cutting annular ligament to promote tendon healing

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To cut a long story short!!
10 weeks ago my gelding gashed his hind leg out hunting. Up until now we have been treating it as a 'wound' - but despite box rest bute and several courses of antibiotics, he was still at least 3/10ths lame.
My current vet could not offer any explanations so we had another vet ultrasound him yesterday and gave the worst news possible - damage to the superficial flexor tendon with the scan showing up a small hole and significant disruption in 2 other areas of the fibres.
Initially the vet said that he would have a 40% chance of returning to soundness, but if we considered cutting the 'annular ligament' he would have a lot better prognosis.
Has anyone had experiences of this, good or bad? Also any ideas of costs?
Thanks for reading.
 
I really can't get my head round cutting ligaments. Sorry.

It was an option discussed with my vet for Amy at one point (Annular ligament) but given the questionable success rate it was not persued.

Time, time, time and more time would really be my preferred option.

However, I think I may be a lone voice in my opinions on this.
 
I know of a horse that was treated for the same problem a few years back and had the Annular Ligament cut- John Walmsley did the Op - she was going so much better after the operation and came back to full soundness. Sorry -I don't know how much it was to as the owners insurance paid.
 
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Is Amy still with you?

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No sadly not, I lost her last year. I have the grey horse on my siggy now.
 
Was that due to the tendon injury as I haven't discounted worst case scenario of him being pts. I am afraid that I believe that all horses should have a job and would not consider keeping a permanetly lame horse - not fair on him or me, especially if he was in pain.
 
I have a horse with a similar sounding injury and read about cutting the annular ligament - but my vet said no way, the sucess rate is very low, can lead to other complications. My horse was eventually turned out and now 10 months later is sound and about to start walking.
 
I've known a couple of horses who have had annular ligaments cut, but this was due in both cases to damage to the annular ligament itself initially. I *think* it was done because the damaged ligament can scar/tighten or be inflamed and swollen, in turn putting pressure on the tendon, thus causing further problems. I guess in your case, the vet is saying a similar thing, only the ligament is constricting swelling in the tendon. My own boy had annular ligament problems but fortunately recovered with rest alone. The other two horses are able to be worked lightly, but I think were advised against jumping and fast work (after much box rest and restricted turnout). I do wonder, as AmyMay says, whether time and rest would bring about the same result!
 
my horse had his annular ligaments cut but this was due to damage to the actual ligaments. He did come sound for 6mths but then re-injured it in the field and has now had another year off - he's paddock sound, but I took the decision to retire him and now have a new horse.
 
My horse had her annular ligament cut as she had really bad windgalls and they thought that the ligament was basically strangling the tendon. The windgalls were getting bigger as the tendon was being aggrevated by it. If you can imagine a piece of elastic around your ankle that isnt tight, if you sprained your ankle and it swelled then the elastic would then be restricting. It is a really small operation. She was knocked out for it but the incision is tiny, she had to be walked in hand straight away every day.
I dont know if you are insured but my vet did it for £1000 (not insured)
I have some pics of this post op if you want to PM me with your email address.
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My horse is currently on week 11 of 12 weeks paddock rest for an injury to her annular ligament and her superficial digital flexor tendon, she also had 2 months box rest before that.

We are due to go back to vets on 1st April for scans and further prognosis and my vet has talked about the operation, but only if we haven't managed to get her right by the end of the insurance period. Although to be honest I don't just want her operated on because the insurance is due to run out and would rather give her more time and see what happens and have to pay for the operation myself if necessary in the future.

My understanding though is that the operation itself is quite simple, but isn't always successful. The idea is as someone said above, it releases the constriction of the annular ligament around the fetlock, allowing the leg to swell as much as it needs to, to prevent pressure on other areas.

I think H's mum on here has a mare that has recently had it done and is now being brought back into work, but not sure.

For me, it will be a decision of whether it is right for my mare long term, whether she is retired or in work, not whether it keeps her sound enough to be ridden. She owes me nothing and can be a pasture pet for the rest of her life if that is what has to be.

Saying that, things are tentatively looking good with her.
 
i have to say, although my horse went lame again 6mths later, he is still alive and before he had the op he was so crippled that it was op or PTS so i'm still glad I went for the op even if he's not sound enough to ride. At least he is a happy pasture ornament now.
 
My pony has had an annular ligament desmotamy on 3 legs, the 4th leg, which was the first one she went lame on came right after 6 months rest & loads of physio. She had thickening of the ligament, which was constricting the tendon, she came completely sound, & still is at 18. She continued jumping until a couple of years ago, she is now "retired" to dressage, & still happily competing at elementary. John Walmsley did both ops, one was for a diagonal pair of legs, but he did warn me each time that he wasn't sure how sound she would be, ie dressage sound, but would be fine for hacking. Happily, as I said, she did really well.
 
Where is John Walmsley based as his name has come up a couple of times? The vet that scanned my boy has recommended a hospital in West Yorkshire and am waiting for some more info on it.
Thanks for all your replies so far - still not overly keen on the op but if my vet recommends it as the best chance for recovery, I will give it serious consideration.
 
Yes, he was at Liphook Equine Hopsital in Hampshire, but I'm pretty sure he has since retired to somewhere exotic. I would definately look further into the operation, my own vet who referred me to Liphook was very positive about it, as she felt the pony had little chance of recovery to work without it. & she had experience of other horses who had returned to full work following the surgery. Good luck, let us know how it goes.
 
Seems a little extreme and unsubstantiated. Very severe option fro something that if left alone will eventually heal. This may mean it takes a hell of a lot longer to heal but I really can't understand why anyone would want to cause damage to try and heal damage. Not enough evidence to back it as far as I'm concerned. Everyones opinions differ and you have to do what's right for you, but I would personally be very concerned at using a procedure like this.
 
My pony had an operation to cut the annular ligament a year ago this week. She was 18 years old at the time and had a 9 month history of going lame on and off. She had various scans and x-rays at my locals vets but it was felt that they needed to go into the leg and have a look around as the exact problem wasn't clear form the tests that had been done.

She was referred to Liphook and it was then they I was advised that there may be a problem with the ligament. I had no hesitation in giving them consent to do whatever they felt was in her best interests. Without the operation she would have spent her life in a small turnout pen (as previously had lamininitis) and would have been thoroughly miserable.

She was on box rest following the operation but had to be walked out in hand very early on. A year on and she is sound and back in full work.
 
My previous horse had her annular ligament operated on twice due to problems with the ligament itself. Unfortunately, despite lots of box rest, restricted exercise and later a good six months field rest she never returned to soundness and was put to sleep.
 
My mare's had both her hind leg annular ligaments operated on - first one was operated on in Dec 05 following 7 months of alternative treatments - the second operation happened in June 07 after bringing her slowly back into work she struggled and the decision to operate on her again was made - She's now fully back in work and stronger than ever - she's producing fabulous work and her attitude now that she's comfortable is amazing - The reasoning behind the operation is to relieve tension built up around the tendons - the downside is adhesions can build up after surgery which can result in lameness but we buted and worked her hard to stretch and break down these adhesions - sounds cruel but it was the best thing to do and it's worked... twice!
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Kate x
 
So Monstermunch, how is this procedure "extreme & unsubstantiated" I am pretty sure that John Walmsley, one of the UK's leading surgeons would not have carried out the procedure if this was the case. In my pony's case, the first leg did respond well to 6 months rest, box & field. The second hind leg did not respond at all, there was no improvement & she was very lame, hence the decision to operate rather than leave her in pain. If there is sufficient thickening & scarring of the annular ligament it will not respond to any amount of rest. Perhaps I was just lucky that the outcome was so good, but I carried out the post op instructions on care & exercise to the letter to give her the best chance, & I am glad I did or she would have been PTS long ago, so clearly the decision I took was the best one for us.
 
Montstermunch - I recommend you do your research before posting, as your post is unsubstantiated and incorrect!

If the annular ligament continues to cause problems, it is my understanding from my vet that it will always do so without the operation. The annular ligament isn't like other ligaments and is a lot less flexible, plus once thickened it tends to stay that way. Therefore if a horse gets wind gall type fluid on the leg, it presses down on the thickened ligament which in turn restricts the tendons. The operation cuts the annular ligament releases the restriction.

Rest is in this case not the whole answer. Your post is very judgemental on people who have had this op done on their horses inferring that they haven't wanted to rest them. I am sure that this is not the case and most just want what is best for ther horses.

I assure you that certainly in my case my mare can have as long rest as is recommended, but also if the op is recommended she will have that - whatever is the best route to allow her to be comfortable for as long as possible, in work or out.

H's mum - that's interesting regarding the adhesions and bute/work. This thread has highlighted some good stuff for me for decisions I may have to make in the future. Thanks
 
Good luck doublethyme, yes h's mum is correct about the adhesions, which is why I had to start walking out etc etc quite quickly after the op to try & stop them forming to begin with. I am sure you will be able to make a good decision for you, & hope it works out like it did for me & Meg!
 
Many thanks Kizzywiz - its very heartening to hear positive posts about annular ligament issues, as it has been quite hard to find information on this ligament and the operation.
 
my horse had 4 months of rest before i decided to go for the op. he was getting worse, not better and eventually was in so much pain i couldn't bear to watch him. it was either the op or PTS and i'm very glad he had the op, despite my reservations as he was 20yrs old. he recovered well, followed his in-hand walking schedule to the letter, was sound from day1 for the next 6mths and was back cantering again, before twisting his leg on a rut in the field and flaring everything up again. If he was younger i would have considered having him operated on again, but he was 21 by this stage, hated box rest and i didn't think i fair. i turned him away and we are now a year down the line, he's loving his retirement and if i want to ride him, he's quite capable of gentle hacking. i have no regrets about the op, just wish i'd had a flatter field for his recovery and he wouldn't have twisted the fetlock in a rut. cutting the ligament is a beneficial thing, it's not drastic, extreme and certainly not unsubstantiated! there are many good results from it.
 
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