Summary: Reasons for performing study: Constriction of the digital flexor tendon sheath (DFTS) and its contents by the palmar/plantar annular ligament (PAL) is well recognised. However, primary injury of the PAL has not been well documented. Objectives: To describe the clinical features of PAL injury, determine its prevalence with or without subcutaneous fibrosis and/or concurrent injury within the DFTS, and assess response to treatment. Methods: Horses were selected for inclusion based upon clinical features consistent with PAL injury and the presence of a thickened PAL (≥2 mm) verified ultrasonographically. A retrospective analysis of case records from 3 clinics was performed. Details of breed, age and use, and results of clinical and ultrasonographic assessments and response to treatment were recorded. Horses were treated conservatively or surgically by desmotomy of the PAL, with or without tenoscopic evaluation of the DFTS. A telephone questionnaire was performed to assess response to treatment. Results: Seventy‐one horses were included in the study and middle aged or older general purpose riding horses predominated. PAL desmopathy occurred more frequently in hind‐ than in forelimbs. The method of treatment, thickness of the PAL or presence of subcutaneous fibrosis did not significantly affect prognosis; however, <50% of horses were able to return to athletic function. There was a trend for horses with PAL desmopathy alone to have the best outcome. Bilateral thickening of the PAL or concurrent fore‐ and hindlimb injuries had a negative effect on prognosis, as did the simultaneous presence of subcutaneous fibrosis and lesions within the DFTS. Conclusions and clinical relevance: PAL injury is characterised by a convex contour of the palmar/plantar aspect of the fetlock, associated with thickening of the ligament with or without subcutaneous fibrosis. Bilateral PAL thickening is common in older horses, ponies and cobs; however, bilateral PAL enlargement is often present with only unilateral lameness. Treatment methods used in this study did not appear to influence outcome significantly.

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