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Ultrasonography is a valuable tool for evaluating soft tissue injuries, but accurate interpretation requires an understanding of normal tissue appearance. Changes in tissue structure may be mistaken for disease when they are, in fact, normal variations.
Since tendons and ligaments do not appear well on X-rays, ultrasound is a preferred method for diagnosing soft tissue injuries in horses’ legs. Ultrasonography works by using high-frequency sound waves, which are emitted from a handheld transducer. These waves bounce off different tissues, such as tendons and ligaments, and return to the device to generate a live image on the screen.
When fluid accumulates between tissue fibres, it can disrupt the normal tissue structure. Because fluid does not reflect ultrasound waves, it appears dark on the screen, while tissue fibres, which reflect sound waves, appear as white spots or lines. Fatty tissue has a different ultrasound appearance compared to fibrous tendon and ligament tissue.
Ultrasonography is increasingly used to investigate potential patellar ligament damage in horses. However, researchers question how much variation in ligament appearance is normal.
A team from the Swedish University of Agricultural Sciences in Uppsala, led by Ellen Law and colleagues from the Diagnostic Imaging Clinic and the Department of Animal Biosciences, conducted a study to examine the ultrasonographic appearance of patellar ligaments (PLs) and the patellar fat pad in healthy horses.
The prospective observational study included 116 horses in training—Cavalry horses, Warmbloods, and Standardbred Trotters. To be eligible, the horses had to be in training with no reported lameness or performance issues according to their riders or trainers.
Researchers used B-mode and colour Doppler ultrasound to examine the PLs and infrapatellar fat pad in both hind limbs. They also conducted objective gait analyses on all 116 horses.
Findings showed that hypoechoic (darker) regions in the intermediate patellar ligament were common (24/116), particularly in the caudal aspect of the mid-third of the ligament. The infrapatellar fat pad typically had a hypoechoic striated appearance, except in one horse, where it was hyperechoic.
There was no association between ultrasonographic findings in the PLs and infrapatellar fat pad and lameness.
The researchers emphasised that patellar ligament appearance varies among horses, and these variations may or may not be linked to pain. They stressed the importance of using local analgesia to accurately determine the source of lameness before making a diagnosis.
For more details, see:
Ellen Law , Linda Wright , Margareta Uhlhorn , Elin Hernlund , Carolina Nilemo , Marie Rhodin
Hypoechoic ultrasonographic findings in the patellar ligaments are common in riding and trotting horses in training (116 cases)
Vet Radiol Ultrasound (2025) 66(1):e13446
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