and varied from 6.0 to 10.0 cm in length. The left apical ligament was longer and thicker than the right. The left apical ligament of the sheep penis was divided into a dorsal and a ventral branch. Both the goat and sheep possessed flattened perivenous ligaments that originated from the apical fascia and extended caudally along each side of the dorsal vein of the penis.

Animals↗
PubMed1993

Desmitis of the accessory ligament of the deep digital flexor tendon in the horse: clinical and ultrasonographic features. A report of 24 cases.

The clinical and ultrasonographic features of desmitis of the accessory ligament of the deep digital flexor tendon (carpal check ligament) are reported in a series of 24 horses. Lameness associated with the carpal check ligament especially was found in Warmblood riding horses ranging in age from 6 to 18 years with a mean age of 11.3 years. The most striking clinical feature was a firm, painful swelling medially and laterally in the proximal and/or mid metacarpal region, corresponding with the dorsoproximal-palmarodistal oblique direction of the carpal check ligament. Sonographically swelling of the carpal check ligament was common, the enlarged ligament mostly showing a type 1-2 texture. Occasionally a more localized lesion with a type 3-4 texture was present. About 40% of the horses also showed additional lesions in (one of three other flexor tendons or ligaments in the metacarpal region. Most horses were treated conservatively, i.e. boxstallrest and/or a controlled exercise regime were applied. From the 19 horses available for follow up (1-36 months), only 3 horses resumed full work. Obviously the prognosis of this injury is guarded.

Animals↗