Suspensory Ligament Injury in Horses – 2025 Vet Guide to Hindlimb Disease & Treatments 🐴🦵🧬
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Suspensory Ligament Injury in Horses – 2025 Vet Guide to Hindlimb Disease & Treatments 🐴🦵🧬
By Dr Duncan Houston, BVSc
What is the Suspensory Ligament? 🧠
The suspensory ligament is a key structure in your horse's leg, running from just below the knee or hock down to the fetlock. It acts like a strong elastic band, supporting the fetlock joint during weight-bearing. Damage to this structure—especially in the hindlimb just below the hock—can seriously affect performance. 🏇
Hindlimb Suspensory Ligament Disease: Overview 🔍
Horses with suspensory ligament disease in the hindlimbs may show clear lameness—or they may simply underperform. This condition involves inflammation and compression of the ligament in an area where there's little room for swelling. As inflammation builds, the ligament compresses adjacent nerves, causing chronic pain and poor biomechanics.
Symptoms of Suspensory Ligament Injury 🚨
- Unilateral or bilateral hindlimb lameness
- Poor performance without clear lameness
- Stiffness in hind end, especially in collection
- Resistance during transitions, especially canter
- Dragging or toe-stabbing hind gait
How It’s Diagnosed 🧪
1. Clinical Lameness Exam
- Flexion tests and palpation of the limb
- Observation during trot and lunging
2. Nerve Block (Perineural Anesthesia)
- Desensitizes the affected area to confirm pain source
3. Ultrasound Imaging
- Compares affected ligament to the other leg
- Assesses fiber alignment and core lesions
4. MRI (if needed)
- Detailed view of soft tissue and bone
- Used when ultrasound findings are unclear
Why Rest Alone Isn’t Enough 😓
Historically, rest was the go-to treatment. But data shows that only 14% of horses treated with rest alone return to performance for a full year. The confined anatomy of the hindlimb suspensory area prevents inflammation from resolving easily, and pain can persist even after months of rest.
Treatment Options in 2025 🧰
1. Shock Wave Therapy ⚡
- Used to stimulate healing and reduce inflammation
- Effective in about 40% of cases
2. Surgical Treatment: Neurectomy + Fasciotomy 🏥
- Neurectomy: Cuts the nerve transmitting pain from the ligament
- Fasciotomy: Opens the tissue to relieve pressure on the ligament
In a study of 92 horses with hind suspensory ligament disease, 78% returned to previous work levels for at least one year after surgery—making it the most effective known treatment to date.
3. Regenerative Therapies 🌱
- Platelet-rich plasma (PRP) – May support collagen repair
- Stem cells – Still under research for effectiveness in suspensory injuries
Prognosis 📊
- Without surgery: low return to function
- With shockwave only: ~40% success rate
- With neurectomy/fasciotomy: up to 78% resume athletic work
Case Study: Dressage Gelding with Chronic Lameness 🐎
- 12-year-old Warmblood gelding, Grade 2 hindlimb lameness
- Ultrasound revealed fiber disruption in hind suspensory ligament
- Initially rested with NSAIDs and shockwave – limited improvement
- Underwent neurectomy/fasciotomy on both hind limbs
- Returned to FEI-level performance after 7 months of rehab
FAQs About Suspensory Ligament Disease 💬
Q: Can horses return to jumping or upper-level work?
A: Many can with surgery and rehab, but long-term management is essential.
Q: Is this more common in certain breeds?
A: Yes—Warmbloods, Thoroughbreds, and sport horses under high workload are more at risk.
Q: How do I prevent this condition?
A: Proper conditioning, avoiding overwork on hard ground, and early detection of performance issues are key.
Conclusion
Suspensory ligament disease in the hindlimbs is one of the more challenging lameness conditions to treat in sport horses. In 2025, surgery remains the most successful option when conservative therapies fall short. The key is early diagnosis and tailoring treatment to your horse’s discipline, age, and athletic goals. 🧬💪
Have concerns about your horse’s hind end? Connect with Dr Duncan Houston on the AskAVet.com app 📱 for expert consultation, lameness guidance, and personalized recovery plans to keep your horse sound and successful. 🐴
