So one of my clients horses, a wonderful, incredibly well built athetic sane and talented 3 yr old TB was diagnosed with a torn meniscus today.
X-rays showed narrowing of the joint space, and ultrasound confirmed (as much as can be in that area).
We injecetd with HA/anti-inflamatorry steriods today, are continuing stall rest/handwalking and are considering the different treatment options.
At this point, it sounds like we have 3 main treatment options. IRAP, stem cell and arthroscopic surgery...though my understanding is that the surgery is essentially more of a diagnostic tool then a treatment (though they could clean up the area if needed while in there). Essentially the surgery will run about 3k, and then any treatments done would be in addition to that...with stem cell also being in the 2500-3000 range, and IRAP closer to the 1500 range.
I am hoping that the wealth of knowledge here can share some insight! Anyone else dealt with this? What treatments have you done? Is the surgery really worth the money? Any other treatments you have added to it (adequan, etc) or other recommendations? Anyone ever used acuscope to assist in healing?
The more information we can gather at this point the better! We were hoping for this guy to have a career in low-mid level dressage, do trails, etc-but for right now the goal is to keep him comfortable and see what we can do!
interleukin-1 receptor antagonist protein - it's used in osteoarthritis (OA) treatments. IL-1 is a cytokine involved in inflammation, and since OA is currently considered to be a non-specific inflammatory disease of the joint, it is thought that by "neutralizing" this cytokine, you can reduce the inflammation. I have no idea about it's efficacy, though.
Jingles for the pony & owner! This is a tough one. Unless they repair the meniscal tear, OA will continue to develop. In other animal models (e.g. dogs), I think OA lesions begin to form within a few weeks, so I would assume the same in the horse. Considering the horse already has radiographic evidence of JSN, OA is already in the advanced stage.
Treatment depends on how much $ the owner is willing to spend. None of those treatments will reverse the damage or even slow it down. You can probably make the horse comfortable by IA injections and other therapies (adequan, bute, etc). Stem cells are new and unproven to help, but they also don't hurt as far as anyone knows. I, personally, would avoid surgery. It's too risky and costly, IMO, for something that isn't going to attempt to repair the damage.
I too have never dealt with that in a horse but I remember clearly when they suspected I had torn my meniscus that they said it is something that never heals. Thankfully it wasn't torn but if it had been surgery would have been my only recourse. I imagine the healing properties or lack of in this case are universal for the different species.
Another one here drawing parallels between species, but I know several humans that have had this problem and surgery had been indicated as the best, if not only, treatment.
They were told that if they did not do surgery - which was quick and virtually painless for all involved - that the meniscus could potentially "shatter" - or break into more severe bits. By doing the surgery to remove the damaged, smaller area it preserved what was left of it.
Hopefully someone will chime in with equine, not human, experience.
agree with above. My mom tore hers in BOTH knees (yikes!) and surgery was really the only option. Recovery was terrible for her (however, she had also torn the ACL and MCL((i think)) in both. It was a while back so my facts could be a little off).
Personally, I would probably go with the surery--IF its the same surgery done in humans. (Mom is doing well these days, not able to run the 10 miles/day she used to, but doing 2 aerobics classes a day and skiing in winter!)
Had a horse with torn meniscus. Who knows how long it had been torn before I got the ride on him, I'm thinking a year, then I got on him and said, "whoa this needs looked at". He had surgery done, an excellent recovery (which he showed me by having a jubilant bucking spell once I began riding him again). He was on Adequan before and after the surgery, and last I heard he is doing quite well.
So I would definitely go with the surgery, keep him on supplements and your goals with him seem incredibly reasonable from what I have experienced with meniscus surgery.
I have dealt with a torn meniscus in not such a great way. Horse was lame for a loong time even with stall rest and injections. Got an ultrasound and they found a torn meniscus. We tried shock wave treatment and more rest but he was the same even after 6 months. Finally decided to have the operation on the stifle to see what was going on and they found that the meniscus was torn as well as the collateral ligament to the stifle. The torn meniscus was secondary to the collateral ligament tear which the surgeon said was not visable on a ultrasound because of the position of the ligament. Anyway, surgeon said no need to clean up meniscus because of the collateral ligament. Stitched up horse and said if he was insured, I could put him down and claim him. She said it was the arthritis that would do him in. I decided to keep him and turn him out to pasture. Five years later, he still has a pretty significant hitch to his trot. He walks sound. It was a heartbreaker to say the least. He was a very talented event horse. Anyway, I would do the surgery sooner than later so you can get an idea what you are dealing with. I think I paid close to 2500.00 at Mid-Atlantic in NJ. Good luck. I hope you just have a meniscus tear. Although they are pretty substantial, at least you might have a shot of some sort of soundness if it is just that and they go in an clean it up.
I'll assume that a torn meniscus is in the stifle of a horse and comparable to a tear in the meniscus of a human knee. If so, I just recently had surgery for multiple tears in my left knee. I also have a chronic tear in my ACL and no intact PCL left - it ripped apart when I was bucked off a horse and slammed down on landing. Surgery was done 3 1/2 months ago and I have been running again for a month. That's what surgery can do, with a good surgeon. Before that, I could barely walk any sort of distance. So I think you should do surgery or it will never heal, at all.
Basically the meniscus is spongy material that seats the bones in the joint. It is cartilage-like material, but softer than cartilage. When there is a tear , the tear acts like a pebble or grain of sand in there grinding away causing pain, inflammation, and definately arthritis. If you trim that part out then things get happy again. So you may not have as much cushion which can lead to later arthritic changes, but the "pebble" left in there will definatley cause arthritis. You can actually survive without any meniscus, you just need to be smart with your training schedule, etc.. Do the surgery.
I have dealt with a torn meniscus in not such a great way. Horse was lame for a loong time even with stall rest and injections. Got an ultrasound and they found a torn meniscus...
Yep. Same thing happened to my Gus here in the spring of '08. He had had previous stifle issues on the LH, but never on the RH.
Anyways, after stall rest and bute doing nothing, we trailered him to the specialist. He had torn some ligaments and had a slight tear in the meniscus. Lovely.
He was not insured (heck, too old for that anyways, as he was 18 at the time of that injury) so all I could do for him was stall rest. We did about three months or thereabouts of that and then turned him back out.
Had A LOT of setbacks. Still having issues. But he was really good for about 8 months. Since May, we've had on and off issues not always dealing with the stifles. But he busted both hinds here back in October. I'm still dealing with that...
It's very depressing and unfortunately stifles can be a career AND life-ending issue. We almost put Gus down back right after his "accident". But I thought I'd give him another couple months, as long as his pain is manageable. Thankfully, for the time being it is. Still not sure if we'll be able to rebound from this last incident though.
We dealt with this. It was a minor lesion on the meniscus (medial horn). Vet recommended shock wave. Shock wave produced clinical improvement but not improvement in the ultrasound image. (apparently thats not uncommon). Then we did PRP and saw a big improvement. The lameness went from a grade 1 to just a few bad steps every once in a while. Good Luck!
I manage a horse rehab center and just finished treating a horse with a torn meniscus. Surgery is where you want to go. Then follow up with IRAP unless surgeon finds tendon or ligament damage then you want to go with stem cells. Shockwave helps with pain from the injury. I highly encourage you to look into aquatred therapy. The swimming is a great way to keep the area moving and the horse sane while the area heals but minimizes any concussion and inflammation. I can recommend several places if you will tell me your location. Best of luck and please let me know if you need guidance!
"ronnie was the gifted one, victor was the brilliant intellect, and i [GM], well, i am the plodder."
I'll second what alteringwego said. My mare tore her meniscus (medial meniscus ligament) in Jan. of this year at age 14. We actually did all three treatments. Initial arthroscopy to clean up the abraded ligament, then PRP immediately after surgery, followed by a series of three IRAP injections during rehab. Her surgeon said it was one of the cleanest meniscal surgeries he's ever done. The mare was in stall rest/rehab/handwalking for 6 months before starting back under saddle (she was my ammy eq horse prior to injury).
Her stifle healed well and her joint is back 100% after the surgery, treatments and rehab. I can't comment on how her career/usefulness has been post-surgery because she's since been retired due to another non-stifle injury. Surgery, IMO, is definitely the way to go and worth it on a horse with a long life ahead of him.
Thank you all so much for the replies-and please keep them coming!
We are located in Reno, NV-the vet clinic we have been using is Comstock Large animal, more importantly the vet/surgeon we are using is Dr. Shane Miller.
Initially the impression I recieved was that surgery really was almost entirely diagnostic, and while they were in there getting a better look at what was going on, that they clean up the area. I plan on calling the vet tomorrow after the feedback from this thread-it definitly raises some new questions!
alteringwego- I would love some information on any aquatred therapy that may be in our area, and also have you dealt with any meniscal tears that have not had surgery performed-if so, what were the outcomes?
Yes, initially arthroscopy is diagnostic in that without it the vet cannot see the extent of damage or integrity of the cartilage. At least, this is how it was presented to me as well, I am certainly no surgeon. When my mare's stifle was done, our surgeon was able to go in, look at the damage (no cartilage damage for mine), and "clean up" her ligament.