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stifle procedures?

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  • stifle procedures?

    Hi all! I was hoping to hear from those of you with experience or input on some potential stifle procedures. Here's what's going on...I have a four-year-old mare (quarter dutch warmblood, eighth TB and the rest Arab). She's had issues with her stifles locking up since she was about 2-2.5 yo. I've done a ton of hill work with her, she's turned out 24/7 on hills, and I lunge and ride her properly (at least as much as you can for a young horse without frying their brains! But I make sure she's using her hind end properly). I've put four shoes on her to provide some support and have had her on a six week course of estrone sulfate injections. The shoes seemed to make an amazing difference, however, after about 5 weeks she's as bad as ever with locking up. The estrone injections don't seem to have helped. The vet suggested the next step would either be stifle blistering or splitting. He also mentioned completely severing the stifle tendon. I plan to do dressage and event my mare.

    So, what are the advantages/disadvantages of the procedures? Is one generally tried before the other? What about risks, cost? I'd just like a little more knowledge to take with me when I get a second opinion. Thank you!

  • #2
    Just out of curiosity, for how long have you been doing the exercise w/ her? Also, I believe the exercise work should be done on straight lines and lunging is not good for this situation. The physical therapy can take months of time.

    Re the alternatives, blistering would be the next option; surgery last. The first is presumably less costly and less risky. Splitting the tendon is the more "current" process, severing it is the older method. I have also heard but can't verify that acupuncture may help.

    At this point, I would just get the second opinion, hopefully from a vet or vet school that has expertise in these cases. You might also want to be sure that there isn't something else going on in that area... good luck.
    We don't get less brave; we get a bigger sense of self-preservation........


    • #3
      I can totally sympathize with your situation. My 7 yr old gelding had mild intermittent upward fixation since I got him as a 4 yr old. We tried conditioning, cavs, estradiol, etc. He'd get better and then plateau. I started to notice that it was usually when his dressage work was increased that he would get more stifly. Eventually he got back sore as well. My vet recommended the splitting and I took him into our teaching hospital for a workup. At first, they agreed it was just UFP and we made plans for the splitting surgery. Almost as an afterthought, I asked them to take rads first just to make sure there wasn't anything else going on. Turns out he had OCD on both sides. He had no swelling (which I was always told was how OCD would present) and was only a 1/5 lame on flexions on concrete.
      We did arthroscopy and stem cells ~ 4 months ago and he's rehabbing well so far. Hindsight being 20/20, I wish I would have listened to my gut a lot sooner and had him radiographed. I felt like I had done as much conditioning as I could do and he still wasn't 100%.

      As far as treating UFP it that's all it is, splitting was recommended to me as the best of the three treatments (blistering, splitting, and actual cutting of the ligament). I think the main risk of cutting the ligament is the instability / future arthritis. I've known horses that were blistered with good results but I think there's still a risk if the horse kicks or moves during the procedure they can get the blistering agent in the joint. Splitting seems to have the fewest risks and since they can now do it standing, that's the route I would go. My gelding actually had the splitting done while he was under for the arthroscopy. We're just beginning rehab so it's too soon for me to say how that's worked for him (and I probably couldn't differentiate the effects of that vs. the overall surgery).

      Splitting at our hosp was around $1200.

      Hope that helps. Good luck!


      • #4
        Do NOT go to severing that ligament The rate of arthritis later is pretty high.

        The splitting procedure has a very high success rate with a much lower rate of negative issues.

        Any chance you could post a conformation picture and perhaps a close up (hoof, pastern, fetlock, and lower cannon bone) of a hind leg? Make sure she's standing squarely, on a flat, level surface for both pictures.

        No amount of "corrective" shoeing will help if the toes are too long and/or the heels too low (not talking about wedge pads to lift heels, just low heels with flat shoes)
        The CoTH CYA - please consult w/your veterinarian under any and all circumstances. - ET


        • Original Poster

          Thank you all for your input! That's exactly the kind of info I need!

          I've been doing the exercises with her for almost a year and half, and we did a ton of straight line excercises, especially with all of our hill work. A vet suggested we add the lunging in side reins, as well, to get her hind end more engaged. I had x-rays done when she was 2.5 to rule out OCD or other joint issues. I didn't want to push her if there was any chance of it causing permanent injury. I actually had them x-ray her whole hind end to make sure no issues were hiding in another joint.

          I have a consult lined up with a highly recommended vet/surgeon in VA - I sent him all the info today and will send him her x-rays as soon as I get them from the other vet. He's about 2.5 hours away and I don't have a truck and trailor of my own, so I'm hoping he'll be willing to discuss some things with me before I find someone to take me down there.

          If I can make it out to the barn in between storms tonight I'll try to get some good conformation shots. I have some pics of her, but they won't tell you much other than how pretty she is :-) Thank you all for your comments!


          • Original Poster

            Originally posted by mightyarrow View Post
            We did arthroscopy and stem cells ~ 4 months ago and he's rehabbing well so far.
            Glad to hear he's doing well!! It's always awesome to hear success stories :-)


            • Original Poster

              So, some not good news from vet #3. I had a phone consult with him tonight. He identified a "significant" lesion in my horse's left stifle that vet #2 missed. I'm really glad I thought to forward along her x-rays. So, next step is to take my girl down to VA and have this vet examine her, re- x-ray her stifles and go from there. He said there could be two things going on...the OCD and the UPF. He also said that it is possible that the cyst has a narrow "neck" which might make it an incidental finding and not significant in terms of her soundness. Let's hope for the latter, as having to address the cyst surgically would require a much more significant intervention. :-(


              • Original Poster

                I couldn't get to the barn tonight b/c of the storms. This is a confo-ish pic of Nan from last summer. She's about 2 inches taller and much more filled out now, but her hind end confo is pretty much the same, just a little more muscle now. I'll try to get a close up of her lower legs tomorrow. I also added an action shot of her from a few weeks ago...when she can use her legs she's awesome!
                Last edited by seejp083; Oct. 10, 2011, 08:54 PM.


                • #9
                  Awww, what a cute cute girl!!!

                  I will say it looks like her hind toes are a bit long, from what I can see on the RH. Just a feel, it may not be accurate based on this picture.

                  I hope you get the news you want and hope you can take here there soon!
                  The CoTH CYA - please consult w/your veterinarian under any and all circumstances. - ET


                  • #10
                    Sorry to hear about your phone consult but at least you're getting closer to getting some answers. Feel free to PM me and I'd be happy to share more info on my gelding's OCD surgery. In my guy's case anyway, it seems like the OCD and UFP were related.

                    Nan is a cutie!

                    Good luck!!


                    • #11
                      I have a close friend with a UFP horse and the splitting did not help her horse one bit. Apparently he is a 7 on the scale of 1-10 severity. I don't believe there is an actual scale used on these horses - it was just her vet's way of illustrating how bad he is. He locks up really bad regardless of any procedure she's had done. I don't know exactly everything she's done but he's been in several times for various injections and then the splitting. After the splitting I think he was ok for about 3 weeks before it started up again as bad as ever. Cutting the ligament completely is her only option left but I don't think she's going to do it.


                      • #12
                        AT, good point, as I believe the splitting surgery is only recommended for UFP horses who are that way due to having tight ligaments. I think I have that right.

                        The reason is the splitting causes some laxation in the ligament, thereby relieving the issue of it being too tight.

                        But if the UFP is because the ligament is already too loose, then no, this won't help at all.

                        Now, if I have this backwards (I learned all this on EqTrainer's thread), then the surgery causes scar tissue which tightens a ligament that's too loose, so if the UFP is because the ligament was already too tight, it won't work.

                        But, because I think I always thought the goal of the surgery was to produce tightening scar tissue, I think it's the former because I remember being when I found out it was otherwise. Meaning, I think it's because it creates a looseness, therefore only works on tight ligaments.
                        The CoTH CYA - please consult w/your veterinarian under any and all circumstances. - ET


                        • Original Poster

                          Thank you all for your posts! I have an appt on Thursday morning down in VA. Hopefully I'll have some answers after that! I'll post an update... I'll also try to get some decent pics tonight at the barn :-)


                          • Original Poster

                            A surprisingly positive update from today's vet appt! The vet conducted a lameness exam and flexion tests. Of course Nan was significantly better today than she has been for months, but he could still see enough to determine that she was having issues with her stifles locking. Isn't that the way it always goes?! We redid the x-rays of her stifles - the OCD cyst on her left side was gigantic (that according to the vet - it was 3.7mm tall and almost 2mm wide), however the "neck" of the cyst was extremely narrow, which is what is preventing it from interfering with the joint function. So...he attributed her lameness to her ligament issues and not the OCD. She also has a small cyst on the right side, but he said it was insignificant and not of concern. It was also a promising sign that the cyst hasn't changed since the last x-rays from last summer. We went ahead and blistered her stifles - he prefers this procedure over splitting for a number of reasons, all of which were convincing. The procedure went well, and Nan is recuperating in a stall for the night. I'll start walking her tomorrow and have a plan for getting her back in shape over the next few months. Turnout tomorrow, as well. Her prognosis at this point is good. The vet recommended that if the blistering procedure produces good results that I should consider tildren as a final step. Both of which are less expensive than a major OCD procedure. Pretty good news considering how today could have gone! He also had a few suggestions for my farrier (move the shoe further back on her hind feet and shorten up the toe), but overall he said her feet looked good. :-)


                            • #15
                              Blistering is indeed a preferred step before the surgery, so yay

                              Good news!
                              The CoTH CYA - please consult w/your veterinarian under any and all circumstances. - ET


                              • Original Poster

                                Thank you! And thanks everyone for your info and support! It's really nice to hear about others' experiences and to be able to bounce things off of people who "get it!" Thanks :-)


                                • #17
                                  Just came across this thread and saw your lovelyhorse :-)
                                  Hope she has a good outcome!



                                  • Original Poster

                                    Originally posted by cottagefarm View Post
                                    Just came across this thread and saw your lovelyhorse :-)
                                    Hope she has a good outcome!
                                    Thank you! My fingers and toes are crossed for the same lol! I went out to the barn to hand walk her yesterday and am about to head out again to do the same today. Hopefully in about 2 weeks I'll be back to walk/trot with her and maybe even some light trail riding. I'm excited to see how she progresses


                                    • Original Poster

                                      Another update on my mare...almost two months after having her medial stifle ligaments blistered, she's still not right behind. She still locks in cross ties and is really wierd under saddle - I'm not sure how else to describe it, but she's not using her hind end well when I ride her. She looks great on the lunge line, but when you add the weight of a rider she struggles. She is hard to bring to a canter and is almost impossible to keep going for more than a straightaway...she's 4 now so this shouldn't be an issue. She has better days and worse days, but she always struggles when going downhill, even without a rider on her. She still stands super parked out in the field and in cross ties. She is much less fussy under saddle since having her stifles blistered (at first I thought it was because she was more comfortable), but she's almost depressed now. She used to be super spirited, and now she trudges along without much effort toward anything. She's being a good girl, but she has definitely changed. Her back isn't sore and she doesn't have a fever. I have a call into another vet...but I'm running out of money. I have an old retired boy who can't be ridden in addition to my little girl, and two unrideable horses is an awful lot for someone on a single income (preaching to the choir, I know!).

                                      What I've tried:
                                      - 4 different vets
                                      - 2 sets of x-rays of hocks and stifles (identified OCD lesions in both stifles, much worse in left, minimal flattening in right. two different vets say not source of her issues and they wouldn't operate.)
                                      - time off
                                      - hill work
                                      - ground poles
                                      - lunging in side reigns
                                      - shoes
                                      - estrone sulfate (made things worse)
                                      - blistered medial stifle ligaments 2 months ago

                                      When I get a hold of the new vet, I'm going to ask him about EPM and Lyme but I really don't know that I suspect them. I guess I'm just looking for any suggestions or insight. At what point do I cut my losses? She's lovely, but because of her OCD, I don't know that she should be bred, and I'd hate for someone to take her as a companion horse and then try to ride her b/c she looks OK and end up hurting her. I'm at a cross roads in regards to how much longer I can support two unrideable horses...horse ownership is really hard sometimes.

                                      Thanks for reading...


                                      • #20
                                        I'm so sorry! I don't have any brilliant suggestions but will send good thoughts your way that things will turn around for you and her. I had a mare that had ongoing issues and I got to the point you're at now financially. I ended up turned her out to pasture for almost 2 years and then brought her back. She might never by 100% but she was happy and serviceably sound.
                                        When you have your new vet see her, maybe withhold all background info from him until he has a chance to look at her with fresh eyes. I have a friend who's a vet and he told me that he finds it helpful if he has a chance to objectively look at the animal before everyone's other opinions cloud the picture. And I know that's hard with a horse that has a lot of background!

                                        Best of luck to you guys. Time is a great healer and she's only 4