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View Full Version : Cunean Tenectomy-Anyone have this done?



Warmbloodmom
Aug. 12, 2005, 03:07 AM
Am considering going the route of a Cunean Tenectomy for my gelding. He is 11 and has a spur on the lower portion of the left hock since birth. The sides of the hock have some fusing but the center is wide open still. Read the discussion on Cunean Tenectomy and was very interesting but would love to hear from people who have had this done. Hock injections last only 4-6 weeks on him.

luv2jump
Aug. 12, 2005, 05:10 AM
Does injecting the cunean bursa give him any relief? If it does, then releasing the tendon may help ,otherwise the pain is coming from the joint and the tenectomy would probably not be all that effective.
Luv2Jump

sk_pacer
Aug. 12, 2005, 07:12 AM
Over the years, I have had the jack cords cut (cunean tenotomy - the tendon is just cut, nothing is removed) on several horses. In most horses, soundness returns within a few days, if not the next day, and performance improves greatly over a short period. The reason for the speedy return to soundness is that the cunean tendon is severed over the rough portion of the bone, and by the time the tendon reconnects (several months) the offending hock(s) fusing is complete, and the scraping of the tendon over the partially fused bones is no longer an issue. If I remember right, the first couple of days after the cords are cut, the horse is handwalked, and then returned to light jogging within a few days.Return to full work is generally a month to six weeks; some horses return sooner, others take longer.

A small and fairly gross aside here: if you are present for the procedure, you can tell the extent of tendon damage by the sound the scalpel makes as the tendon is cut; the louder the crunch, the more inflamed and scarred it is.

Hope this makes sense, as I am quite decaffeinated at this point in time, so forgive any rambling.

Warmbloodmom
Aug. 12, 2005, 12:10 PM
Thanks for the info, gorry details and all! I do have a rather strong stomach, people tell me I should have been a nurse! I am seriously looking into this procedure, it is the last ditch effort I can give him to be comfy. Have had him 6 years and have been through navicular (so I thought and nerved him, grew back sound http://chronicleforums.com/groupee_common/emoticons/icon_rolleyes.gif)terrible suspensory tear on the hind leg that has the spurred hock http://chronicleforums.com/images/custom_smilies/cry.gif,EPSM http://chronicleforums.com/images/custom_smilies/uhoh.gif, AND a fractured coffin bone on the "good" hind leg http://chronicleforums.com/groupee_common/emoticons/icon_eek.gif! So all have healed well EXCEPT that darn hock, so if I can get that to heal up I will have a sound horse after all of this! If not, he will have a few years being a lawnmower and see if that cures it!

Adagio
Aug. 12, 2005, 03:19 PM
I would love to take this discussion one step further. There are two vets in my area that will perform this surgery. One cuts the tendon the other cuts the tendon and clears out the bursa. can any that have had this surgery say if the vet they dealt with did one or the other procedure? and if so your feelings on the success of the surgery?

Warmbloodmom
Aug. 12, 2005, 06:46 PM
Well I was able to send my disc with the digital xrays of his hocks to a surgeon a few hours away, very highly recommended. He will get this on Monday but in speaking with him on the phone he highly agreed that this procedure will help him and once he sees the xrays he may take it the extra step if he sees what he feels is enough arthritis in it and do arthrodesis by drilling 3 holes into the cartilage. He said this is the new procedure for this and he has done a few and has had great success with it. It is very much less painful than the old way and he will be turned out for 2 months, then brought back to work slowly. He said 90% of them come back and fuse without a problem. When they do the arthrodesis they cut the cunean tendon anyway. He may be able to do this within the next week. http://chronicleforums.com/groupee_common/emoticons/icon_biggrin.gif

Warmbloodmom
Aug. 19, 2005, 09:09 AM
My gelding is scheduled for the Cunean Tenectomy on Tuesday. Surgeon viewed his xrays and said he has very little arthritis in them but lots of spurs along the front of the lower hock joint. He does not want to do any drilling because the arthritis is not advanced enough, however he feels the tenectomy will help him tremendously. Will keep you posted.

Warmbloodmom
Aug. 23, 2005, 10:56 AM
Cuneon tenectomy was performed this morning. Surgeon said that the tendons were so tight that yes, they made a huge snapping noise. Had about 1/2" of scar tissue that he was able to remove. The tendon retracted quickly after he took out the section. Bursa was fine. He feels that he should be a whole lot more comfortable now. 14 days of handwalking, then stitches out and turned out with back to light work, gradually building up to full work after a few weeks. I am very glad that I decided to go this route. It was an easy surgery and he is in minimal pain from it. Will follow up in a few weeks so others can determine if this may be a surgery that can help them.

Plumcreek
Sep. 15, 2005, 09:09 AM
Warmblood mom, really sorry I missed this thread. How is your horse doing post CT?? Per the original thread, I have had 4 personal horses done and all have totally or greatly improved.

If you have found a vet surgeon who is not in Colorado to do CTs, this is exciting.
Would you be kind enough to PM me and tell me where you live and what vet did your surgery? Not many vets across the country advocate this very useful surgery, or do the modern version of removing a piece of tendon and cleaning out the scar tissue.

My vet feels that a lot of the post surgery improvement comes from the elimination of inflamation in the joint due to cessation of hock joint twisting from being torqued by a tight or scarred down tendon. I am discussing with her finding some grant money to re-radiograph horses several years post surgery to see if arthritic changes and/or bone spurs have reduced in size.

Bea
Sep. 15, 2005, 10:41 AM
I missed this thread as well. I had CT done on my horse in March. Plumcreek, I've been meaning to PT you for ages to tell you. I'm definitely pleased I had it done. She had never been lame, but xrayed with some hock arthritis.

Plumcreek
Sep. 15, 2005, 10:47 AM
Cool, Bea. Is she riding and/or stopping (reiner) any different?

Warmbloodmom
Sep. 15, 2005, 11:09 AM
Hi, I am very glad I did the CT. I live in Illinois near the Wisconsin border. Dr. Langer at Wisconsin Equine Clinic in Oconomowac was kind enough to do this. I called all around (even the big teaching hospitals!) and nobody would do it, said they haven't done that procedure in 20+ years! Dr. Langer looked at my boys xrays and thought it would be worth doing, being that he has a bone spur on the lower joint right where the tendon laid. Both hocks have arthritis, but the left with the bone spur has extreme narrowing of joint space. He said he would consider drilling that one being it has so little space left but he felt the CT would give him some relief, enough to where he would be able to continue riding so fusion would begin. He said that the tendons were so scarred up and tight, he took all that he could of the scarring off of them. The left he took about 1 inch, the right about 1/2 inch. He was on hand walking only for 14 days, bandages came off after 7 days and I did standing wraps for the 14 days of rest. Stitches removed at 14 days and then full turnout. Never any swelling, no pain, stood totally square about a day after surgery. It has been 3 weeks now and I have ridden him for the past 4 days. He is not yet totally sound, just starts out stiff but does warm out of it, something he has never done in the past. I would love to know of horses that have had this procedure done and how they are doing now, and if fusion has occured. I have read that it usually takes about 8 weeks or so before a noticeable improvement is seen. He still has a decent size "bump" where the tendon is laying and I would think that once the tendon shrinks the bump will shrink. Either way, it is not a big noticeable thing. Thanks for asking!

Bea
Sep. 15, 2005, 11:19 AM
Originally posted by Plumcreek:
Cool, Bea. Is she riding and/or stopping (reiner) any different?
Huge difference in her stopping. http://chronicleforums.com/images/custom_smilies/yes.gif Which is where I hoped to see a difference. I have done other stuff as well, injected her hocks, Legend, and she's on a good supplement.

But, the reason I'm feeling more and more pleased for having done CT is that she's stopping better and better as time goes on. And as we know, with joint injections say, the biggest effect is noticed right after and then starts to fade. Doesn't continue getting better months later. Which the literature said happens with CT. It cost me $700 and if it means she can go longer, or even without, joint injections, it will be more than worth it.

Warmbloodmom, please keep us up to date on your guy. When my mare was xrayed she wasn't anywhere close to fusion. I'll be xraying her again next year.

Plumcreek
Sep. 15, 2005, 11:33 AM
Warmbloodmom,
As posted in the original thread, most of the horses in my H-J trainer's barn have had a CT, since both vet clinics near here advocate the surgery. All these horses are majorly improved, both in hocks and back pain. All I have heard of are sound for the rest of their careers, retiring for other reasons. All my CT'd horses with arthritic changes have stayed sound in their hocks, without any supplements, injections, nothing.

Keep riding your horse regularly. Dr. Page, my vet, thinks they should have LIGHT walk-trot-canter exercise from the beginning to insure that new scar tissue does not cause adhesions at the surgery site. She cites 80% improvement at 8 weeks, due to greatly reduced inflamation, and the balance of the average 95% improvement in 6 months. Never gets to re-radiograph these horses (they are sound), so does not know about hock fusion (I have asked her).

I found it staggering that the major vet schools are so dismissive of this surgery.

Warmbloodmom
Sep. 15, 2005, 03:12 PM
Thanks for all of the input! Even if he doesn't improve much more than he has, I know he is in much less pain just from the expression on his face and the way he stands now. With every ride he seems to be getting better and stronger. He suffered a major suspensory tear that we found last August (first one) and a second tear that was higher up that we missed last December. Both tears have healed well and this was the same leg as the bone spur. I am being very careful not to do circles for at least another 4-6 months. Before the CT we were just starting on straight line canter work and he just kept deteriorating. Thought it was the suspensory again but it was the hock. Actually, the vet thinks the suspensory really didn't bother him much but the hock was the major problem. Now he is loading that leg properly instead of twisting it to the side when he lands so hopefully the suspensory will be o.k. now. When I bought him 6 years ago he had the bone spur then. Wish I would have known about CT's back then, would have done it in a second! Amazing how many vets are against doing it also. They would rather inject, which to me has a lot more risk than a Ct.

Plumcreek
Oct. 29, 2005, 08:56 PM
Warmbloodmom, how is your gelding doing now? Please give us an update.

Warmbloodmom
Oct. 30, 2005, 02:36 AM
He is doing well! http://chronicleforums.com/groupee_common/emoticons/icon_smile.gifWith the colder weather setting in he was a little stiffer in the hocks being that he has very little joint space left in the lower joint of the left hock. He is able to work through the soreness regularly now. Before the CT he never worked through it. I am hoping that fusion will happen by next
Spring. I started him on some Hyalun and that is really making a difference. He is also on Adaquan, which helps keep him comfy enough to work, too. I have been told it takes about a year for fusion to happen. One thing I have noticed is he now stands straight on the left leg instead of having it being twisted to the outside all of the time. And his hoof was always growing a little angled when you look from the front, but it appears that it is growing down and straighter now. He is very willing to stand on his hind legs for the farrier and the suspensory that was so badly torn in the left hind is doing wonderful now (knock on much wood). I have him doing more circle work now and a little leg yielding, but being careful. I am very glad to have done the CT, it is amazing how much more comfortable he is! Will post an update this winter when we are a little further along with this!

Plumcreek
Oct. 30, 2005, 07:57 PM
Glad to hear things are going well. So nice to keep a good horse from becoming an expensive, painful pasture ornament. The thing that gets me is, injecting the hocks will help very litle if the problem is a too tight or scarred down cunean tendon. One significant clue, in the horses I know about, to whether the cunean tendon is the problem, seems to be narrowing of the joint space. My large gelding had clean joint X-rays, but progressively narrowing joint space, and back pain. His cunean tendons were so tight they made a zinging sound when cut, says the vet.

Warmbloodmom
Nov. 28, 2005, 02:45 AM
Wanted to give an update on my gelding. It has been 3 months now since the cuneon tenectomy and he is doing the best he ever has! He still has stiffness in hocks when beginning to work but very quickly warms out of it. His left hock has extreme narrowing in lower joint space with a spur so it is a given he will still have soreness till fusion happens but before the surgery he NEVER warmed out of it. He is as happy as can be and sometimes a little too happy under saddle now! Will update again at the 6 month mark. Will do xrays at the 1 year mark to see if fusion has happened or not.

Warmbloodmom
Jan. 6, 2006, 11:59 AM
Wanted to update on my gelding with cunean tenectomy. He has been a little short in the left hind leg trotting in circles lately, fine on straight line, so wanted to check it out. While trying to block the lower joint (which he is terrible with doing, hates needles, kicks!) he never flinched (no sedation) and the vet could not get a needle into the back of the joint without them bending in half. Appears that the back of the joint is almost fused, she finally found a very small spot after 4 bent needles and (still a very unflinched horse) to get the needle into. He went sound after blocking so fusion is progressing quickly. I think the cunean tenectomy helped him to use himself better and has helped with fusion. Injected with a small amount of steriod to calm down the inflamation so he can continue to work on it and fuse. Will xray in a few months to see where he is at.

Plumcreek
Feb. 6, 2006, 02:23 PM
It seems the original Cunean Tenectomy thread (containing everyone's research and answers to questions by vets) has been purged in a general COTH housecleaning.

With help by furlong47, the Google cached version was located and saved to my hard drive. (The google site only gets page 1). I am pasting the relevant passages (minus the chit-chat) below:


Plumcreek
Working Hunter
Posted Aug. 30, 2004 09:44 PM
I promised this thread awhile ago. I can't believe this procedure is not more widespread. Perhaps this surgery works for my vet because the hard ground out West helps to uncover hock soreness earlier and and the surgery works better on hock joints that are not horribly damaged. Here goes...

Hand out from my vet who does this surgery a LOT:
CUNEAN TENECTOMY
Six hundred million years ago the horse had three toes. To improve his ability to survive, the horse evolved to one toe which gave an extra joint and thus the horse could run faster to avoid predators. Anatomically, in all mammels, muscles become tendons which attach to bones and cause the bones to move. For example, the tendons on the back of your hand are continuations of the muscle in your forearm and attach and cause your fingers to move. The second toe of the horse was formally on the ground but is now located a great distance above the ground on the inside of the hock. The cunean tendon, still attached to this second toe bone, now courses at a very oblique angle, almost 90 degrees, and still connects the higher muscle to the former toe and lower row of hock bones. When the limb is moved forward, the lower row of hock bones are pulled by the cunean tendon. The upper row of hock bones are not. Thus, there is a torqueing motion between the upper and lower rows of bones with every step. Removal of a section of the cunean tendon (which has no current purpose) will stop the movement of the lower row of bones and thus stop the torque between the two rows of bones in the hock joint. Cessation of the torque decreases the inflamation and one major cause of arthritis. This, then, gets at the major cause of DJD conditions.

The removal of a section of the cunean tendon is a procedure done in sterile conditions using a tranquilizer and local anaesthetic. A 1/2 to 3/4 inch piece of the cunean tendon is removed and any associated scar tissue is removed to assure that the remaining end of the Cunean tendon is completely free. Patients are worked lightly for 2 weeeks, then return to previous exercise levels. 90% of the patients which have been treated at our Equine Clinic resume full work in 14-28 days and recurrance of documented pain in the distal hock region occurs in less than 5% of the patients over the patients' life time. Most horses are 70% improved two weeks after surgery and the last 30% improved by 5 months post surgery. With accurate diagnosis and surgical technique, the reaults of a cunean tenectomy is very therapeutic and long lasting.

Post surgery instructions: 2 gms bute/day for 2 days. Back to light work the day after the surgery. Light work until bandages come off in 10-14 days, then whatever work your horse did before surgery.

My personal experience with CTs:
Horse #1. 5 year old QH gorgeous hunter with dainty hocks. This horse could not make the distances, was a flat jumper and chicken-hearted stopper; needed a perfect distance every time. Slight lameness on circles led to X-rays which revealed moderate arthritis w/ ragged joint surfaces. 3 weeks after CT surgery, horse almost jumped me out of the saddle the first time. This gelding quit stopping, was sound with no maintenance, and became a winning low hunter. 4 years later, passed pre-purchase hock flexions at Calif. Univ. Davis Vet School with no request for X-rays (and I did tell them about the CT surgery). Horse #2. Hot tempered 6 year old gelding with hips not even from a fence accident as a weanling. He was fairly sound, but would blow up and buck when ridden in deep sand footing spots, or for just any reason. X-rays showed some bone spurs in his hocks at the CT crossing point. CT surgery uncovered a lot of adhesions between the C Tendon and hock joints - sticking the CT firmly to the joint and accerbating the hock joint torqueing effect, and probably causing the bone spurs. After CT surgery, he quit blowing up and would canter much more collected and relaxed, plus was sounder in hips. Horse #3. Friend in other State had tall gorgeous semi-sound 7 year old gelding with really terrible hock X-rays. Horse was agitated and jumped low fences flat, could not collect at the canter. Friend sent him to my vet for CT surgery and I kept him for awhile afterward. He became sound, collected and relaxed, even though he always had a big motor. Friend sold him soon after. I almost died a year later when I looked at the AQHA Youth World Show results and saw him 4th out of 60 in Hunter Hack, placing over very famous horses. Horse # 4. My large green 5 year old gelding was a lot of horse, good mover but quick and bucky after low fences. He had to hop with his hind end to change leads. Hock X-rays were normal, but 2 years later X-rays showed joint narrowing, and he had back X-ray changes under the saddle and soreness, plus 2 fibrous cysts on spine over X-ray changes. When vet did CT, cunean tendon was so tight it went sprrooonnng as she cut it (he had straight hind leg conformation, which tightens the tendon against the hock joint). After resuming work, he suddenly was relaxed and soft after fences and could get his changes without hopping behind. Doughy cysts on spine went away in 5 weeks after being there for years!! Added shockwave treatment on spine where the cysts were (probably from the very tight tendons that affected how he used his back) and back soreness went away for good.

Cost of CT surgery is around $1000. in 2006, by my vet.

Bea
Premium Member (4/05)
Posted Aug. 30, 2004 11:33 PM
Many thanks, plumcreek. I've been waiting for this post. I nearly sent you a PT reminder.
Equuleus
Working Hunter
Posted Aug. 31, 2004 01:20 PM
This is all I could I find:

"Cunean tenectomy is one of several surgical procedures that have been recommended for treatment of bone spavin. The cunean tendon is a branch tendon from the tibialis cranialis muscle that goes across the inside of the leg and across the joint. When the tendon is cut it is thought that there is a reduction in the rotational and shearing forces of the distal hock joints. This procedure does not fuse the hock joints, just remove some of the source of trauma. This procedure is usually used in combination with joint injections. The prognosis if favorable for alleviating pain but the data on its efficacy is sparse and inconsistent."

I dont get how that tendon can be the cause of the problem. It doesn't affect the fusion process. My understanding was that the pain was from the lack of cartilage within the joint space.........
Posts: 490 | Registered: Dec. 04, 2002

monstrpony
Grand Prix
Posted Aug. 31, 2004 01:28 PM
Has anyone been able to follow this really long term? I've heard that this is old technology, and that after several years, the destabilization of the hock catches up with the horse. But I've also talked to people who believe in this procedure totally.

Would love to hear info and opinions on both sides.

___________
sk_pacer
Working Hunter
Posted Aug. 31, 2004 01:37 PM
quote:
--------------------------------------------------------------------------------
Originally posted by monstrpony:
Has anyone been able to follow this really long term? I've heard that this is old technology, and that after several years, the destabilization of the hock catches up with the horse. But I've also talked to people who believe in this procedure totally.

Would love to hear info and opinions on both sides.
--------------------------------------------------------------------------------



Wish you had posted before I did...could have tried answered this at the same time

Have raced horses that had their jack cords cut. They seem to last as long as their counterparts. Oldest horse I saw still going that had this procedure done was 17, and on the fair circuit, and still winning - if I remember right, this horse was done at the same time I had one done and both horses were 6ish at the time. Sometimes, now, they do freeze the jack cords, rather than remove a part of them. The tendon DOES regenerate after a period of time, so it isn't as if the horse is missing a piece of the tendon forever.

Bea
Premium Member (4/05)
Posted Aug. 31, 2004 01:57 PM
Hey Gargamel, the impression I'm getting from reading is that the thinking behind this procedure is that this tendon causes the lower joints in the hocks to move. It wraps from the back around the side to the front so besides general movement (a compressing effect on the joint) it also has a torquing (twisting) effect. By removing it, movement and tension in those joints is reduced. One reference I read describes a vet saying when he cut it the tension in it was so great it practically zinged. As we know, if the joint is lacking fluid or cartilage, hock pain is caused by, besides general inflammation, bone rubbing on bone because the space between them becomes so small. That's why fusing works, because it stops the pain from bone moving on bone. So I think they're saying that by cutting this tendon the joint is no longer as compressed or gets twisted, the joint can open up, so to speak. Perhaps a bit like cutting the tendon on a foal with contraction, once the tendon is cut, the foal's leg can straighten up. Does that make sense? Plumcreek can probably better explain it than I. I'm having a little trouble getting my head around removing a piece of tendon that's part of the horse's mechanical system. Does it destabilize the joint? On the other hand, I guess a foal whose tendon has been cut is not considered destablized.

Plumcreek
Working Hunter
Posted Aug. 31, 2004 02:13 PM
I am just an owner who has had 4 horses done, not a vet, so bear with me. The best I understnd is that cutting CTs can aleviate pain two ways. 1. The tendon sliding over the outside front joint surface can irritate and form scar tissue/adhesions like my horse #2 or be very tight and cause joint compaction like my horse #4. 2. The torque (grinding action) in the joint caused by the flexing of a too-tight tendon running diagonally across the joint, dramatically increases inflamatin in the joint. Inflamation promotes bone spurs, etc. Without torque (after the tendon is cut), the inflamation subsides enough to end most, if not all, of the pain. I know nothing about fusing. I think there is probably a large outcome gap between horses that get a CT with mild pain/radiographic changes, vs horses that only get a CT when they are beyond hope. This could account for the difference in opinion between vets.

I have asked my vet if existing radiographic joint changes would reduce or remodel with lack of inflamation after a CT. She said she did not know because these horses seldom come back for for more X-rays, which leads me to believe they no longer have a problem.

CTs are in the 'little bag of tricks' of some winning western pleasure horse trainers (the deep hocked thing) and they also call it "cutting the jack cords." There also is one well known quarter horse trainer in Florida who became well known by buying sore hocked horses and having CT surgery done on them (she said she had accesss to a great track vet at the time). She then returned these now-sound horses to the show ring to win with her clients on them.


Plumcreek
Working Hunter
Posted Sep. 01, 2004 12:22 AM
quote:
--------------------------------------------------------------------------------
Originally posted by Bea:
"MANAGEMENT OF BONE SPAVIN Shane M. Miller, DVM, Diplomate ACVS Littleton Large Animal Clinic, Littleton, Colorado..... Performance ability improved with surgery in 80%, was unchanged in 18% and worsened in 1%. "
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Differing from the above paper citing an 80% success rate (given in 1997),
LEP relates (with prudent second party conversation caveat) that Dr Miller told her friend that there was a 30-40% failure rate (which translates to a 60-70% success rate) and that injections or other therapies should be used until they were no longer effective before this surgery was done. I wonder if the 7 year time gap has resulted in a success rate change?

My vet, in the hand out paper, cites a 5% lameness reoccurance rate (translating to a 95% success rate). I do not know the numbers involved, but think they are significant. If my perception is correct, in this clinic, CT surgery is done much sooner - not waiting until all other methods no longer work. This then, could be one large difference in the success rate and veterinary perception of the surgery: how long one waits before doing it, and how much damage has occurred to the joint surfaces.

Plumcreek
Working Hunter
Posted Sep. 01, 2004 01:17 PM
On reflection, I think we can get answers to the questions members here have. I am interested also. Two vet clinics specializing in lameness, here in Colo, have been performing this surgery for many years on a large number of horses. Let's put together a short list of questions for them to answer.

Plumcreek
Working Hunter
Posted Sep. 09, 2004 11:14 PM
We have answers! First let me state that these are not back alley Dr. Feelgood vets performing CT surgery. Littleton Large Animal Clinic (LLAC) 303-794-6359 is one of the largest and most prestigeous private clinics in the country, on par with Rood and Riddle in Kentucky. They have 9 vets on staff. Dr. Shane Miller is their surgery specialist. All three of their founding partners have been President of the AAEP, and Dr. Marvin Beeman is widely known for his "Form to Function" conformation lecture. Colorado Equine Clinic (CEC) 303-791-4747, was founded by Dr. Barbara Page, who started her career at LLAC. CEC is a two vet clinic with full surgery facilities, specializing in lameness of the performance horse. She also heads a foundation studying wild horse vs domestic horse hoof structure. Both these clinics are located South of Denver, Colo. in an major area of high level horses of all types.

Dr. Page's staff gave me an outdated CT surgery cost figure. Currently she charges $750. (soon to be $800.) Dr. Miller quoted $800 - $1000.

QUESTIONS:
1. What is your general success percentage with CT surgery? On appx. how many horses is this figure based?
DR. PAGE: With our surgical and post-surgical method, 90% of the horses resume their athletic pursuits at the same or higher level. Horses that return for lameness are almost always lame in a different anatomic location based on diagnostic nerve and joint blocks. Have done about 40 horses/year for 25 years = 1000 horses.
DR. MILLER; 75% improve up to 3 years, 30% may still require intra-articular injections. (Did not give number of horses, but based on 285 in his 1999 study, number should be near double by now.)

2. Are your success percentages with CT surgery based mostly on horses with early or advanced DJD?
DR. PAGE: Early cases have good results right away because the surgery takes the strain off the Cunean Tendon, thus decreasing the pain from that strain. Severe cases with considerable cartilage loss will be 70% improved after two weeks, but the final beneficial response will take 5 months. These horses are in work for that five months and most are improved from before the surgery.
DR. MILLER: Early stage mostly. Does not help near as much on horses with advanced DJD. Need to do it early.

3. Ideally, in what time frame or circumstances would you recommend CT surgery?
DR. PAGE: If the horse is in the heavy part of show season, I may inject the hocks and do the surgery when show season is over. Non-show horses are done when diagnosed with hock pain. If the horse has concurrent problems, I may inject the hocks to assure that the other problems have a successful treatment before doing a CT. Other factore, such as lack of response to other treatments is not a consideration in when to do a CT in our practice.
DR. MILLER: Usually, if joints have been managed with medication once or twice and improve, but duration of effects is not very long, 2-4 months, then I recommend CT surgery.

4. Of horses in your practice that were sound or significantly improved after CT surgery, how many have maintained appx. the same level of hock soundness for Appx. 6 years or longer?
DR. PAGE: 90% of horses will maintain the same or improved level of soundness for 6 years or longer after CT surgery.
DR. MILLER: 75% for 3 years in our case study looking at follow up and success. Would guess 6 years - about 50%. Six years is a long time for athletic use horses.

5. Does CT surgery destabilize the hock joint in any way or will it be detrimental in the very long term?
DR. PAGE: There is no destabilization of the hock after surgery. There is no detriment in the long term.
DR. MILLER: No - Cunean Tendon is not a support/stabilizing tendon.

6. What is the downside and worst case scenario for the horse if the surgery fails?
DR. PAGE: The down side, usually in higher level dressage horses, if the horse is asked for collection and to put more weight on the hind limbs in the days after surgery, is that there can be swelling and edema at and above the surgery site. If collected gaits are started 3 weeks after surgery, there is not a problem. For the first 3 weeks after surgery, exercise is an important part of the post-surgical treatment for best results, but that exercise, walk, trot, and canter, should be done only on a long frame. I have not had infections or any other problems.
DR. MILLER: Nothing, other than the horse may not improve as much as we would like it to. (Plumcreek here - I did not ask Dr. Miller if he had said "the surgery could fail and the horse would be DONE." I think his answer here speaks for itself.)

7. Would most veterinary surgeons be able to satisfactorily perform this surgery, or does an individual need to do the surgery often to be successful?
DR. PAGE: This is a simple surgery and can be done by most equine veterinarians. As with any surgery, good surgical technique and focus during the procedure is important. The most difficult aspect is in doing the horses standing, which is the method we use. There is some strain on the surgeon because they are squatting down for 2+ hours with their head next to a hind leg, working on the inside of the oposite hock during anesthesia and the surgery itself.
DR. MILLER: Most veterinary surgeons would most likely be able to perform it. It is a technique that has been around for a long time, more than 25 years. However, a lot of DVMs do not feel it helps horses very much. My opinion is that they wait too long to recommend it and don't see good results. The earlier the better!

8. Do you have any referrals for Veterinarians in states other than Colorado who are knowledgeable with this procedure?
DR PAGE: Dr. Scott Linford, Utah.
DR. MILLER: I think we by far do more than anyone - certainly not to say others don't and can't do the procedure, just do not know which ones!

Dr Page wrote an additional note:
In my opinion, and most clients, this is a very good procedure because it removes the original cause of degenerative joint disease of the tarsal/metatarsal and distal inter tarsal joints. This tendon, the cunean tendon, still goes from the extensor muscle to the bone, but that location is no longer in a straight alignmeent to the muscle fibers and muscle contraction. Now the tendon is positined at a very oblique angle to the muscle fibers, almost 90 degrees, because of its present location in the, now, single toed horse. In my opinion, it is a fact that contraction of the muscle will pull obliquely via the cunean tendon, at the attachment of the tendon. That attachment is on the head of the inside splint and the lowest most medial tarsal bone. This causes a rotating of those bones to the bones on top of them with every step the horse takes. It is this regular rotation of the lower bones on the upper tarsal bones which cause the common radiographic changes and tendonitis of the cunean tendon. Removal of a part of the cunean tendon stops this rotation.

It is very important in the surgery tht a 1/2 inch piece of tendon is removed and that the proximal aspect of the tendon is loosened from its location. This will allow, through the light exercise after surgery, for there not to be scar tissue. Scar tissue would negate the surgery and effect renewed rotation of the lower bones on the upper.

Bea
Premium Member (4/05)
Posted Sep. 10, 2004 11:37 AM
Very, very interesting. I'll only read plumcreek's post quickly and need to read more carefully later. My initial thoughts are that it's stated clearly best results are achieved by doing this procedure early. And that, although it's a simple procedure, experience and/or familiarity with it by the vet ensures lack of scar tissue forming which might negate the effects. And that if I lived near Dr. Miller, I would be on the phone asking his opinion re this procedure and my horse in particular.

But no adverse effects leap out at me. Interested in others' thoughts.

MsM
Working Hunter
Posted Sep. 11, 2004 09:59 AM
Interesting! It would also be great to get some feedback from a vet who doesnt recommend this procedure to get a detailed WHY.
Posts: 390 | Location: CT | Registered: Aug. 22, 2000

schwung
Working Hunter
Posted Sep. 21, 2004 02:22 PM
I have been following this thread with interest. I have a 15 year old mare with a bone spur in her upper hock joint that despite injections and oral supplements will not get sound. I am really having a hard time with the idea of retiring her as she's such a talented mare.

Anyway, I asked two vets in my area about this. One basically shunned it as "old school" and a "bunch of crap that doesn't work". Also said no one around here would even do it, you would have to haul to Washington State Univ. to have it done.

The other vet (my regular vet), was familiar with the procedure and actually used to work with one of the Colorado vets work mentioned in this thread. He said it was mainly done in Colorado at Littlefield, but said that was a very large and respected place and he didn't necessarily discount their work. He said the theory was interesting and made sense to him, and couldn't necessarily answer why the procedure wasn't done more commonly. He said he used to see it used a lot with Saddlebreds and other gaited breeds. He said that he was taking an online course right now in hind limb lameness and that he would ask on their message board about the procedure. I am very interested to hear what he finds out. I would also like to to email the vet with the 90% success rate and find out if my mare would be a good candidate based on her specific problem.
Posts: 846 | Location: Monroe, WA | Registered: Jan. 03, 2003

Plumcreek
Working Hunter
Posted Sep. 21, 2004 04:11 PM
quote:
--------------------------------------------------------------------------------
Originally posted by sk_pacer:
Cunean tenotomy (the term I learned years ago) is frequently performed on racing Standardbreds that are starting to show signs of jack trouble. Removal of a section of the tendon reduces the inflamation and therefore the pain, while these tarsal bones are fusing.

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Since posting, I have learned that, many years ago, the procedure involved only CUTTING the tendon, not removing a section, and was called a 'Cunean Tenotomy' as sk_pacer said above. Simple cutting would allow the tendon to grow back together and not solve the problem. I believe the Colorado vets have refined Cunean Tenectomys so they are more effective at reducing inflamation in both upper and lower joints, thus reducing pain. My vet, Dr. Page, gets her fingers inside the incision and feels all around to loosen existing scar tissue or adhesions between the tendon sheath and the surface of the hock joint capsule (something a horse owner really doesn't want to watch). This was not done years ago. I would guess that the vets who think the procedure is old school or a bunch of crap, may have gotten their info from the earlier, not very effective, 'Tenotomys', any have NO experience with the current Tenectomy methods used in Colorado. If your vet dismisses CTs, ask how many they have done or have knowledge of, using modern methods, and followed the horse's progress afterwards.

My trainer's barn is serviced by both vet clinics cited. She has a barn full of teenaged AA hunters who had CTs years ago, and are still going sound. Hock problems, joint supplements, HA injections, et cetera, are just not a topic of conversation in this barn. Additionally, my own horses I described never were fed joint supplements, had additonal injections or anything other than a CT.

I would not be discouraged by the vets' statement of 'earlier the better'. My friend's horse (#3) was a TRAIN WRECK. He was so sore in his entire rear end from compensating for his hocks, that he got "The Works"; CT surgery, internal stifle blister, and estrogen shots in his muscles. Two months later, he was a new horse, and judging by 50 subsequent points earned in QH over fence classes (which would take a LOT of showing) he remained sound.

Like I said, and the reason for this topic, I am floored that this procedure is not done more by performance horse lameness vets. I can only guess that the 'throw away horse' mentality prevails among trainers ("Gee, your horse is broken. Can't afford a new one? Too bad, see you around.") Trainers are more interested in commissions on new horse purchases than directing vets to search hard for existing solutions to hock problems. Vets find repeated injections easier than traveling across the country to learn a career saving surgery for horses. (Rant over, feel better now).

Bea, hocks are hocks. Sound, pain free hocks, can take more force in a stop or spin and allow the horse to give a higher scoring run. I don't think reiners are any different. I took Dr. Page to watch the open senior horse class at our local reining futurity (RMRHA Summer Slide) a few yers ago. She had never seen a tough reining. She sat there during the warm up and pointed out which horses were sore hocked, just from the way they used their rear ends. Of course, I had no way to verify if she was right, but she usually is.

Equuleus
Working Hunter
Posted Sep. 21, 2004 07:58 PM
I wish there was a vet closer. I am having my horse's hocks done Sat and I will ask but I already know the answer. this vet is already annoyed with me trying to find a way other than injections and Legend to address the arthritis.

I wonder if any of this has do with the fact that if they do the surgery they would not make as much money as they would with frequent injections and Legend?? Just seems SOO weird that there are such opposite views. My vet is a surgeon as well and has never mentioned this to me as an option. My horse is rather young and has DJD of the lower hock joints and would seem a good candidate for the surgery.

Bea
Premium Member (4/04)
Posted Sep. 23, 2004 01:56 PM
My very nice surgeon just called. He knows of Dr. Shane Miller and has met him briefly. He was not at all appalled I asked him about this. He wasn't aware that the procedure has changed, as Plumcreek posted, from simply cutting the tendon to removing a piece of it. He has done the old procedure, only on cadavers, and in fact taught it to vet students on cadavers when he worked at universities, Tufts, and I think IL. Said off the top of his head that that change made sense.

His immediate thought was to use it after injections etc have stopped working. Seemed interested to hear perhaps it's best done not as last resort.

quote:
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Originally posted by Bea:
Gargamel, I'm gathering it's well worth mentioning Dr. Shane Miller's name when broaching this topic. I'm learning he's highly regarded and well known.
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Also worth mentioning is the name 'Littleton Large Animal Clinic' and Dr. Marvin Beeman (one of the, now retired, founders). They all are very politically active in vet circles and carry a lot of weight. Dr. Beeman is also well known for being a current Master of Foxhounds and the son of the late, venerable George Beeman, famous Huntsman of the Arapahoe Hunt in Denver. (I hope I got the Huntsman/Master titles right. Hunt prople, let me know if I did not.)

Gargamel
Working Hunter
Posted Sep. 23, 2004 06:22 PM
Sigh...........

The usual response: "That procedure would only be considered as a last ditch effort and there are no more options."

Oh well. I will ask her partner and surgeon the same question on Saturday. Just another Legend shot for now!!!

Bea I sent you a PT.

Thanks for the info Plumcreek. I am seriously baffled by these radically different ways of thinking. Either completely for or completely against. No imbetweens

Plumcreek
Working Hunter
Posted Oct. 25, 2004 02:02 PM
I started this thread by wondering why Cunean Tenectomy surgery was not more widespread, as I am surrounded by horses that "had their hocks done", some many years ago, and are sound today without injections.


quote:
--------------------------------------------------------------------------------
Originally posted by Gargamel:
Sigh...........

The usual response: "That procedure would only be considered as a last ditch effort and there are no more options."

I am seriously baffled by these radically different ways of thinking. Either completely for or completely against. No imbetweens.
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After asking a lot of questions these last few weeks, I now have the answer to Gargamel's, and probably everyone else's, bafflement - incredibly, these two Colorado vet clinics may be the ONLY ones doing a changed, new and improved version of CT surgery that actually works very well to significantly reduce or end hock pain. Since they are privte clinics, not teaching hospitals, knowledge of their new and effective methods is not getting out to other vets.

After reading this thread, if you ask your vet about CT surgery, you and your vet are not talking apples to apples. You are referring to the improved, effective CT surgery as descrbed by these Colo vets, and your vet is referring to the old and abandoned snip-the-tendon procedure they learned in school. But, you both are saying Cunean Tenectomy. I would guess that many vets do not like to believe their clients are more informed than they are.

So, when you talk to your vet about CT surgery, you ned to emphasize that you are referring to a changed and improved procedure as done in Colorado by LLAC and CEC Vet Clinics. That these vets are getting 70 - 95% significant improvement rate in long lasting hock soundness and back strain reduction. And, that this new procedure may be worth their time to at least call about??

I realized the above after reading that Bea's vet, a former surgery professor from Tufts, only knew the old original procedure. Then I called New Bolton (U of Penn Vet School) and got the same response as Gargamel did from her vet. They only know the old version of CT and almost never use it. The surgeon I talked to said they have much better options these days like injections and ultimately fusing the lower hock joint with lasers ( general anesthesia and $$$$). If major vet schools aren't aware of the improved procedure, probably independent vets are not either.

For those who are still hazy on the difference in surgeries, here is my layman's take on it:
1. The original Cunean tendon surgery, simply snipping the tendon, had spotty results. If the cut tendon had no adhesions and remained free, results were excellent and long lasting. If the tendon grew back together, the horse was better for awhile. If the tendon was firmly stuck to the hock joint by adhesions/scar tissue (as a result of inflamation caused by rubbing against the front of the joint), little or no improvement was seen. 2. Hock injections came along and replaced CT surgery. 3. Dr. Beeman and later Dr. Miller at Littleton Large Animal Clinic, Denver, continued to include Cunean Tenectomy surgery after seeing better results (70% significant improvement) by removing a segment of the tendon and performing the surgery early, not as a last resort. 4. Dr. Page learned this method at LLAC, then started her own clinic, Colo Equine Clinic (CEC), Denver. Besides realizing DJD could possibly be minimized by recommending the surgery even earlier, as soon as hock issues were confirmed, she made further improvements. She manually breaks loose any existing adhesions/scar tissue between tendon and hock joint, so there will be no chance of continued torque on the joint, and increases exercise from hand walking to cantering during the two-week healing period to insure new scar tissue does not develop. These final changes may be the key to Dr. Page's stated 95% significant improvement rate.

Colorado Vet Clinics that do Cunean Tenectomy surgery:
Colorado Equine Clinic - Dr. Barbara Page
303-791-4747
Littleton Equine Clinic - numerous vets there
303-794-6359
Vets elsewhere than Colorado that do the advanced version of Cunean Tenectomy:
California - I believe vet surgeon Dr. Shane Miller from Littleton Equine has moved to a well known vet clinic in Oakdale, but not sure.
New York: Dr Bassage at Rhinebeck Equine (did Bea's mare)
www.rhinebeckequine.com (http://www.rhinebeckequine.com)
Wisconsin: Dr. Langer at Wisconsin Equine Clinic in Oconomowac (Warmblood Mom's horse)
Massachusets - Dr Seal, Meridian, Mass.