Splitting ligaments of stifle

[CJBean]

Hi, I have a four year old mare that has been having a sticky stifle since early last fall. I have been working her lots with hills and cavalettis to the max without seeing much improvement. I don’t have an arena so all of my riding is done out in the fields up and around hills all the time.

I had another vet come out and look at her two weeks ago and we discussed what to do next. He said it seemed odd that I was finding the more I worked her, the more likely it seemed to lock up. He said it was possible the muscle directly above the stifle could be experiencing fatigue and could be dropping which in turn could make the ligaments droop a bit which then could cause the lock up of the stifle.

He suggested our next course of action to be the ligament splitting procedure, he seemed very confident with this procedure. And he said it would be ligament splitting where he goes in with a needle and punches holes into ligaments so then the ligament will build scar tissue to help firm up the ligaments.

I haven’t seen much discussion on this board of the ligament splitting of the stifle. Is there anyone out there that has done this and seen success with it? Or what problems if any did you encounter? My vet informed me that my mare would be off work for a month, with those of you that have had this done, were your horses good to go back to work after a month?

[Laurierace]

Not an answer to your question but have you tried an estrone regimen yet? I would definitely give that a try before resorting to surgery if you haven't tried it already.

[vxf111]

That is the only thing I haven't tried for my stifle horse.

The progression of treatment for his "came off the track with a sticky stifle" issue has been...

Strengthening (hillwork/cavaletti)
Esterone
Internal blistering of the stifle with almond oil
Injection of the stifle with HA/steroids

I did not get any relief whatsoever from the esterone though other horses at the barn used it in the same time frame, same vet to good results. I found that the internal blistering helped significantly but that the effects only lasted a few months and then the horse went back the being locky as he had been. I did not get more than a few days of relief from the injection, and part of that was probably the bute he was on post-injection.

I would ask about other potential treatments before jumping right into the surgery, and I have heard that the perforating version (the one your vet discussed with you) is far superior to the actual splitting. A horse around here had the perforating surgery. I don't know the horse well and didn't know him pre-surgery, but I have seen him around post injury and he's doing W/T/C and jumping small jumps and seems fairly normal.

[buck22]

perhaps consider 24/7 outdoor living for your horse if she isn't already? on my posty legged weak stifled mustang, it was the one thing that helped the most. Any time spent in a stall resulted in lameness and stickiness. Speaking with the farrier about keeping his toes well rolled for quick breakover really helped too back then, so he didn't have to work too hard to turn over.

[vxf111]

Oh yeah. I forgot to add to the list of things I tried "turning him out for a year" and "various different shoeing philosophies from glue-ons to barefoot." Neither of those really did much for the problem long-term, though I think turnout is just plain good for them AND properly shaped feet are also a must-have for any horse.

Good options to try though, if you haven't already. They might work for your horse.

[EqTrainer]

Have you xrayed and ultrasounded this stifle? What about his back feet?

[KnKShowmom]

I would ask about other potential treatments before jumping right into the surgery, and I have heard that the perforating version (the one your vet discussed with you) is far superior to the actual splitting. A horse around here had the perforating surgery. I don't know the horse well and didn't know him pre-surgery, but I have seen him around post injury and he's doing W/T/C and jumping small jumps and seems fairly normal.

The perforating version and the splitting version are the same thing, the old method you are thinking of actually cut the ligament which caused a host of other problems.

Our horse had the splitting surgery and we were pleased with it. Be aware that there will be a period of stall rest and limited turn out (30x30 paddock) for about a month and then an undersaddle rehab regime that you should be very diligent about. If you follow it though I think you will be pleased with the results.

Since you have a mare, DO NOT try the estrone injections! You haven't seen mareish til you've gone down that road :)

Finally, in my research and experience, turn out seems to be the kiss of death for most hind end issues - it is a use it or lose it thing and its very hard to bring them back. Turn out for just 3 months is what eventually led us to have this surgery and I will never turn a horse out again until its ready to retire.

[vxf111]

The perforating version and the splitting version are the same thing, the old method you are thinking of actually cut the ligament which caused a host of other problems.


I've heard the cutting version of the surgery referred to as "splitting," but I am sure terminology varies from vet to vet. When I initially looked into the surgery options, it was in 2004, I am sure there has been great progress since then but at the time the perforating technique was kind of new and I was hesitant to try it.

My gelding was a raving bitch on the Esterone and I was told by the vet that she NEVER sees that as a side effect-- but he was. I think there have been a few threads on COTH and other people experienced this too-- but it was geldings and it was a very limited number of people. Trust me, after all I went through with this horse-- I would have GLADLY accepted a few weeks of bitch-hormone-mode in exchange for soundness :( so yes, it's a side effect but it still might be worth trying and outweighed by the cost/risk benefit of avoiding surgery.

Stifles stink. :( They really do. I am always happy when I hear a happy ending to a stifle problem story-- because I think that's the exception rather than the rule. :(

[CJBean]

Thanks for the posts so far, I appreciate them.

Yes my mare is out on 24/7 turn out now, she has been since early April. When she started the sticky stifle it was also when she was out on 24/7 turn out as well. I just have my horses in stalls at night through winter months.

The sticking is very very random and I haven't been able to find any kind of pattern with it. Some days are better then others. Many days I will watch her in the pasture and she will go to walk off and it will be stuck other times it seems I could go a good stretch of three days with out a single issue.

In regards to her feet, the morning the vet came out to look at her was the same morning I had my farrier out to reset her, the farrier was still there when vet arrived and they both discussed what was going on. Both the vet and the farrier seem very satisfied with her feet and don't think they could be the culprit.

The vet did feel around on her stifle and he did notice that the one stifle that is the issue does have kind of a proud feeling to it, like the joint itself is slightly larger?? And he was thinking that is what could be causing one of the ligaments to catch on it, if that makes any sense?

In regards to the estrone, the vet had said its not suggested to give that to mares as it doesn't seem to work well for mares.

We have not done xrays on her yet, but the vet is coming on Friday and I am thinking I will have him do some xrays. He also suggested I could try injecting the stifle and see how she does on that too.

[Laurierace]

I have used it on probably a dozen mares and it helped every single one of them. Take that for what its worth. I wouldn't use ECP on a mare but have no problem with estrone. At worst it does nothing. I get the whole bottle for less than $40 so its always worth a try in my book.

[vxf111]

IMHO I would try the blistering before the injection. Blistering is the one thing I thought had some mild effect and I probably should have blistered a second time before deciding to rachet up to the next step.

[KnKShowmom]

You might be better off to try an ultrasound before going any further if your vet thinks something doesn't feel quite "right". There might be an underlying issue that neither blistering or splitting will help.

[cllane1]

Perforating has done wonders for a mare at our barn. Tried blistering, strengthening regimes, etc., but nothing worked out. Vet suggested splitting (perforating), owner agreed, quick and easy procedure with limited downtime, and now she's 100%.

[farmgirl]

Can someone help me understand something? Why would you use estrone and blister the same horse? I thought a blister would be to tighten the ligament and estrone would relax it?

If one doesn't work, does that imply the problem is the opposite problem with the ligament? Thx, fg

[Donkey]

You might be better off to try an ultrasound before going any further if your vet thinks something doesn't feel quite "right". There might be an underlying issue that neither blistering or splitting will help.

Ditto. I'd want x-rays and ultra sound before I would consider doing anything to the joint.

[Auventera Two]

My best riding friend raised a colt who was diagnosed with UFP very early in life. He was blistered I believe 3 times with no improvement. She worked a lot on strengthening him with hill work and just let him grow up and mature. He is 6 now and recently had the splitting surgery. She really didn't notice much improvement or change. I think she's decided it just "is what it is." She rides him when she can and when the stifle is really bad, she doesn't ride.

[KnKShowmom]

Can someone help me understand something? Why would you use estrone and blister the same horse? I thought a blister would be to tighten the ligament and estrone would relax it?

If one doesn't work, does that imply the problem is the opposite problem with the ligament? Thx, fg

Estrone would be used along with an exercise program but if that didn't work then the blistering/splitting could be an option. Once those procedure have been done, you wouldn't want to go back to Estrone because yes it will relax what you just had tightened.

[katarine]

Esterone would lay down those ligaments.

$5 a shot. Once a week, 4 weeks.

Use the horse immediately and see how it goes.

It couldn't hurt, I don't suspect. And it's cheap.

My vet says he hasn't cut a stifle in years.

BEST wishes.

[Lieslot]

Nice article on the options for IUFP, aka sticky stifles, aka delayed patellar release.

http://www.equestmagazine.com/v4s2/article03-02-c3.php

[rcloisonne]

We have not done xrays on her yet, but the vet is coming on Friday and I am thinking I will have him do some xrays. He also suggested I could try injecting the stifle and see how she does on that too.
Doubtful your vet's portable x-ray machine is large enough or powerful enough to get good shots of the stifle. You'll need to take him to a large animal hospital for that.

Better to take x-rays of his rear feet to check pedal bone alignment and medial/lateral balance.

[OlmosHeaven]

My Savannah, now 18, began having stifle problems as a 2-year-old. I didn't do much with her until she was 5 or 6, partly because I was afraid of aggravating the problem, partly because I had another two horses to try to ride. But with my dressage trainer's help, we overcame it.

Both sides were affected, although more to the left than the right. A hind leg would catch hyperextended and then she would pop it back in place. I don't know if was painful, but it pained me to watch or feel it.

She hasn't had problems in years now and I think it's due to the strength she gained from the slow dressage work. She might not like sitting on her hindquarters, but it really strengthened the muscles surrounding her stifles. I think lots of cavaletti jumping exercises helped, too. We have a little roll to our land, and I would trot her up the hill, but I don't know if the "hill" was steep enough to have an effect.

Oh, and my horses all live outside.

[dwblover]

My gelding came off the track with a sticky stifle too. I've been dealing with it for about a year. I tried Estrone and cavaletti work and I'd say he improved about 30%. We radiographed (got great pictures of both stifles with the portable digital X-ray machine). All was clean. Then we ultrasounded the worse stifle and again nothing showed up.

My farrier feels many TBs probably over-stretch their stifle ligaments at the track and they just end up being too long, but not torn or anything. So we are now trying eggbars on the hind feet. I already feel an improvement with them, we're probably up to 50% better now. Hoping for 100%!

[bellboots]

I had my geldings done 4 years ago with great results. I have to keep up with strength exercises, but all in all I am very satisfied with the results.

I have also found that it helps if the farrier keeps his back toes squared off.

[Lieslot]

Bellboots, interesting.
May I ask how bad was your horse? Was it mild catching or bad.
Was your horse actually lame or just having the "hindleg pothole step" at times?
Here's a video of my guy where he catches at 0:34
-deleted-
Is that what you were experiencing with your horse prior to surgery. I'm trying to get an idea of how bad or mild my guys' stifles are and if I ought to consider surgery.

How old was your horse when you had it done?
Was it done under general anaesthesia or standing sedation?

Thanks so much!

[Lieslot]

Another question, does anyone know in the Hunterdon region or acceptable distance from Hunterdon, which vet clinic would be able to do the ligament splitting on general or standing?

[KnKShowmom]

Don't know of anyone in your area but your vet should be able to give a referral or contact a teaching hospital in the area.

Ours was done as a standing procedure - 2 stitches and home the same day.

[fourwhitesocks]

I just had the tendon splitting performed on my very large 4 year old Hanoverian and am very very pleased so far with the result! It seems the post-surgery handling is changing. My vet had me work him the very day I brought him home if you can believe that and he was MARKEDLY improve right away. He only wanted him to stay in his stall for 3 days just until the incision areas closed up as to keep dirt out. I was to WORK him every day though. It seems aggressive but it has really seemed to help my guy!! I also had some chiropractic work done on him to even up his hips and so far so good.

[dwblover]

Wow, very interesting! Work right away makes sense I suppose since inflammation might thicken the ligaments. The eggbars that were working for my OTTB have now made him worse, so I'm going back to barefoot behind and I'm having my farrier square his hind toes. Glad to hear there was immediate improvement.

[fourwhitesocks]

That's exactly why he wanted me to work him right away. He wanted to irritate it! Crazy but it does make sense.

FYI my horse is barefoot and I do keep him pretty squared off. I don't think it's a miracle cure though, the chiropractic work seems to have really helped too. The surgery was the turnaround point though...made a huge difference!!

Good luck!

[Lieslot]

Hi fourwhitesocks, was the surgery done under standing sedation or did the vet lay your horse down. How long did the whole thing take?
Does your horse appear to be in a lot of pain, where you given painkillers for him?
Did they inject the stifle joint too or only the ligament splitting?
Thanks for updating us on his surgery, sounds like the right way to go.

[fourwhitesocks]

Yes, the surgery was done under sedation. I was done at MSU teaching hospital. The procedure itself does not take long at all ...it's just all that other hospital stuff that took the time; like admitting, paperwork, horse history, and making sure he was sufficiently out of the sedation for the trailer ride home. I took him in in the morning and picked him up around 4:30. Lots of time for coffee! All together it was pretty simple.

He never seemed to be in alot of pain but did have trouble especially trying to canter. That is getting much better now; but I did the chiropractic work too. He was not on painkillers before or after the surgery. I did not have the injecting done before the surgery.

Hope this helps...

[EqTrainer]

I am having the perforation surgery done on one of mine at blue ridge equine in va in two weeks.. They recommend two weeks stall rest, two weeks hand walking and then back to work... Wondering why the difference in rehab protocols, will have to ask. Hope your boy keeps improving!

[Lieslot]

Thanks very much Fourwhitesocks! Sounds like a quick procedure, and not overly painful, and the immediate results are very encouraging.

Eqtrainer, please update us after the surgery, would love to know how it goes with your horse too.
Did they tell you whether they'd do the procedure under standing sedation or whether they'll lay the horse down & flip over?
I agree with you the rehab suggestions are very different from one practice to another.

I'm also curious as to how much risk for further tearing early turnout after surgery poses, as the mp ligament has been weakend by the slicing and if a horse goes a little too much woohaa in the field, would that risk injury rather than therapeutic perforation. I guess it would seem prudent to me to stick to some stall rest & paddock confinement.