Morphological Classification and Radiological Assessment of Insertional Desmopathies of the Nuchal Ligament in Show Jumping Horses

Morphological Classification and Radiological Assessment of Insertional Desmopathies of the Nuchal Ligament in Show Jumping Horses | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Morphological Classification and Radiological Assessment of Insertional Desmopathies of the Nuchal Ligament in Show Jumping Horses Miriam Turlejska, Katarzyna Michlik-Połczyńska, Roland Kozdrowski This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8253834/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Insertional desmopathy of the nuchal ligament in sport horses remains a poorly characterized orthopaedic phenomenon, with limited and inconsistent terminology in the scientific literature. This study investigated the prevalence, morphology, and localization of nuchal ligament enthesopathies in a cohort of actively competing horses using clinical and radiological assessments. Pathological changes were detected in 91% of evaluated individuals, predominantly as asymptomatic lesions identified during routine imaging. Two principal morphological types were discerned: rounded and coronoid-like bone formations, with comparable distribution among sexes and age groups. Lesion localization most commonly encompassed both the upper and lower regions of the occipital plate but was rarely confined to ligament attachment alone. No correlation was found between lesion size, shape, or location and sex, breed, or age, but horses over 7 years have greater length, depth, sum, and surface area of the new bone formations and more frequently display lesions in both the upper and lower positions than only in the upper. None of the studied horses exhibited related clinical symptoms. The functional relevance of these changes remains to be established, suggesting the necessity for long-term follow-up and further biomechanical investigation to determine potential effects on equine performance. Health sciences/Anatomy Health sciences/Diseases Health sciences/Health care Health sciences/Medical research insertional desmopathy nuchal ligament sport horses Figures Figure 1 Figure 2 Figure 3 Introduction In recent years, pain and stiffness in the occipital region have been increasingly diagnosed as a cause of decreased performance in sport horses. One of the most frequently identified conditions underlying these issues is insertional desmopathy of the initial attachment of the nuchal ligament (1). The nuchal ligament ( ligamentum nuchae ) is one of the long ligaments of the spine, located along the dorsal midline between the occiput, the cervical vertebrae, and the spinous processes of the thoracic vertebrae (2,3). It is present in ruminants, horses and dogs, while being absent in pigs, cats, primates and birds (2, 3). In horses, the nuchal ligament is composed of two parts—the funicular part ( funiculus nuchae ) and the lamellar part ( lamina nuchae ). The funicular part is a cord-like and narrow structure at its occipital attachment, whereas it becomes wide and flat at the level of the thoracic vertebrae (the so-called hooded portion) (2, 3, 4). The supraspinous ligament, which runs along the spine to the sacral bone, is a continuation of the funicular part of the nuchal ligament (5). The tension of the funicular part of the nuchal ligament is primarily influenced by the position of the head. In horses, individual differences in neck posture during movement may stem from variations in training or running speed (during galloping, the neck becomes considerably extended) (2, 3, 6). According to Biermann (7) and Knese and Biermann (8), the ligament’s attachment serves to balance different modules of elasticity in the tendon and skeletal tissue, thereby avoiding local tension peaks. This reflects the general principle that stress accumulates at the interfaces between structures with differing mechanical properties (9). The concept of insertional desmopathy encompasses degenerative changes within the origin and insertion sites of ligaments, tendons, and joint capsules. In horses, these changes most frequently occur at the proximal and distal attachments of the suspensory ligament and the interspinous ligaments in the thoracic region of the spine; however, the attachment of the nuchal ligament is increasingly mentioned as well (9). It connects to the occipital bone via both mineralized and non-mineralized cartilaginous zones, which transition into the bone matrix. Single or repetitive injuries of the nuchal ligament attachment lead to irritation of the cartilage matrix and partial soft tissue damage in the region of the external occipital protuberance ( protuberantia occipitalis externa ). In cases of severe trauma, avulsion of a bone fragment from the occipital plate may occur, which is referred to as avulsion fracture (10).  Repair processes occurring during healing lead to the formation of scar tissue and calcification of the cartilaginous portion of the attachment, resulting in insertional exostoses (11, 12). This process is also referred to as new bone formation (1) or the development of bone spurs (13). The underlying etiopathogenesis involves overloads associated with excessive flexion or bending of the occipital region (13). Therefore, this study tested the hypothesis that insertional desmopathies of the nuchal ligament are prevalent in sport horses and that lesion morphology, size, and location at the occipital attachment differ systematically across age groups. Specifically, it was hypothesized that older jumping horses would exhibit a higher frequency of insertional desmopathies, with larger and more morphologically advanced lesions, compared with younger horses, reflecting the cumulative effects of athletic loading on the cranial nuchal enthesis. The aim of the study was to characterize insertional desmopathies of the equine nuchal ligament in show jumping horses by describing lesion’s morphology, size, and location at the occipital bone and to determine how these lesion features vary across age groups of horses. Furthermore, the study sought to assess statistical associations between lesion shape and morphometric parameters and to evaluate whether age and sex are related to the prevalence and specific patterns of these insertional changes. Materials and Methods The study was conducted on a group of 35 horses representing four breeds: Holsteiner (N=14), Polish Warmblood (N=13), Wielkopolski (N=4), and Dutch Warmblood (N=4). The group comprised 16 mares, 17 stallions, and 2 geldings, aged 4 to 16 years, with body weight ranging from 550 to 650 kg and withers height between 158 and 170 cm. The horses included in this study were actively used as sport show jumpers at levels ranging from 1 to 1.5 meters, representing a population exposed to repetitive high-intensity loading of the cervical region associated with jumping and collection work. Each horse began competing at the age of four in events with jumps of 1 meter and progressed in accordance with the requirements for young horses up to a height of 1.5 meters. The horses underwent palpation examination of the occipital region, with attention paid to potential swelling, increased warmth, fibrosis, and tenderness in accordance with Hinchliff’s method (14). The next step involved radiological examination of the occipital region. For this purpose, a Gierth HF 80/20 (Germany) X-ray lamp and a FireCR-Flash CR Medical 70 indirect radiography system were used. Lateral projection images were taken according to previously established guidelines (15) — the horse’s head was extended forward, and the X-ray beam was perpendicular to the palpably detectable occipital crest. The distance from the X-ray lamp to the cassettes was 0.75 m, and the radiographs were taken at KV-70 with an exposure time of 0.06 s. X-ray images were evaluated for the presence of insertional desmopathies, as well as their shape, size, and location on the occipital plate. Morphological changes were classified into two groups: rounded new bone formations and coronoid-like new bone formations (Fig. 1). The length and depth of the observed changes were assessed (Fig. 2). Lines indicating these values were drawn on the insertional desmopathies seen in the lateral projection. These lines connected the most distant points of the change, maintaining a right angle at their intersection (Fig. 2). After connecting the ends of the previously described segments, a quadrilateral with sides of different lengths was formed, with diagonals intersecting at a right angle. A mathematical formula was then used to calculate the area of the change in the lateral profile. Surface area = (a × b)/2 × sin α a, b – length and depth of the lesion (diagonals) sin α – angle between the diagonals = in each case 90° = 1 In assessing lesion size, the length, depth, sum of both parameters, and surface area (Table 1) were considered. Based on the values of these parameters, horses were divided into four subgroups: 0 – no lesions, 1 – small lesions, 2 – medium-sized lesions, 3 – large lesions (Table 2). For the purpose of identifying the location of the lesion on the occipital plate, it was divided into two sections. The upper location was defined (upper 1/3, within the external occipital protuberance), the lower location (lower 2/3), and the upper-lower (constituting a connection of the upper and lower sections) (Fig. 2). The animal experiments conducted in this study were approved by the Local Ethics Committee in Poznań (document number 39/2025). All procedures were performed in accordance with relevant institutional and national guidelines and regulations. The authors confirm compliance with the ARRIVE guidelines to ensure the ethical treatment and welfare of the animals involved. Statistical analysis The data were cataloged using MS Excel spreadsheets. Statistical analysis was performed using IBM SPSS Statistics 25. Descriptive statistics are presented in tables containing means, standard deviations, standard errors, and 95% confidence intervals. The Shapiro-Wilk test was used to determine whether the measurements followed a normal distribution. Homogeneity of variance was checked with Levene’s test. Continuous data that met normal distribution and homogeneity of variance assumptions were analyzed using parametric statistical tests: Student’s t-test and one-way analysis of variance (ANOVA) with Tukey’s post-hoc test for multiple comparisons. In cases of significant deviations from the normal distribution occurring during the division of continuous variables into groups, the nonparametric Mann-Whitney U test was used. To determine statistical differences in terms of sex, breed, lesion shape, and lesion location for lesion length, lesion depth, and lesion surface area, the parametric tests described above were used. Age was split into young animals up to 7 years old and old animals over 7 years. To determine significant differences between age groups for lesion length, lesion depth, and lesion surface area, the nonparametric Mann-Whitney U test was used. To calculate the correlation between lesion length, lesion depth, and lesion surface area, Pearson's r correlation test was used. The following scale was used to describe the strength of correlation: 0.0 ≤ r ≤ 0.2 – no correlation, 0.2 < r ≤ 0.4 – weak correlation, 0.4 < r ≤ 0.7 – moderate correlation, 0.7 < |r| ≤ 0.9 – strong correlation, 0.9 < r ≤ 1.0 – very strong correlation. The chi-square test was used to verify whether there is a statistical difference between sex and lesion shape, sex and lesion location, breed and lesion shape, breed and lesion location, age group and lesion shape, age group and lesion location, and lesion shape and lesion location. The results obtained were adjusted using the Bonferroni correction for multiple comparisons. Data were analyzed at two significance levels: 0.05 < p < 0.1 was interpreted as a statistical trend and p < 0.05 as statistical significance. Results Clinical examination of the nuchal ligament did not reveal any pathological changes such as swelling, pain, or increased tension of muscles and ligaments. Radiographic examination showed the presence of insertional desmopathy of the nuchal ligament in 32 horses (91.4%). Only 3 horses (8.6%) did not show any radiological changes (Table 1). Based on the previously described method for categorizing lesion shape at the nuchal ligament attachment, rounded new bone formations were observed in 19 horses (59%), while coronoid-like new bone formations were recorded in 13 cases (41%). Among males, the shape of the changes was as follows: 12 rounded new bone formations (67%) and 6 coronoid-like new bone formations (33%). The distribution of these changes among females was nearly equal: rounded in 8 cases (57%) and coronoid-like in 6 cases (43%). Lesions in the upper-lower part of the occipital plate were documented in 20 horses (62.5%) (Table 4). In 12 horses (37.5%), lesions were found only in the upper part of the occipital plate (Table 4). No lesions confined solely to the lower part were observed. In the male group, upper location was identified in 14 cases (78%), while upper-lower localization was observed in 4 cases (22%). Among females, upper location was identified in 12 cases (86%), and upper-lower location in 2 cases (14%). According to the sum of the length and depth (the most significant statistically size parameter) small changes were noted in 38% (N=12), medium-sized in 31% (N=10), and large in 31% (N=10). The chi-square test revealed that mares tend to show changes more frequently in both the upper and lower positions, rather than just the upper position (p = 0.098). In stallions, the changes are equally often localized in both places. A statistically significant difference between the length and the shape of the lesion was also observed (p < 0.05). Rounded changes are longer (Table 1). Horses over 7 years of age more frequently exhibit rounded than coronoid-like new bone formations. Younger horses, however, do not show this dependence: rounded and coronoid-like new bone formations occur equally often (chi-square test p = 0.017). Comparing the shape of the formations to their position, the chi-square test did not show statistically significant differences (p > 0.05). This result may have been influenced by the insufficient sample size. Rounded lesions more often encompass both the upper and lower locations. Comparing age to length, depth, sum, and surface area—where normality was checked using the Shapiro-Wilk and Levene tests—none of the distributions were normal, and attempts at data transformation did not improve normality. Therefore, the non-parametric Mann-Whitney U test was used, which showed that horses over 7 years have greater lesion length, depth, sum, and surface area (Table 3). Analyzing the position of the lesions in relation to age, the chi-square test demonstrated a statistical trend (p = 0.098). Horses older than 7 years of age more frequently display lesions in both the upper and lower positions than only in the upper (Table 4). In horses up to 7 years, no similar correlation was observed. The size, position, and shape of the lesions were not correlated with the sex, breed, or age of the horses (p > 0.05). Discussion Apart from several publications (1, 16, 17), there are no reports regarding insertional desmopathy of the nuchal ligament in sport horses. Available studies (1, 16, 17, 18) indicate the presence of this pathology in the occipital region in the majority of horses without clinical symptoms (80%–88%). These results are consistent with our own findings, which noted degenerative changes in the nuchal ligament in 91% of horses. The study group consisted of adult horses kept individually in stalls, regularly exercised on the lunge and under saddle, with a focus on show jumping. It may be assumed that changes seen on radiographs may be related to the intensive work in excessive collection of the horses. Some authors regard insertional desmopathy of the cranial attachment of the nuchal ligament as clinically irrelevant (1). However, given that the nuchal ligament is critically important in the biomechanics of head, neck, and back movement, degeneration in this region may affect horse performance (1, 17, 19, 20). This is partially due to the fact that the high stiffness of the nuchal ligament may serve to protect other cervical structures from excessive strain. Some muscles utilize the traction of the nuchal ligament as a counterbalance for the cervical vertebrae, enabling protraction of the forelimb. This is a significant consideration for differential diagnosis in horses with protraction lameness. Furthermore, it has been observed that oscillation of the head and neck mass during movement most likely enhances propulsion of these structures by stretching and mobilizing the nuchal ligament, especially in the cervicothoracic section (21). It is assumed that the connection between the nuchal ligament, the supraspinous ligament, and the spinous processes of the thoracic region forms the main stabilizing element for the horse’s trunk (2). It remains unclear whether radiologically identified changes have clinical importance. The functional aspect and its role in the development and training of horses is also ambiguous. Research conducted so far does not provide an answer to these questions. Analyses by German scientists (17, 22, 23, 24) suggest that the occurrence of exostosis may cause clinical symptoms, contributing to reduced training ability, as well as stiffness and lameness. Long-term observation of horses with defined lesions, their sport careers, and any clinical symptoms potentially associated with desmopathy of the nuchal ligament attachment is essential. One of the contentious issues concerns the terminology used in relation to insertional desmopathy of the nuchal ligament in horses. There is a lack of consistency in the literature on this aspect, but most often insertional desmopathies are described as "new bone formations" or "enthesophytes" (19). There is also a lack of reliable information regarding the nomenclature for the specific shapes of these bone formations. In the present study, two types of enthesophytes were clearly distinguished among the observed changes. Based on this, they were divided into two groups— rounded and coronoid-like new bone formations (Figs. 2). In the present study, rounded lesions predominated (59%), while coronoid-like accounted for fewer cases (41%). To date, only one study has classified the size of radiological changes at the cranial attachment of the nuchal ligament (17). The author created a seven-point scale (0-6) for the size of enthesophytes. However, this scale seems rather complicated for practitioners and may be impractical from a clinical perspective. Based on the analysis of the present research results, a simplified evaluation method was proposed that enables reliable measurements. Since the surface area of the lesion correlates with the sum of its length and depth, and the sum is correlated with lesion length (Fig. 3), it appears that measuring only the length provides a reliable result. Nonetheless, this is a statistical inference, as lesion size is not determined solely by length. Therefore, it was determined that this correlation should be mentioned, but precise measurements must be made to achieve accurate study results. The divergent results of size changes taking into account the area and the sum of the length and depth are related to a different calculation method, taking into account other parameters. In the present study based on the statistical data the most significant size parameter was selected as a sum of the length and depth. According to the data presented in Table 2, it was determined that the lesion sizes were proportionally equal: small changes accounted for 38%, medium for 32%, and large for 32%. Regarding enthesophyte localization, there is also a gap in the literature. Previous studies describing insertional desmopathy in horses have not provided precise information concerning the position of the changes within the occipital plate. Only Butler et al. (15) reported that enthesophytes can appear on the occipital plate at the nuchal ligament attachment and in the surrounding muscles. The nuchal ligament is directly adjacent to the bilaterally arranged semispinalis muscle, while ventrally it is in contact with the rectus capitis muscle (1). In the present study, the localization was classified as upper (directly concerning the nuchal ligament), lower (concerning the rectus capitis muscle), and upper-lower (involving both structures) (Fig. 2). Where lesions were found in both parts (upper and lower), one can suspect more extensive remodeling processes of the occipital plate—not only at the nuchal ligament attachment, but also at the rectus capitis muscle. It was demonstrated that the location of most insertional desmopathies of the nuchal ligament encompasses both the upper and lower parts of the occipital plate (62.5%). A much smaller proportion involves only the ligament attachment region (upper position) (37.5%). The lower position of enthesophytes is rare and does not fall within the definition of insertional desmopathy of the nuchal ligament. Since the horse group analyzed in the studies conducted in vivo did not exhibit clinical symptoms, no conclusion can be drawn whether the particular shape and location of lesions influence horse performance. Conclusion The study provides a novel morphological classification of insertional desmopathies of the nuchal ligament in horses, distinguishing primarily between nodular and coronoid-like new bone formations. A simplified scale for assessing the size of these lesions is proposed, improving the standardization of radiological evaluations. The correlation between lesion location on the occipital plate and horse sex was also analyzed, contributing new insights to the field. Further research is urgently needed to elucidate the causes, clinical significance, and long-term prognosis of these lesions. This study fills an important gap in equine sports medicine and serves as a foundation for improved diagnosis and management of nuchal ligament desmopathies. Declarations Author contributions Miriam Turlejska: Data collection, performing radiological assessments, supporting data analysis, and reviewing and editing the manuscript. Katarzyna Michlik-Połczyńska: Conceptualization of the study, experimental design, data analysis, and drafting the original manuscript. Roland Kozdrowski: Project supervision, interpretation of results, manuscript revision, and final approval of the version to be published. Data Availability All data generated or analyzed during this study are included in this published article. Additional datasets or materials are available from the corresponding author upon reasonable request. Competing Interests Statement The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Funding Declaration This research did not receive financial grants and any other forms of financial support. References Dyson, S.J., Ross, M.W. The cervical spine and soft tissues of the neck in Diagnosis and Management of Lameness in the Horse (ed. Ross, M. W., Dyson, S. J.) 606-616 (Saunders, 2003). Gellman, K. 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Insertionsdesmopathien beim Pferd, ein Beitrag zur Orthologie und Pathologie von Sehnen-, Band- und Gelenkkapselverankerung beim Pferd unter besonderer Berücksichtigung der Insertion des Funiculus nuchae an der Squama occipitales. FN-Verlag d. Dt. Reiterl. Vereinigung (Warendorf, 2001). Tables Table 1. Characteristics of radiological changes at the cranial attachment of the nuchal ligament observed in radiograms in the study group. Horse Lesion lenght (mm) Lesion depth (mm) Sum of the length and depth (mm) Surface area (mm 2 ) Lesion shape Location Lesion size according to the surface area Lesion size according to the sum of the length and depth 1. 29.5 14.7 44.2 216.8 rounded upper 3 2 2. 2 2.7 4.7 2.7 coronoid-like upper and lower 1 1 3. 17.3 8.5 25.8 73.5 coronoid-like upper and lower 2 2 4. 13.4 4.4 17.8 29.5 coronoid-like upper 1 1 5. 3.6 4.8 8.4 8.6 coronoid-like upper 1 1 6. 8.5 4.1 12.6 17.4 rounded upper and lower 1 1 7. 0 0 0 0 no lesion no lesion 0 0 8. 0 0 0 0 no lesion no lesion 0 0 9. 13.3 6.2 19.5 41.2 coronoid-like upper 1 1 10. 10.6 6.4 17 33.9 coronoid-like upper and lower 1 1 11. 24.1 8.2 32.3 98.8 rounded upper and lower 2 2 12. 17.2 7.7 24.9 66.2 rounded górne 2 2 13. 6.7 4.8 11.5 16.1 rounded upper and lower 1 1 14. 8.9 5.6 14.5 24.9 rounded upper and lower 1 1 15. 11.2 6.6 17.8 37 coronoid-like upper 1 1 16. 29.5 19.8 49.3 292.1 coronoid-like upper and lower 3 3 17. 31 14.7 45.7 227.9 rounded upper 3 3 18. 8.7 10.2 18.9 44.4 coronoid-like upper and lower 1 1 19. 7.1 5.4 12.5 19.2 rounded upper 1 1 20. 12.2 5.8 18 35.4 coronoid-like upper 1 1 21. 25.5 5.3 30.8 67.6 rounded upper and lower 2 2 22. 37.8 10.3 48.1 194.7 rounded upper and lower 2 3 23. 0 0 0 0 no lesion no lesion 0 0 24. 18.3 34.9 53.2 319.3 rounded upper and lower 3 3 25. 36.6 11.8 48.4 215.9 rounded upper and lower 3 3 26. 40.8 22.7 63.5 463.1 coronoid-like upper and lower 3 3 27. 29.7 7.8 37.5 115.83 rounded upper and lower 2 2 28. 38.4 9.1 47.5 174.72 rounded upper 2 3 29. 23.5 7.5 31 88.1 rounded upper 2 2 30. 42.7 18.5 61.22 395 rounded upper and lower 3 3 31. 32.4 10.3 43.7 166.9 coronoid-like upper 2 2 32. 42.7 6.4 49.1 136.64 rounded upper and lower 2 3 33. 31.6 15.7 47.3 248.1 rounded upper and lower 3 3 34. 18.5 14.2 32.7 131.35 rounded upper and lower 2 2 35. 28.4 15.5 43.9 220.1 rounded upper and lower 3 2 Table 2. Scale of the size of insertional desmopathies at the cranial attachment of the nuchal ligament. Small Medium Large Length 33mm Depth 16mm Sum 45mm Surface area 200mm 2 Table 3. Size of new bone formations in different age groups of horses. N Mean Standard deviation Standard error 95% Confidence interval Minimum Maximum Lower bound Upper bound Length (mm) ≤ 7 18 14.156 a 8.9216 2.1028 9.719 18.592 2.0 31.0 >7 14 31.921 b 8.3441 2.2300 27.104 36.739 18.3 42.7 Total 32 21.928 12.3703 2.1868 17.468 26.388 2.0 42.7 Depth (mm) ≤ 7 18 7.811 a 4.4422 1.0470 5.602 10.020 2.7 19.8 >7 14 13.571 b 7.8727 2.1041 9.026 18.117 5.3 34.9 Total 32 10.331 6.7262 1.1890 7.906 12.756 2.7 34.9 Sum of the length and the depth (mm) ≤ 7 18 21.9667 a 12.94840 3.05197 15.5276 28.4058 4.70 49.30 >7 14 45.5657 b 10.09835 2.69890 39.7351 51.3963 30.80 63.50 Total 32 32.2913 16.61873 2.93780 26.2996 38.2829 4.70 63.50 Surface area (mm 2 ) ≤ 7 18 71.4222 a 84.69012 19.96165 29.3068 113.5376 2.70 292.10 >7 14 209.8100 b 114.59906 30.62789 143.6425 275.9775 67.60 463.10 Total 32 131.9669 119.60619 21.14359 88.8442 175.0895 2.70 463.10 Length (mm) U= 233 ; p < 0.001; Depth (mm) U= 198 ; p < 0.001; Sum of the length and the depth (mm) U= 227 ; p < 0.001; Surface area (mm2) U= 219 ; p < 0.001 Table 4. Location of new bone formations in different age groups of horses Location Total Upper Upper and lower Age ≤ 7 Number of horses 9 9 18 Age - percentage 50% 50% 100% Location - percentage 75% 45% 56.3% >7 Number of horses 3 11 14 Age - percentage 21.4% 78.6% 100% Location - percentage 25% 55% 43.8% Total Number of horses 12 20 32 Age - percentage 37.5% 62.5% 100% Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 20 Apr, 2026 Reviewers agreed at journal 15 Apr, 2026 Reviewers agreed at journal 14 Apr, 2026 Reviewers invited by journal 14 Apr, 2026 Editor invited by journal 08 Dec, 2025 Editor assigned by journal 05 Dec, 2025 Submission checks completed at journal 05 Dec, 2025 First submitted to journal 01 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8253834","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":626367084,"identity":"c6ccc199-9a32-46d5-b3db-686cdbb33c96","order_by":0,"name":"Miriam Turlejska","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABA0lEQVRIiWNgGAWjYBACPhhDgoGxgSGBgUEOxDnwAI8WNnQtxmAtCcRpgYDEBhCJVwv78YefK2rqEmdOO9z24UHNtvT5YYcfAm2xk9NtwKGFJyFZ8swxtsTZ0onNMxKO3c7deDvNAKgl2djsAC6HJRyQbGzgSZwH1MKQwAbUMjsBpOVA4jZcWvgfNv9sbJCAavl3O91wdvoH/FokktmAthiAHcaQ2HY7QV46h4AtEs/YLBuOJRjPnA3S0nfbcIN0TsGBBAPcfuHnT398s6GmTnbG7fTHjD++3ZaXn52++cOHCjs5XFpgwLEBxjIAqzTArxwE7OEs+QbcqkbBKBgFo2BkAgAoZmNgJ/PGJQAAAABJRU5ErkJggg==","orcid":"","institution":"Poznań University of Life Sciences","correspondingAuthor":true,"prefix":"","firstName":"Miriam","middleName":"","lastName":"Turlejska","suffix":""},{"id":626367085,"identity":"9b3cfad4-8c6b-4b4b-ab9f-210dc679b219","order_by":1,"name":"Katarzyna Michlik-Połczyńska","email":"","orcid":"","institution":"Poznań University of Life Sciences","correspondingAuthor":false,"prefix":"","firstName":"Katarzyna","middleName":"","lastName":"Michlik-Połczyńska","suffix":""},{"id":626367086,"identity":"4f36ae96-f92e-468c-a155-ced575c7b320","order_by":2,"name":"Roland Kozdrowski","email":"","orcid":"","institution":"Poznań University of Life Sciences","correspondingAuthor":false,"prefix":"","firstName":"Roland","middleName":"","lastName":"Kozdrowski","suffix":""}],"badges":[],"createdAt":"2025-12-01 20:38:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8253834/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8253834/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107450704,"identity":"834185f5-fd6e-4818-8f1b-d0de80aa9b7f","added_by":"auto","created_at":"2026-04-21 15:14:35","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":128149,"visible":true,"origin":"","legend":"\u003cp\u003eLateral radiograph of the occipital region\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ea\u003c/strong\u003e physiological appearance.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eb\u003c/strong\u003e pathological appearance—coronoid-like new bone formation, upper location.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ec\u003c/strong\u003epathological appearance—rounded new bone formation, upper location.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8253834/v1/dd1d29db6267dd341daa466e.png"},{"id":107450706,"identity":"b1aafdb2-51ae-4a31-8283-bdee4d445283","added_by":"auto","created_at":"2026-04-21 15:14:35","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":205057,"visible":true,"origin":"","legend":"\u003cp\u003eLateral radiograph of the occipital region pathological appearance\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ea\u003c/strong\u003e coronoid-like new bone formation, upper and lower location, diagram for assessing length (red arrow) and depth (blue arrow).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eb\u003c/strong\u003e rounded new bone formation, upper location, diagram of the division of the occipital plate into upper and lower parts.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8253834/v1/0860189c8bd2cf1be9870d77.png"},{"id":107450705,"identity":"4a942243-402d-4625-b1a4-a53ef9337c84","added_by":"auto","created_at":"2026-04-21 15:14:35","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":25252,"visible":true,"origin":"","legend":"\u003cp\u003ePearson correlation\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ea\u003c/strong\u003e analysis sum of the lesion to area of the lesion\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eb\u003c/strong\u003e analysis area of the lesion to length of the lesion\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ec\u003c/strong\u003e analysis sum of the lesion to length of the lesion\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-8253834/v1/439006950e4064e6c6b7caea.png"},{"id":107487767,"identity":"bbf25806-2e33-4068-af3b-c8d2a183bf8c","added_by":"auto","created_at":"2026-04-22 02:42:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":864587,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8253834/v1/7f96341a-554a-4233-9b2f-6fd07d894bbe.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Morphological Classification and Radiological Assessment of Insertional Desmopathies of the Nuchal Ligament in Show Jumping Horses","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIn recent years, pain and stiffness in the occipital region have been increasingly diagnosed as a cause of decreased performance in sport horses. One of the most frequently identified conditions underlying these issues is insertional desmopathy of the initial attachment of the nuchal ligament (1). The nuchal ligament (\u003cem\u003eligamentum nuchae\u003c/em\u003e) is one of the long ligaments of the spine, located along the dorsal midline between the occiput, the cervical vertebrae, and the spinous processes of the thoracic vertebrae (2,3). It is present in ruminants, horses and dogs, while being absent in pigs, cats, primates and birds (2, 3). In horses, the nuchal ligament is composed of two parts—the funicular part (\u003cem\u003efuniculus nuchae\u003c/em\u003e) and the lamellar part (\u003cem\u003elamina nuchae\u003c/em\u003e). The funicular part is a cord-like and narrow structure at its occipital attachment, whereas it becomes wide and flat at the level of the thoracic vertebrae (the so-called hooded portion) (2, 3,\u0026nbsp;4). The supraspinous ligament, which runs along the spine to the sacral bone, is a continuation of the funicular part of the nuchal ligament (5).\u003c/p\u003e\n\u003cp\u003eThe tension of the funicular part of the nuchal ligament is primarily influenced by the position of the head. In horses, individual differences in neck posture during movement may stem from variations in training or running speed (during galloping, the neck becomes considerably extended) (2, 3, 6). According to Biermann (7) and Knese and Biermann (8), the ligament’s attachment serves to balance different modules of elasticity in the tendon and skeletal tissue, thereby avoiding local tension peaks. This reflects the general principle that stress accumulates at the interfaces between structures with differing mechanical properties (9).\u003c/p\u003e\n\u003cp\u003eThe concept of insertional desmopathy encompasses degenerative changes within the origin and insertion sites of ligaments, tendons, and joint capsules. In horses, these changes most frequently occur at the proximal and distal attachments of the suspensory ligament and the interspinous ligaments in the thoracic region of the spine; however, the attachment of the nuchal ligament is increasingly mentioned as well (9). It connects to the occipital bone via both mineralized and non-mineralized cartilaginous zones, which transition into the bone matrix. Single or repetitive injuries of the nuchal ligament attachment lead to irritation of the cartilage matrix and partial soft tissue damage in the region of the external occipital protuberance (\u003cem\u003eprotuberantia occipitalis externa\u003c/em\u003e). In cases of severe trauma, avulsion of a bone fragment from the occipital plate may occur, which is referred to as avulsion fracture (10).\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRepair processes occurring during healing lead to the formation of scar tissue and calcification of the cartilaginous portion of the attachment, resulting in insertional exostoses (11, 12). This process is also referred to as new bone formation (1) or the development of bone spurs (13). The underlying etiopathogenesis involves overloads associated with excessive flexion or bending of the occipital region (13).\u003c/p\u003e\n\u003cp\u003eTherefore, this study tested the hypothesis that insertional desmopathies of the nuchal ligament are prevalent in sport horses and that lesion morphology, size, and location at the occipital attachment differ systematically across age groups. Specifically, it was hypothesized that older jumping horses would exhibit a higher frequency of insertional desmopathies, with larger and more morphologically advanced lesions, compared with younger horses, reflecting the cumulative effects of athletic loading on the cranial nuchal enthesis.\u003c/p\u003e\n\u003cp\u003eThe aim of the study was to characterize insertional desmopathies of the equine nuchal ligament in show jumping horses by describing lesion’s morphology, size, and location at the occipital bone and to determine how these lesion features vary across age groups of horses. Furthermore, the study sought to assess statistical associations between lesion shape and morphometric parameters and to evaluate whether age and sex are related to the prevalence and specific patterns of these insertional changes.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eThe study was conducted on a group of 35 horses representing four breeds: Holsteiner (N=14), Polish Warmblood (N=13), Wielkopolski (N=4), and Dutch Warmblood (N=4). The group comprised 16 mares, 17 stallions, and 2 geldings, aged 4 to 16 years, with body weight ranging from 550 to 650 kg and withers height between 158 and 170 cm.\u0026nbsp;\u0026nbsp;The horses included in this study were actively used as sport show jumpers at levels ranging from 1 to 1.5 meters, representing a population exposed to repetitive high-intensity loading of the cervical region associated with jumping and collection work. Each horse began competing at the age of four in events with jumps of 1 meter and progressed in accordance with the requirements for young horses up to a height of 1.5 meters.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe horses underwent palpation examination of the occipital region, with attention paid to potential swelling, increased warmth, fibrosis, and tenderness in accordance with Hinchliff’s\u0026nbsp;method (14).\u003c/p\u003e\n\u003cp\u003eThe next step involved radiological examination of the occipital region. For this purpose, a Gierth HF 80/20 (Germany) X-ray lamp and a FireCR-Flash CR Medical 70 indirect radiography system were used. Lateral projection images were taken according to previously established guidelines (15) — the horse’s head was extended forward, and the X-ray beam was perpendicular to the palpably detectable occipital crest. The distance from the X-ray lamp to the cassettes was 0.75 m, and the radiographs were taken at KV-70 with an exposure time of 0.06 s.\u003c/p\u003e\n\u003cp\u003eX-ray images were evaluated for the presence of insertional desmopathies, as well as their shape, size, and location on the occipital plate. Morphological changes were classified into two groups: rounded new bone formations and coronoid-like new bone formations (Fig. 1). The length and depth of the observed changes were assessed (Fig. 2). Lines indicating these values were drawn on the insertional desmopathies seen in the lateral projection. These lines connected the most distant points of the change, maintaining a right angle at their intersection (Fig. 2). After connecting the ends of the previously described segments, a quadrilateral with sides of different lengths was formed, with diagonals intersecting at a right angle. A mathematical formula was then used to calculate the area of the change in the lateral profile.\u003c/p\u003e\n\u003cp\u003eSurface area = (a × b)/2 × sin α\u003c/p\u003e\n\u003cp\u003ea, b – length and depth of the lesion (diagonals)\u003c/p\u003e\n\u003cp\u003esin α – angle between the diagonals = in each case 90° = 1\u003c/p\u003e\n\u003cp\u003eIn assessing lesion size, the length, depth, sum of both parameters, and surface area (Table 1) were considered. Based on the values of these parameters, horses were divided into four subgroups: 0 – no lesions, 1 – small lesions, 2 – medium-sized lesions, 3 – large lesions (Table 2).\u003c/p\u003e\n\u003cp\u003eFor the purpose of identifying the location of the lesion on the occipital plate, it was divided into two sections. The upper location was defined (upper 1/3, within the external occipital protuberance), the lower location (lower 2/3), and the upper-lower (constituting a connection of the upper and lower sections) (Fig. 2).\u003c/p\u003e\n\u003cp\u003eThe animal experiments conducted in this study were approved by the Local Ethics Committee in Poznań (document number 39/2025). All procedures were performed in accordance with relevant institutional and national guidelines and regulations. The authors confirm compliance with the ARRIVE guidelines to ensure the ethical treatment and welfare of the animals involved.\u003c/p\u003e\n\u003cp\u003eStatistical analysis\u003c/p\u003e\n\u003cp\u003eThe data were cataloged using MS Excel spreadsheets. Statistical analysis was performed using IBM SPSS Statistics 25. Descriptive statistics are presented in tables containing means, standard deviations, standard errors, and 95% confidence intervals. The Shapiro-Wilk test was used to determine whether the measurements followed a normal distribution. Homogeneity of variance was checked with Levene’s test. Continuous data that met normal distribution and homogeneity of variance assumptions were analyzed using parametric statistical tests: Student’s t-test and one-way analysis of variance (ANOVA) with Tukey’s post-hoc test for multiple comparisons. In cases of significant deviations from the normal distribution occurring during the division of continuous variables into groups, the nonparametric Mann-Whitney U test was used. To determine statistical differences in terms of sex, breed, lesion shape, and lesion location for lesion length, lesion depth, and lesion surface area, the parametric tests described above were used. Age was split into young animals up to 7 years old and old animals over 7 years. To determine significant differences between age groups for lesion length, lesion depth, and lesion surface area, the nonparametric Mann-Whitney U test was used. To calculate the correlation between lesion length, lesion depth, and lesion surface area, Pearson's r correlation test was used. The following scale was used to describe the strength of correlation: 0.0 ≤ r ≤ 0.2 – no correlation, 0.2 \u0026lt; r ≤ 0.4 – weak correlation, 0.4 \u0026lt; r ≤ 0.7 – moderate correlation, 0.7 \u0026lt; |r| ≤ 0.9 – strong correlation, 0.9 \u0026lt; r ≤ 1.0 – very strong correlation. The chi-square test was used to verify whether there is a statistical difference between sex and lesion shape, sex and lesion location, breed and lesion shape, breed and lesion location, age group and lesion shape, age group and lesion location, and lesion shape and lesion location. The results obtained were adjusted using the Bonferroni correction for multiple comparisons. Data were analyzed at two significance levels: 0.05 \u0026lt; p \u0026lt; 0.1 was interpreted as a statistical trend and p \u0026lt; 0.05 as statistical significance.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eClinical examination of the nuchal ligament did not reveal any pathological changes such as swelling, pain, or increased tension of muscles and ligaments.\u003c/p\u003e\n\u003cp\u003eRadiographic examination showed the presence of insertional desmopathy of the nuchal ligament in 32 horses (91.4%). Only 3 horses (8.6%) did not show any radiological changes (Table 1).\u003c/p\u003e\n\u003cp\u003eBased on the previously described method for categorizing lesion shape at the nuchal ligament attachment, rounded new bone formations were observed in 19 horses (59%), while coronoid-like new bone formations were recorded in 13 cases (41%). Among males, the shape of the changes was as follows: 12 rounded new bone formations (67%) and 6 coronoid-like new bone formations (33%). The distribution of these changes among females was nearly equal: rounded in 8 cases (57%) and coronoid-like in 6 cases (43%). Lesions in the upper-lower part of the occipital plate were documented in 20 horses (62.5%) (Table 4). In 12 horses (37.5%), lesions were found only in the upper part of the occipital plate (Table 4). No lesions confined solely to the lower part were observed. In the male group, upper location was identified in 14 cases (78%), while upper-lower localization was observed in 4 cases (22%). Among females, upper location was identified in 12 cases (86%), and upper-lower location in 2 cases (14%). \u0026nbsp;According to the sum of the length and depth (the most significant statistically size parameter) small changes were noted in 38% (N=12), medium-sized in 31% (N=10), and large in 31% (N=10).\u003c/p\u003e\n\u003cp\u003eThe chi-square test revealed that mares tend to show changes more frequently in both the upper and lower positions, rather than just the upper position (p = 0.098). In stallions, the changes are equally often localized in both places. A statistically significant difference between the length and the shape of the lesion was also observed (p \u0026lt; 0.05). Rounded changes are longer (Table 1). Horses over 7 years of age more frequently exhibit rounded than coronoid-like new bone formations. Younger horses, however, do not show this dependence: rounded and coronoid-like new bone formations occur equally often (chi-square test p = 0.017). Comparing the shape of the formations to their position, the chi-square test did not show statistically significant differences (p \u0026gt; 0.05). This result may have been influenced by the insufficient sample size. Rounded lesions more often encompass both the upper and lower locations. Comparing age to length, depth, sum, and surface area—where normality was checked using the Shapiro-Wilk and Levene tests—none of the distributions were normal, and attempts at data transformation did not improve normality. Therefore, the non-parametric Mann-Whitney U test was used, which showed that horses over 7 years have greater lesion length, depth, sum, and surface area (Table 3). Analyzing the position of the lesions in relation to age, the chi-square test demonstrated a statistical trend (p = 0.098). Horses older than 7 years of age more frequently display lesions in both the upper and lower positions than only in the upper (Table 4). In horses up to 7 years, no similar correlation was observed.\u003c/p\u003e\n\u003cp\u003eThe size, position, and shape of the lesions were not correlated with the sex, breed, or age of the horses (p \u0026gt; 0.05).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eApart from several publications (1, 16, 17), there are no reports regarding insertional desmopathy of the nuchal ligament in sport horses. Available studies (1, 16, 17, 18) indicate the presence of this pathology in the occipital region in the majority of horses without clinical symptoms (80%–88%). These results are consistent with our own findings, which noted degenerative changes in the nuchal ligament in 91% of horses. The study group consisted of adult horses kept individually in stalls, regularly exercised on the lunge and under saddle, with a focus on show jumping. It may be assumed that changes seen on radiographs may be related to the intensive work in excessive collection of the horses. Some authors regard insertional desmopathy of the cranial attachment of the nuchal ligament as clinically irrelevant (1). However, given that the nuchal ligament is critically important in the biomechanics of head, neck, and back movement, degeneration in this region may affect horse performance (1, 17, 19, 20). This is partially due to the fact that the high stiffness of the nuchal ligament may serve to protect other cervical structures from excessive strain. Some muscles utilize the traction of the nuchal ligament as a counterbalance for the cervical vertebrae, enabling protraction of the forelimb. This is a significant consideration for differential diagnosis in horses with protraction lameness. Furthermore, it has been observed that oscillation of the head and neck mass during movement most likely enhances propulsion of these structures by stretching and mobilizing the nuchal ligament, especially in the cervicothoracic section (21). It is assumed that the connection between the nuchal ligament, the supraspinous ligament, and the spinous processes of the thoracic region forms the main stabilizing element for the horse’s trunk (2). It remains unclear whether radiologically identified changes have clinical importance. The functional aspect and its role in the development and training of horses is also ambiguous. Research conducted so far does not provide an answer to these questions. Analyses by German scientists (17, 22, 23, 24) suggest that the occurrence of exostosis may cause clinical symptoms, contributing to reduced training ability, as well as stiffness and lameness. Long-term observation of horses with defined lesions, their sport careers, and any clinical symptoms potentially associated with desmopathy of the nuchal ligament attachment is essential.\u003c/p\u003e\n\u003cp\u003eOne of the contentious issues concerns the terminology used in relation to insertional desmopathy of the nuchal ligament in horses. There is a lack of consistency in the literature on this aspect, but most often insertional desmopathies are described as \"new bone formations\" or \"enthesophytes\" (19). There is also a lack of reliable information regarding the nomenclature for the specific shapes of these bone formations. In the present study, two types of enthesophytes were clearly distinguished among the observed changes. Based on this, they were divided into two groups— rounded and coronoid-like new bone formations (Figs. 2). In the present study, rounded lesions predominated (59%), while coronoid-like accounted for fewer cases (41%).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;To date, only one study has classified the size of radiological changes at the cranial attachment of the nuchal ligament (17). The author created a seven-point scale (0-6) for the size of enthesophytes. However, this scale seems rather complicated for practitioners and may be impractical from a clinical perspective. Based on the analysis of the present research results, a simplified evaluation method was proposed that enables reliable measurements. Since the surface area of the lesion correlates with the sum of its length and depth, and the sum is correlated with lesion length (Fig. 3), it appears that measuring only the length provides a reliable result. Nonetheless, this is a statistical inference, as lesion size is not determined solely by length. Therefore, it was determined that this correlation should be mentioned, but precise measurements must be made to achieve accurate study results. The divergent results of size changes taking into account the area and the sum of the length and depth are related to a different calculation method, taking into account other parameters. In the present study based on the statistical data the most significant size parameter was selected as a sum of the length and depth. According to the data presented in Table 2, it was determined that the lesion sizes were proportionally equal: small changes accounted for 38%, medium for 32%, and large for 32%.\u003c/p\u003e\n\u003cp\u003eRegarding enthesophyte localization, there is also a gap in the literature. Previous studies describing insertional desmopathy in horses have not provided precise information concerning the position of the changes within the occipital plate. Only Butler et al. (15) reported that enthesophytes can appear on the occipital plate at the nuchal ligament attachment and in the surrounding muscles. The nuchal ligament is directly adjacent to the bilaterally arranged semispinalis muscle, while ventrally it is in contact with the rectus capitis muscle (1). In the present study, the localization was classified as upper (directly concerning the nuchal ligament), lower (concerning the rectus capitis muscle), and upper-lower (involving both structures) (Fig. 2). Where lesions were found in both parts (upper and lower), one can suspect more extensive remodeling processes of the occipital plate—not only at the nuchal ligament attachment, but also at the rectus capitis muscle. It was demonstrated that the location of most insertional desmopathies of the nuchal ligament encompasses both the upper and lower parts of the occipital plate (62.5%). A much smaller proportion involves only the ligament attachment region (upper position) (37.5%). The lower position of enthesophytes is rare and does not fall within the definition of insertional desmopathy of the nuchal ligament. Since the horse group analyzed in the studies conducted in vivo did not exhibit clinical symptoms, no conclusion can be drawn whether the particular shape and location of lesions influence horse performance.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe study provides a novel morphological classification of insertional desmopathies of the nuchal ligament in horses, distinguishing primarily between nodular and coronoid-like new bone formations. A simplified scale for assessing the size of these lesions is proposed, improving the standardization of radiological evaluations. The correlation between lesion location on the occipital plate and horse sex was also analyzed, contributing new insights to the field. Further research is urgently needed to elucidate the causes, clinical significance, and long-term prognosis of these lesions. This study fills an important gap in equine sports medicine and serves as a foundation for improved diagnosis and management of nuchal ligament desmopathies.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eAuthor contributions\u003c/p\u003e\n\u003cp\u003eMiriam Turlejska: Data collection, performing radiological assessments, supporting data analysis, and reviewing and editing the manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eKatarzyna Michlik-Połczyńska: Conceptualization of the study, experimental design, data analysis, and drafting the original manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRoland Kozdrowski: Project supervision, interpretation of results, manuscript revision, and final approval of the version to be published.\u003c/p\u003e\n\u003cp\u003eData Availability\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll data generated or analyzed during this study are included in this published article. Additional datasets or materials are available from the corresponding author upon reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCompeting Interests Statement\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.\u003c/p\u003e\n\u003cp\u003eFunding Declaration\u003c/p\u003e\n\u003cp\u003eThis research did not receive financial grants and any other forms of financial support.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eDyson, S.J., Ross, M.W. The cervical spine and soft tissues of the neck in \u003cem\u003eDiagnosis and Management of Lameness in the Horse\u003c/em\u003e (ed. Ross, M. W., Dyson, S. J.) 606-616 (Saunders, 2003).\u003c/li\u003e\n \u003cli\u003eGellman, K. S., Bertram, J. E. A. The equine nuchal ligament 1: structural and material properties. \u003cem\u003eVet. Comp. Orthop. Traumatol.\u003c/em\u003e \u003cstrong\u003e15\u003c/strong\u003e, 1-6 (2002).\u003c/li\u003e\n \u003cli\u003eGellman, K. S., Bertram, J. E. A. The equine nuchal ligament 2: passive dynamic energy exchange in location. \u003cem\u003eVet. Comp. Orthop. Traumatol.\u003c/em\u003e \u003cstrong\u003e15\u003c/strong\u003e, 7-14 (2002).\u003c/li\u003e\n \u003cli\u003eMercer, S. R., Bagduk, N. Clinical Anatomy of Ligamentum Nuchae. \u003cem\u003eClin. Anat.\u003c/em\u003e \u003cstrong\u003e16\u003c/strong\u003e, 484-493 (2003).\u003c/li\u003e\n \u003cli\u003ePilliner, S., Elmhurst, S., Davies, Z. The head and neck in \u003cem\u003eThe horse in motion,\u003c/em\u003e \u003cem\u003eThe Anatomy and Physiology of Equine Locomotion\u0026nbsp;\u003c/em\u003e(ed.\u0026nbsp;Pilliner, S., Elmhurst, S., Davies, Z.) 13-16 (Blackwell Science, 2002).\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eStory, M. R., et al. Equine Cervical Pain and Dysfunction: Pathology, Diagnosis and Treatment. \u003cem\u003eAnimals\u003c/em\u003e \u003cstrong\u003e11\u003c/strong\u003e, 422 (2021).\u003c/li\u003e\n \u003cli\u003eBiermann, H. Die Knochen bildung im Bereich Periostaler-Diaphysar Sehnen- und Bandansatze. \u003cem\u003eZ. Zellforsch. Mikrosk. Anat.\u003c/em\u003e \u003cstrong\u003e46\u003c/strong\u003e, 635–671 (1957).\u003c/li\u003e\n \u003cli\u003eKnese, K. H., Biermann, H. Die knockenbildung an sehnen-und bands a tzen im bereich urspr u nglich chondraler apophysen. \u003cem\u003eZ. Zellforsch. Mikrosk. Anat.\u003c/em\u003e \u003cstrong\u003e49\u003c/strong\u003e, 142–187 (1958).\u003c/li\u003e\n \u003cli\u003eBenjamin, M., et al. The skeletal attachment of tendons - tendon ‘entheses’. \u003cem\u003eComp. Biochem. Physiol. A\u003c/em\u003e \u003cstrong\u003e133\u003c/strong\u003e, 931-945 (2002).\u003c/li\u003e\n \u003cli\u003eVoight, A., Saulez, M. N., Donnellan, C. M. Nuchal crest avulsion fracture in 2 horses: a cause of headshaking. \u003cem\u003eJ. S. Afr. Vet. Assoc\u003c/em\u003e. \u003cstrong\u003e80(2)\u003c/strong\u003e,111-113 (2009)\u003c/li\u003e\n \u003cli\u003eBudras, K. D., Sack, W. O., Röck, S. Axial Skeleton and Neck in \u003cem\u003eAnatomy of the horse\u003c/em\u003e (ed. Budras, K. D., Sack, W. O., Röck, S.) 56-58 \u0026nbsp;(Schluetersche, 2008).\u003c/li\u003e\n \u003cli\u003eNowak M. Choroby Kręgosłupa szyjnego, Desmopatia insercyjna przyczepu więzadła karkowego in \u003cem\u003ePraktyka kliniczna: Konie\u0026nbsp;\u003c/em\u003e(ed. Dietz, O., Huskamp, B.) 921-922 (Galaktyka, 2008).\u003c/li\u003e\n \u003cli\u003eBenjamin, M., McGonagle, D. Entheses: tendon and ligament attachment sites. \u003cem\u003eScand. J. Med. Sci. Sports.\u003c/em\u003e \u003cstrong\u003e19\u003c/strong\u003e, 520-527 (2009).\u003c/li\u003e\n \u003cli\u003eHinchliff, K.W., Kaneps, A. J., Geor, R. J. \u003cem\u003eEquine Sports Medicine and Surgery\u003c/em\u003e (ed. Hinchliff, K.W., Kaneps, A. J., Geor, R. J.) \u0026nbsp; 451-452 (Elsevier, 2004).\u003c/li\u003e\n \u003cli\u003eButler, J. A., Colles, C. M., Dyson, S. J., Kold, S. E., Poulos, P. W. \u003cem\u003eClinical Radiology of the Horse\u003c/em\u003e (ed. Butler, J. A., Colles, C. M., Dyson, S. J., Kold, S. E., Poulos, P. W.), 327- 402 (Blackwell Science, 2000).\u003c/li\u003e\n \u003cli\u003eNowak, M. Die Insertionsdesmopathie des Nackenstrangursprungs beim Pferd. Congres de medecine et chirurgie equine 26-28, 96-97 (2001).\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eHüntemann, G. Vorkommen und Bedeutung der Insertionsdesmopathie des Ligamentum nuchae bei Pferden mit Rittigkeitsproblemen – eine radiologische und klinische Studie. Inaugural-Dissertation zur Erlangung des Grades eines \u0026nbsp;Doktors der Veterinärmedizin an der \u0026nbsp;Freien Universität Berlin (2006).\u003c/li\u003e\n \u003cli\u003eDyson, S.J. Lesions of the equine neck resulting in lameness or poor performance. \u003cem\u003eVet. Clin. N. Am. Equine. Prac.\u003c/em\u003e \u003cstrong\u003e27\u003c/strong\u003e, 417–437 (2011).\u003c/li\u003e\n \u003cli\u003eBrems, R., Weiss, D. Extracorporal shock wave therapy at the insertion desmopathy of the nuchal ligament in horses in \u003cem\u003eProceedings 1st Symposium of Extracorporal Shock Wave Users in Veterinary Medicine\u003c/em\u003e, 11-12, 22-24 (Pardenklinik Barkhof, Sottrum, Germany, 2002).\u003c/li\u003e\n \u003cli\u003eMachado, V. M. V., Aguiar, A. C. S., Bueno, L. M. C., Viana, G. F. MRI of multiple lesions of the nuchal structures in show jumper horses - case report in \u003cem\u003eIVRA Meeting\u0026nbsp;\u003c/em\u003e(School of Veterinary Medicine and Animal Science, São Paulo State University, Brazil, 2015).\u003c/li\u003e\n \u003cli\u003eDunbar, D. C., Macpherson, J. M., Simmons, R. W., Zarcades A. Stabilization and mobility of the head, neck and trunk in horses during overground locomotion: comparisons with humans and other primates. \u003cem\u003eJ. Exp. Biol.\u003c/em\u003e \u003cstrong\u003e211\u003c/strong\u003e, 3889- 3907 (2008).\u003c/li\u003e\n \u003cli\u003e\u0026nbsp;Nowak, M. Zur Diagnostik der Insertionsdesmopathie des Funiculus nuchae an der Squama occipitalis (Teil 1: Klinische Aspekte) in \u003cem\u003eInternationales Symposium „Diagnostik beim Pferd”\u0026nbsp;\u003c/em\u003e(Hamburg, 1997).\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eWeiler, H. Zur Diagnostik der Insertionsdesmopathie des Funiculus nuchae an der Squama occipitalis (Teil 2: Pathomorphologische Aspekte) in \u003cem\u003eInternationales Symposium „Diagnostik beim Pferd“\u003c/em\u003e (Hamburg, 1997).\u003c/li\u003e\n \u003cli\u003eWeiler, H. Insertionsdesmopathien beim Pferd, ein Beitrag zur Orthologie und Pathologie von Sehnen-, Band- und Gelenkkapselverankerung beim Pferd unter besonderer Berücksichtigung der Insertion des Funiculus nuchae an der Squama occipitales. FN-Verlag d. Dt. Reiterl. Vereinigung \u0026nbsp; (Warendorf, 2001).\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1. Characteristics of radiological changes at the cranial attachment of the nuchal ligament observed in radiograms in the study group.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003eHorse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003eLesion lenght (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003eLesion depth (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eSum of the\u0026nbsp;length and depth (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003eSurface area (mm\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003eLesion shape\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eLocation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 82px;\"\u003e\n \u003cp\u003eLesion size according to the surface area\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003eLesion size according to the sum of the length and depth\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 46px;\"\u003e\n \u003cp\u003e1.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e29.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e14.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e44.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e216.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003erounded\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 124px;\"\u003e\n \u003cp\u003eupper\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 46px;\"\u003e\n \u003cp\u003e2.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e2.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e4.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e2.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003ecoronoid-like\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 124px;\"\u003e\n \u003cp\u003eupper and lower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 46px;\"\u003e\n \u003cp\u003e3.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e17.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e8.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e25.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e73.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003ecoronoid-like\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 124px;\"\u003e\n \u003cp\u003eupper and lower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 46px;\"\u003e\n \u003cp\u003e4.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e13.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e4.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e17.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e29.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003ecoronoid-like\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 124px;\"\u003e\n \u003cp\u003eupper\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 46px;\"\u003e\n \u003cp\u003e5.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e3.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e4.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e8.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e8.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003ecoronoid-like\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 124px;\"\u003e\n \u003cp\u003eupper\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 46px;\"\u003e\n \u003cp\u003e6.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e8.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e4.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e12.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e17.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003erounded\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 124px;\"\u003e\n \u003cp\u003eupper and lower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 46px;\"\u003e\n \u003cp\u003e7.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003eno lesion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 124px;\"\u003e\n \u003cp\u003eno lesion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 46px;\"\u003e\n \u003cp\u003e8.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003eno lesion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 124px;\"\u003e\n \u003cp\u003eno lesion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 46px;\"\u003e\n \u003cp\u003e9.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e13.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e6.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e19.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e41.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003ecoronoid-like\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 124px;\"\u003e\n \u003cp\u003eupper\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 46px;\"\u003e\n \u003cp\u003e10.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e10.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e6.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e33.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003ecoronoid-like\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 124px;\"\u003e\n \u003cp\u003eupper and lower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 46px;\"\u003e\n \u003cp\u003e11.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e24.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e8.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e32.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e98.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003erounded\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 124px;\"\u003e\n \u003cp\u003eupper and lower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 46px;\"\u003e\n \u003cp\u003e12.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e17.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e7.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e24.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e66.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003erounded\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 124px;\"\u003e\n \u003cp\u003eg\u0026oacute;rne\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 46px;\"\u003e\n \u003cp\u003e13.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e6.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e4.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e11.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e16.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003erounded\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 124px;\"\u003e\n \u003cp\u003eupper and lower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 46px;\"\u003e\n \u003cp\u003e14.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e8.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e5.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e14.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e24.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003erounded\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 124px;\"\u003e\n \u003cp\u003eupper and lower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 46px;\"\u003e\n \u003cp\u003e15.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e11.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e6.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e17.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003ecoronoid-like\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 124px;\"\u003e\n \u003cp\u003eupper\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 46px;\"\u003e\n \u003cp\u003e16.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e29.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e19.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e49.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e292.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003ecoronoid-like\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 124px;\"\u003e\n \u003cp\u003eupper and lower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 46px;\"\u003e\n \u003cp\u003e17.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e14.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e45.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e227.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003erounded\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 124px;\"\u003e\n \u003cp\u003eupper\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 46px;\"\u003e\n \u003cp\u003e18.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e8.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e10.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e18.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e44.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003ecoronoid-like\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 124px;\"\u003e\n \u003cp\u003eupper and lower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 46px;\"\u003e\n \u003cp\u003e19.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e7.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e5.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e12.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e19.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003erounded\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 124px;\"\u003e\n \u003cp\u003eupper\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 46px;\"\u003e\n \u003cp\u003e20.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e12.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e5.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e35.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003ecoronoid-like\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 124px;\"\u003e\n \u003cp\u003eupper\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 46px;\"\u003e\n \u003cp\u003e21.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e25.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e5.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e30.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e67.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003erounded\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 124px;\"\u003e\n \u003cp\u003eupper and lower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 46px;\"\u003e\n \u003cp\u003e22.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e37.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e10.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e48.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e194.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003erounded\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 124px;\"\u003e\n \u003cp\u003eupper and lower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 46px;\"\u003e\n \u003cp\u003e23.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003eno lesion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 124px;\"\u003e\n \u003cp\u003eno lesion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 46px;\"\u003e\n \u003cp\u003e24.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e18.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e34.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e53.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e319.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003erounded\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 124px;\"\u003e\n \u003cp\u003eupper and lower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 46px;\"\u003e\n \u003cp\u003e25.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e36.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e11.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e48.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e215.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003erounded\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 124px;\"\u003e\n \u003cp\u003eupper and lower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 46px;\"\u003e\n \u003cp\u003e26.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e40.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e22.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e63.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e463.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003ecoronoid-like\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 124px;\"\u003e\n \u003cp\u003eupper and lower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 46px;\"\u003e\n \u003cp\u003e27.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e29.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e7.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e37.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e115.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003erounded\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 124px;\"\u003e\n \u003cp\u003eupper and lower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 46px;\"\u003e\n \u003cp\u003e28.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e38.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e9.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e47.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e174.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003erounded\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 124px;\"\u003e\n \u003cp\u003eupper\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 46px;\"\u003e\n \u003cp\u003e29.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e23.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e7.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e88.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003erounded\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 124px;\"\u003e\n \u003cp\u003eupper\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 46px;\"\u003e\n \u003cp\u003e30.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e42.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e18.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e61.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e395\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003erounded\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 124px;\"\u003e\n \u003cp\u003eupper and lower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 46px;\"\u003e\n \u003cp\u003e31.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e32.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e10.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e43.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e166.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003ecoronoid-like\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 124px;\"\u003e\n \u003cp\u003eupper\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 46px;\"\u003e\n \u003cp\u003e32.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e42.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e6.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e49.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e136.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003erounded\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 124px;\"\u003e\n \u003cp\u003eupper and lower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 46px;\"\u003e\n \u003cp\u003e33.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e31.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e15.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e47.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e248.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003erounded\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 124px;\"\u003e\n \u003cp\u003eupper and lower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 46px;\"\u003e\n \u003cp\u003e34.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e18.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e14.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e32.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e131.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003erounded\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 124px;\"\u003e\n \u003cp\u003eupper and lower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 46px;\"\u003e\n \u003cp\u003e35.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 58px;\"\u003e\n \u003cp\u003e28.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e15.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e43.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e220.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003erounded\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 124px;\"\u003e\n \u003cp\u003eupper and lower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 82px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 2. Scale of the size of insertional desmopathies at the cranial attachment of the nuchal ligament.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eSmall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eLarge\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003eLength\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026lt;15mm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e15 - 33mm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026gt; 33mm\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003eDepth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026lt;7mm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e7 - 16mm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026gt; 16mm\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003eSum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026lt;22mm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e22 - 45mm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026gt;45mm\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003eSurface area\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026lt;50mm\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e50-200mm\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026gt;200mm\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 3. Size of new bone formations in different age groups of horses.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eStandard deviation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eStandard error\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e95% Confidence interval\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003eMinimum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eMaximum\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eLower bound\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eUpper bound\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003eLength (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e\u0026le; 7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e14.156\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e8.9216\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e2.1028\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e9.719\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e18.592\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e31.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e\u0026gt;7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e31.921\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e8.3441\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e2.2300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e27.104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e36.739\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e18.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e42.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e21.928\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e12.3703\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e2.1868\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e17.468\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e26.388\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e42.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003eDepth (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e\u0026le; 7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e7.811\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e4.4422\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e1.0470\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e5.602\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e10.020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e2.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e19.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e\u0026gt;7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e13.571\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e7.8727\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e2.1041\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e9.026\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e18.117\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e5.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e34.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e10.331\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e6.7262\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e1.1890\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e7.906\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e12.756\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e2.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e34.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003eSum of the length and the depth (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e\u0026le; 7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e21.9667\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e12.94840\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e3.05197\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e15.5276\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e28.4058\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e4.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e49.30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e\u0026gt;7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e45.5657\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e10.09835\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e2.69890\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e39.7351\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e51.3963\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e30.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e63.50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e32.2913\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e16.61873\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e2.93780\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e26.2996\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e38.2829\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e4.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e63.50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003eSurface area (mm\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e\u0026le; 7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e71.4222\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e84.69012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e19.96165\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e29.3068\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e113.5376\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e2.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e292.10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e\u0026gt;7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e209.8100\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e114.59906\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e30.62789\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e143.6425\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e275.9775\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e67.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e463.10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e131.9669\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e119.60619\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e21.14359\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e88.8442\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e175.0895\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e2.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e463.10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;Length (mm) U= 233 ; p \u0026lt; 0.001; Depth (mm) U= 198 ; p \u0026lt; 0.001; Sum of the length and the depth (mm) U= 227 ; p \u0026lt; 0.001; Surface area (mm2) U= \u0026nbsp;219 ; p \u0026lt; 0.001\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 4. Location of new bone formations in different age groups of horses\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" rowspan=\"2\" valign=\"top\" style=\"width: 328px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eLocation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003eUpper\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003eUpper and lower\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026le; 7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003eNumber of horses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003eAge - percentage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e50%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e50%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003eLocation - percentage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e75%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e45%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e56.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026gt;7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003eNumber of horses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003e\u0026nbsp;Age - percentage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e21.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e78.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003eLocation - percentage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e25%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e55%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e43.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003eNumber of horses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003eAge - percentage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e37.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e62.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"insertional desmopathy, nuchal ligament, sport horses","lastPublishedDoi":"10.21203/rs.3.rs-8253834/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8253834/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"Insertional desmopathy of the nuchal ligament in sport horses remains a poorly characterized orthopaedic phenomenon, with limited and inconsistent terminology in the scientific literature. This study investigated the prevalence, morphology, and localization of nuchal ligament enthesopathies in a cohort of actively competing horses using clinical and radiological assessments. Pathological changes were detected in 91% of evaluated individuals, predominantly as asymptomatic lesions identified during routine imaging. Two principal morphological types were discerned: rounded and coronoid-like bone formations, with comparable distribution among sexes and age groups. Lesion localization most commonly encompassed both the upper and lower regions of the occipital plate but was rarely confined to ligament attachment alone. No correlation was found between lesion size, shape, or location and sex, breed, or age, but horses over 7 years have greater length, depth, sum, and surface area of the new bone formations and more frequently display lesions in both the upper and lower positions than only in the upper. None of the studied horses exhibited related clinical symptoms. The functional relevance of these changes remains to be established, suggesting the necessity for long-term follow-up and further biomechanical investigation to determine potential effects on equine performance.","manuscriptTitle":"Morphological Classification and Radiological Assessment of Insertional Desmopathies of the Nuchal Ligament in Show Jumping Horses","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-21 15:14:28","doi":"10.21203/rs.3.rs-8253834/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-20T13:47:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"214817559167513121847531349074418054216","date":"2026-04-15T06:21:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"252948936436518396037985326991177772833","date":"2026-04-14T08:00:37+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-14T06:21:07+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-08T17:47:28+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-05T13:57:34+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-05T13:54:18+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-12-01T20:29:16+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bdc86181-38a0-48f1-86a6-8076450edbc6","owner":[],"postedDate":"April 21st, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":66663190,"name":"Health sciences/Anatomy"},{"id":66663191,"name":"Health sciences/Diseases"},{"id":66663192,"name":"Health sciences/Health care"},{"id":66663193,"name":"Health sciences/Medical research"}],"tags":[],"updatedAt":"2026-04-21T15:14:28+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-21 15:14:28","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8253834","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8253834","identity":"rs-8253834","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}