Ex vivo evaluation of an alternative technique for resection of the proximal manica flexoria in horses

OBJECTIVE: To describe and evaluate an alternative technique for tenoscopic resection of the manica flexoria (MF). STUDY DESIGN: Descriptive study. SAMPLE POPULATION: Equine cadaver forelimbs and hind limbs (n = 36). METHODS: Three surgeons varying in experience resected the MF in 12 limbs. The procedure was divided into six steps, including resection of the lateral/medial borders of the MF with a hook knife and resection of the proximal border with a micro scalpel. Outcomes compared between surgeons included completeness of resection, appearance of the margins of resection, appearance of the resected MF, collateral damage, and time required for resection. RESULTS: The MF was successfully resected in all specimens, with a median time of 14 minutes 54 seconds (range, 6 minutes 42 seconds to 43 minutes 33 seconds). Nineteen of 36 MF were categorized as symmetric, 11 of 36 MF were categorized as mildly asymmetrical, and six of 36 MF had unequal borders. No differences were detected between surgeons regarding the appearance of the MF and number of iatrogenic lesions. Five lesions were considered potentially clinically relevant; three were caused by the arthroscope in the scutum (1) and the deep digital flexor tendon (DDFT; 2), and two consisted of DDFT damage caused by the microscalpel. CONCLUSION: The MF was successfully and symmetrically resected with minimal damage to adjacent structures by surgeons with varying levels of experience. CLINICAL SIGNIFICANCE: The results of this study provide evidence to justify further evaluation of the technique described here in live horses with rupture of the MF.