Does communication between tendon sheath and navicular bursa persist following navicular bursoscopy via the T‐ligament?

Summary Background Navicular bursoscopy via the T‐Ligament is widely used in equine surgery because it reduces the risk of iatrogenic injury and improves visualisation of the navicular bursa (NB). The distal interphalangeal joint (DIP) may also be entered during T‐ligament dissection via its palmar recess. However, postoperative persistent communication between the digital tendon sheath (DFTS), NB and/or DIP has not been confirmed in vivo. Objective To examine whether communication between the DFTS, NB and/or DIP persists postoperatively and to evaluate whether clinical, MRI or surgical factors are associated with its persistence or loss. Study design Retrospective clinical study. Methods 27 forelimbs from 16 horses undergoing navicular bursoscopy via the T‐ligament were included. All limbs had DDFT lesions and/or navicular bone pathology, no synovial sepsis and postoperative DFTS treatment. Clinical records, intraoperative findings and long‐term data (>12 months) were evaluated. Postoperative (>5 days) DFTS tenography assessed accumulation of contrast medium within the NB/ DIP. Data were analysed descriptively and statistically ( p < 0.05). Results Intraoperatively, the NB was confirmed to be open in all 27/27 (100%) forelimbs; 21/27 limbs (77.8%) had DIP opening. Postoperatively, accumulation of contrast medium within the NB was observed on DFTS tenography in 12/27 (44.4%) forelimbs; whereas no communication was detected in the remaining 15/27 (55.6%) forelimbs, with loss of communication first detected between postoperative days 5–10. In forelimbs with DIP opening, 9/21 (42.9%) showed contrast medium within the NB and 12/21 (57.1%) within the DIP. No significant associations were identified between clinical, MRI or surgical variables and persistence or loss of communication; however, surgery time was significantly associated with outcome ( p = 0.048). At ≥12 months, 9/16 (56.3%) horses returned to their previous or higher level of use. Main limitations Retrospective nature, small sample size. Conclusion DFTS–NB communication loss was evident by 5–10 postoperative days in >50% of forelimbs.