Effusion in stifle + upward fixation of the patella

[Haliburton]

Hello COTHers

TLDR: clean x-rays & some effusion in the stifle + upward fixation of the patella that’s been lingering for the last 8 months, where do I go from here?

Long story:

I purchased a horse this Feb & he had some effusion in the stifle + upward fixation of the patella during the PPE. PPE vet was comfortable in the assumption that it was soft-tissue strain. Horse had been started 6 months prior and wasn’t the fittest so I was also happy with this assumption. Decided to purchase the horse, and hoped that with some time off the joint would heal.

I have been doing not much with him, some ground work, walk/trot long lining in a hay field, bareback strolls, hand walking, etc - I did another lameness exam a couple weeks ago in Oct and to my disappointment the results were identical to the PPE. I did xrays this time where were clean, so vet said “keep doing what you’re doing”. I feel a little deflated from the lack of progress.

So, where do I go from here? Any recommendations of recovery plan to help him heal? At what point do I do more diagnosis w/ the vet? My first thought is to try chiro & body work as I know that’s helped me with a similar issue. But otherwise I’m not sure where to turn to next, any anecdotes of similar situations would be appreciated.

Thanks in advanced

ETA: he lives outside 24/7 in a large pasture w/ a big hill

[tohorse]

Not an expert in this, but I have a suspicion that the (currently unfit) horse I currently have on trial has a hardly noticeable, intermittent issue of this kind too (also clean x-ray of the stifle in question) so I’ve been researching in advance of my next vet appointment. Here’s the skinny of what I’ve understood so far…

My understanding is that the issue actually doesn’t necessarily go away with time nor is it something to retire a horse for unless it’s very serious and limiting (i.e. proper locking, not mild, intermittent stickiness). Most horses tend to grow out of it by the time their skeleton/joints are mature. If your horse is already mature, the first line treatment for this is 24/7 turnout and lots of exercise and specifically exercise that strengthens the hind and quadriceps (i.e. hills, cavalettis, rein backs, but avoid lunging, canter and small circles). If this works you’re expected to see results within a couple of months.

The next in line treatment is estrone injections in stifle, which should be done weekly and in conjunction with the said exercise regimen. Apparently the estrone adds bulk to the soft tissue which prevents the stickiness in motion, which in turn relieves the pain that comes from when the joint gets stuck. This in turn lets the horse develop the quadriceps without experiencing discomfort. I’m not sure how accurate this explanation is in reality, but a bunch of people have reported this to be a low risk, high likelihood of success intervention that helped their horses.

If this doesn’t work the next in line is blistering (essentially injecting iodine into the joint), which apparently is very painful for the horse and is not exactly risk free (can make things worse), but has been done for years and anecdotally I’ve read helped many horses to manage/get rid of the condition. In this same camp is also a new, minimally invasive surgery, which to my understanding cuts small bits of the ligament. I’m not sure how exactly this helps but this study (https://pubmed.ncbi.nlm.nih.gov/25758590/) reports that it is highly effective on a pretty large sample set of horses.

[cnd8]

I have done minimal research, admittedly, on stifle issues, because my gelding has some stickiness. From what I gather, exercise actually minimizes the symptoms. Therefore, given the rest you’ve provided this horse and excessively light workload, I’m wondering if he just hasn’t been given the chance to become stronger in that area? Also, my gelding (10 year old) has fluid on the stifles and was given IA injections. These injections improved his gait probably by about 85% after a couple of weeks post-injection. Then, I was encouraged to exercise him multiple times per week, avoiding circles as much as possible, and adding in hills and backing as much as possible also. Long story short, exercise seems to help these guys. I know mine will still get a little sticky if I even give him a few days off. The more he is worked, within reason, the better he travels.

[Haliburton]

@tohorse That’s great research, thank you for sharing!

Especially re: the estrone injections. My horse seems to be fairly high anxiety in certain situations despite having a very laid back personality. My thought while mulling it over this weekend is that the anxiety may actually be pain related to the stifle. So this is great to know. I’m going to try to be more regimented building his booty and seek help from an equine osteopath. But if there is still no progress I’m glad there are other options that I can discuss with the vet!

@cnd8 yes I think it may not have been enough of the right kind of exercise. Good to know you’re able to work through this.

[Jealoushe]

@tohorse

In this same camp is also a new, minimally invasive surgery, which to my understanding cuts small bits of the ligament. I’m not sure how exactly this helps but this study (https://pubmed.ncbi.nlm.nih.gov/25758590/) reports that it is highly effective on a pretty large sample set of horses.

This is what my vet refers to as blistering. Basically making the cuts causes the ligament to become inflamed and thus tighten, preventing the slipping. The horses who have this done have to be worked right away, and daily after the procedure. I have heard from a few friends who have had a lot of success with this.

[JB]

How old is he? Can you post a conformation picture? Butt-high and/or a straighter hind end confo predisposes them to UFP issues, even if on the lower end of the scale of just catching/slipping

If the horse isn’t actively lame, then he needs work to strengthen things. The work done so far won’t do nearly enough. IMHO there hasn’t been nearly enough work to go to the point of blistering or slicing.

Chiro and massage work is always a good idea when working through any soundness or “soundness” issue.

Blistering is NOT the same as the snipping surgery. Blistering is injecting a caustic agent to affect development of scar tissue. The surgery is making a few diagonal cuts within the ligament .

[Mersidoats]

My mare had this exact issue when she first arrived. I injected to treat the effusion and inflammation, started an estrone regimen for… 8 weeks? and stifle-strengthening protocol.This included lots of bold forward work on straight lines, hill work, ground poles, and then cavaletti. And when I say bold forward work, I mean BOLD FORWARD GAITS. She was not allowed to lag behind my leg. We marched at the walk, motored along at the trot, and covered ground in the canter. If I couldn’t ride, I ground drove her (boy, did I get fit running along behind her). I also put her in four shoes to give her more support.

Hill work started with just walking and I increased the number of times every week: 4, 8, 12, 16. At week 3 I introduced trotting up the hill (walking back down): 4, 8, 12, 16. We did walk poles every day, trot poles starting in week 4, and cavaletti in week 8. I stayed away from curved lines (except at the walk) for the first month, and if I had to turn, it was a big turn. I have a large space to ride in, so I could make a 40 meter circle, if I needed to. We were able to work through this in about 4 months. I haven’t injected her again, and we’re schooling 3rd level.

I followed a similar protocol with my weak-stifled green bean, doing more long-lining and ground driving in the beginning. We also backed up the whole way from the barn to her paddock for a few months (with lots of cookies to sweeten the deal). She’s preggers so I couldn’t use estrone. Vet said just exercise her. He was right.

[Haliburton]

He’s 6 & yes I think both slightly bum-high and straighter hind end. I do agree that blistering and/or slicing is excessive at this point in time.

An update, although I don’t have much of an update, it’s been very challenging for me to get to the barn before the sun sets this winter to work him consistently outside. Hoping with daylight savings I can get into a good routine. Although I may enlist help through a rehab program, we’ll see what this spring brings.

[DMK]

Effusion n the stifle joint is pretty common with IUFP. To me it just means that I need to address that issue as I continue the often hard/never easy work of strengthening the muscles that help stabilize the patella. That could be adequan or 5 days of bute, but it’s almost never “rest”.

And speaking from experience, living on a hill 24/7 didn’t begin to cut it for my horse. Extensive hill work (pulling a carriage with weights), schooling up to 3rd level and building up to the fitness/conditioning to be successful at Intermediate CDEs, combined with 2x year adequan… And doing that for three years… Now that helped!