Suspensory ligament injuries are among the most common soft tissue injuries in equine athletes across all disciplines. Understanding the nature of these injuries, treatment options, and realistic recovery expectations is essential for owners of sport horses.

The sports medicine service brings the examination, imaging findings, and demands of the horse’s discipline together when a suspensory injury is suspected. Read about rehabilitation support for how a return-to-work plan is developed and reassessed.

Anatomy

The suspensory ligament (interosseous muscle) originates at the back of the cannon bone just below the knee (or hock), runs down the back of the leg, and divides into two branches that attach to the sesamoid bones. Its primary role is supporting the fetlock joint during weight bearing.

Types of Injury

Proximal Suspensory Desmitis

Damage to the origin of the ligament, near the knee or hock. This is a common cause of hindlimb lameness and can be challenging to diagnose.

Body Injuries

Tears or inflammation in the main body of the ligament. These are typically identified on ultrasound as areas of fiber disruption.

Branch Injuries

Damage to the medial or lateral branch, often associated with footing conditions and the biomechanics of specific disciplines.

Diagnosis

  • Lameness evaluation with flexion tests
  • Diagnostic anesthesia to localize pain
  • Ultrasound examination — the primary imaging modality for soft tissue evaluation
  • MRI may be recommended through a referral facility when ultrasound does not answer the clinical question

Treatment

Treatment depends on the location and severity of injury:

  • Rest and controlled exercise — commonly part of a case-specific rehabilitation plan
  • Regenerative therapies — PRP or stem cells may be considered in selected cases
  • Shockwave therapy — may be considered in selected cases
  • Corrective shoeing — addressing biomechanical factors
  • Surgery — fasciotomy or neurectomy in selected chronic cases

Prognosis

Return to athletic use varies with the location and severity of the injury, the horse’s discipline, and what follow-up examinations show. A treating veterinarian may adjust the plan as the horse’s comfort, movement, and imaging findings change. Ask for milestones and recheck points tailored to the individual horse instead of relying on a single recovery timeline.