What is the Recovery Rate of a Suspensory Ligament Injury?

Table of Contents

What is the Recovery Rate of a Suspensory Ligament Injury?

Table of Contents

You’re a dedicated horse enthusiast who’s spent countless hours in the saddle, forging a deep connection with your equine partner. Together, you’ve tackled trails, perfected dressage routines, and shared the simple joys of a peaceful ride through the countryside. 

But lately, you’ve noticed something troubling. Your beloved horse, usually so surefooted and strong, is struggling to run and is presenting signs of lameness. After a series of tests, he is diagnosed with an injury to his suspensory ligament. 

How long will it take to recover? Will he ever fully recover? 

Of course, the answer depends on several factors, such as how quickly the injury was detected, the site of the injury, severity and your chosen treatment plan.

But, in short, forelimb injuries tend to have a more favorable prognosis, with around 80% of cases resolving successfully. However, hindlimb injuries pose greater challenges, with fewer than 20% of horses fully recovering. The prognosis for branch injuries is more complicated because of the high incidence of reoccurrence and the slow, unpredictable healing rate.  [1

So, while the prognosis for forelimb suspensory ligament injury is promising, the recovery rate of hindlimb injuries is more concerning. Let’s look at the suspensory ligament and how to prevent injury and aid recovery. 

What is The Function of the Suspensory Ligament?

Ligaments are short, flexible connective tissues that connect bones and hold joints together. They help the horse move. The suspensory ligament is found at the top and back of the cannon bone between the splint bones, running through the fetlock. Its branches attach to the sesamoid bones.

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The suspensory ligament consists of three segments: the proximal portion (origin), the body, and the branches.

The proximal portion – is known as proximal suspensory desmopathy (PSD) and may include damage where the ligament attaches to the cannon bone

The body  the middle third of the suspensory ligament

The branches –  can involve a small lesion that’s contained locally or more widespread tears. 

It performs the following important functions:

  • Supports the weight of the horse: The suspensory ligament helps maintain the stability of the limb by attaching to the back of the cannon bone (the long bone in the lower leg) and branching into two branches that wrap around the back of the fetlock joint. 
  • Acts as a shock absorber:  When a horse moves, the fetlock joint experiences considerable impact. The suspensory ligament helps absorb and distribute these forces.
  • Protects tendons and ligaments: Shields the tendons and ligaments that run along the back of the canon bone from excessive strain and damage.
  • Maintaining flexion: The suspensory ligament also aids in maintaining the correct angle of flexion in the fetlock joint, preventing over-extension. This is essential for the horse’s ability to move comfortably and efficiently.

Recovery Rate Of Suspensory Ligament Injuries

As reported above, the outlook for horses with proximal suspensory lesions varies depending on the affected limbs. Forelimb injuries tend to have a more positive prognosis, with around 80% of cases resolving successfully. However, hindlimb injuries pose greater challenges, with fewer than 20% of horses fully recovering.

Nevertheless, using treatments like shockwave therapy and surgical interventions can improve the chances of an injured horse returning to its previous level of activity. It’s important to note that there’s a significant risk of re-injury if the horse resumes its previous workload. 

Recovery rate of forelimb PSD injuries 

Acute forelimb PSD: Most horses experiencing acute forelimb proximal suspensory desmitis (PSD) show positive responses to rest and controlled exercise lasting between 3 to 6 months. Approximately 80% of these horses regain their functionality during this period. However, you must avoid rushing the return to work, as doing so often leads to the reappearance or persistence of lameness.

Chronic forelimb PSD – In cases of chronic PSD, the rehabilitation process may be prolonged. Some horses might require additional therapies like non-steroidal anti-inflammatory drugs (NSAIDs), shockwave therapy, or regenerative treatments to achieve a consistent level of function for their work. [3]

Recovery rate of forelimb PSD injuries 

Sadly, fewer than 20% of horses fully recover with rest alone. However with surgery, chances of recovery are good at 75%. [4] Each horse is unique and it is best to consult with a veterinarian about a suitable course of treatment. 

Recovery rate of suspensory ligament branch injuries

Desmitis of the Branches of the Suspensory Ligament – Clinical signs can take 6 months or longer to improve, with a possibility of re-injury. The likelihood of re-injury increases where horses are hyperextended in their fetlocks at rest or exhibit significant periligamentous fibrosis around the branch, as seen on ultrasound. However, if one branch is injured, the recovery success rate is good at 80% and approximately 40-60% for both branches.

Please note that recovery rates are only a guideline and will differ for each horse. Factors such as overall horse health, quick diagnoses and severity of the suspensory injury should all be taken into account.

Understanding The Healing Timeline for Ligament Injuries

The healing process for ligament injuries can be a slow journey. A mild strain might require six to eight weeks to heal, while a more severe tear could take up to eight to twelve months. Particularly challenging are high hind suspensory injuries. Due to the complex anatomy of a horse’s hind leg, it’s difficult to accurately monitor the healing progress in this area, making it tricky to determine the right time for your horse to resume work

Diagnoses of a Suspensory Ligament Injury

To diagnose a suspensory ligament injury in a horse, veterinarians employ a combination of clinical assessments and advanced diagnostic tools. They will start with a  gait analysis, where the horse is observed while walking, trotting, or cantering on different surfaces, which can help evaluate movement abnormalities associated with the injury. Palpation of specific areas, including the back and sacroiliac region, helps identify discomfort or pain. However, since suspensory ligaments are deep within the leg, these surface observations may not always provide a definitive diagnosis.

Advanced diagnostic techniques provide a more accurate assessment. Ultrasound imaging is a valuable tool, allowing veterinarians to visualize the ligament’s structure, detect abnormalities such as swelling or fiber disruption, and assess the extent of the injury. Magnetic Resonance Imaging (MRI) offers even more detailed insights into the ligament’s condition, particularly in severe cases. 

Which Horses Are Particularly At Risk?

Dressage horses – The precise and strenuous movements required in dressage training, along with repetitive exercises, place significant stress on a horse’s suspensory ligaments. Moreover, the collection work involved in dressage, which shifts weight to the hind end and flexes joints, increases the load on these ligaments. 

Racing horses – The high-speed galloping and strenuous workouts required in horse racing can strain the suspensory ligament and increase the risk of overuse injuries. Additionally, the hard and often uneven track surfaces can further contribute to the likelihood of ligament issues.

Jumping horses – Repeated jumping, especially over obstacles of varying heights and on firm landing surfaces, and tight turns can stress the suspensory ligaments. 

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Carnosine & injury prevention

Suspensory ligament injuries account for approximately 46% of limb injuries in horses. [2]

And given the potential long-term damage of a suspensory ligament injury, prevention is better than cure. And when it comes to prevention, Carnosine is scientifically proven to improve ligament, joint and muscle health.

But what exactly is Carnosine?

It is a dipeptide naturally found in various tissues within the human and animal body, including muscles, the brain, and the heart, and it is made up of two amino acids: beta-alanine and histidine. 

Related: Is Carnosine the best supplement for performance horses?

How does carnosine help?

First, it helps counter the process of glycation. Imagine glycation as the process that gradually “stiffens” tissues, much like how rubber bands lose their stretch over time. When sugar molecules adhere to proteins, they can reduce the flexibility of tissues, including ligaments and tendons. Carnosine counters this process, helping to maintain the elasticity and functionality of these crucial connective structures.

Second, Carnosine’s role as an antioxidant is invaluable for safeguarding a horse’s body from oxidative stress. Oxidative stress can wreak havoc on cells and is associated with aging and various health issues. Think of carnosine as a protective shield that defends the body against harmful molecules known as free radicals. These free radicals can potentially harm cells, including those within tendons, ligaments, and joints.

So, how can you harness the benefits of carnosine effectively?

While you can increase carnosine levels through dietary choices and supplementation, applying it directly to a horse’s muscles, tendons, and joints is the most direct and efficient way. Consider using a trusted equine gel like Carnogel, which has been tried and tested to support the strength and health of suspensory ligaments.

Ready to enhance your horse’s ligament health with Carnogel? Take the first step towards stronger and more resilient ligaments today. Your horse will thank you for it!

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Risk of Re-injury

It must be emphasized that there is a substantial risk of re-injury if the horse returns to its previous activity level too quickly. Notably, re-injury of the suspensory ligament is more frequently reported in the hind limb compared to the forelimb.

When a ligament undergoes healing, it typically involves inflammation followed by scar tissue formation rather than the restoration of normal ligamentous tissue. Unfortunately, the affected ligament never fully regains the elasticity characteristic of healthy ligaments, which heightens the possibility of re-injury. [5]


The journey to recovery is not only a physical endeavor but also an emotional one. As dedicated horse enthusiasts, we share deep bonds with our equine partners, and witnessing their struggle with injury can be heart-wrenching. In these moments, we are reminded of the importance of prevention.

Take the proactive step today to safeguard your horse’s well-being. Trust Carnogel to support their ligament health and ensure they can continue to thrive in the activities you both cherish. Give your equine companion the gift of strength and resilience. Choose Carnogel for stronger suspensory ligaments and a brighter future together.