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Cunean Tenectomy-Anyone have this done?

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  • #21
    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:

    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:
    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.

    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.
    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

    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.

    Working Hunter
    Posted Aug. 31, 2004 01:37 PM
    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.

    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.

    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.

    Working Hunter
    Posted Sep. 01, 2004 12:22 AM
    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%. "

    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.

    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.

    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.

    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.

    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.

    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

    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

    Working Hunter
    Posted Sep. 21, 2004 04:11 PM
    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.


    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.

    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.

    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.

    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.

    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.)

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

    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

    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.

    Originally posted by Gargamel:

    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.

    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
    Littleton Equine Clinic - numerous vets there
    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)
    Wisconsin: Dr. Langer at Wisconsin Equine Clinic in Oconomowac (Warmblood Mom's horse)
    Massachusets - Dr Seal, Meridian, Mass.
    Last edited by Plumcreek; Oct. 29, 2013, 01:24 PM. Reason: adding vet list
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