A review of the equine suspensory ligament: Injury prone yet understudied

The suspensory ligament (SL) is a key component of the elaborate and highly adapted suspensory apparatus in the horse. In addition to contributing to stabilisation of the metacarpophalangeal joint, the SL has a spring like function to reduce the energetic cost of locomotion. Although the SL is highly prone to injury in horses of all ages and competing in a wide range of disciplines, knowledge regarding fundamental structure-function relationships in the SL is lacking, particularly compared with other injury-prone tendinous structures such as the superficial digital flexor tendon. In this review, we discuss current knowledge of SL composition, structure and mechanical properties and describe the epidemiology, aetiology and pathophysiology of injuries. We evaluate different diagnostic approaches and treatment modalities and identify key areas for future research.