How would you manage this (bad news in stifle)

[Lunabear1988]

Finally after a year, I’ve found a vet to take me seriously about my horse’s stifle and do an ultrasound. My horse is fairly sound but we did not find great things in that stifle.

This vet is new to me and pretty pricey. She seems like she really knows her stuff and they have a lot of technology available to them. I’m waiting to see if I can get a second opinion from CSU but I was wondering if anybody has any thoughts on the possible ways to manage this based on their own experiences.

Here is what we found:
R Stifle Mild-moderate sized osteophyte off femoral condyle into MFT joint. Mild synovial proliferation MFT joint with mild-moderate amount anechoic fluid present. Thickened
irregular cartillage LTR of femur. Mild bulging of medial meniscus. Remainder of exam was unremarkable.

Horse is only 5 years old. Going fairly well in work but has started to show signs that something was up. Last year when I thought he had injured it I basically begged a different bet to do PRP in it although they would not do an ultrasound so we didn’t really know what was. PRP and rehab seemed to help tremendously then.

The recommended path forward is start him on Legends monthly and use surpass for a while while we decide what to inject the stifle with. The plan is to inject in a month. The options giving to me are PRP again, Prostride and Renvo (I think it’s called.) All of them are very pricey at about $1,100. Which is kind of crazy because last year I swear I paid like $500 for the PRP. But a very different type of practice.

We will be adjusting his work accordingly as well and continuing to do strengthening exercises and stretches on the ground.

[RedHorses]

Having dealt with a couple of stifle meniscus injuries I would be inclined to rest the horse for two months and redo the ultrasound. Any changes or lack thereof would give a good idea of how significant any of those issues are, which would allow for a better return to work plan going forward.

I did mention this in one of your previous threads: when I was rehabbing my horse from his torn meniscus the ultrasound showed all healed, and my Equestic clip showed his trot was symmetrical at the time I started adding canter back in to his ridden work about a month after the final ultrasound. The trot symmetry went asymmetrical and returned to symmetrical when I didn’t canter in those rides. After a couple more weeks I reintroduced canter and his trot remained symmetrical.

This data showed me early when I asked for too much and showed the horse was ready when I tried again later. Vets can advise based on what they see and usual/average responses to treatment. It’s up to us to listen to what our individual horse is saying.

Because you have been feeling like there’s been something NQR for a long time I wouldn’t be treating the findings like fresh injuries, but be giving time for some good solid healing to recover from a long term injury and compensation for that injury.

[Lunabear1988]

He did originally have about two months off initially when the injury originally happened but again we did not know what the injury was as the vets seeing him thought it was so mild. Arg.

It definitely has been an ongoing thing but there is a good five to seven month period where overall he looked fantastic. Interestingly, both my trainers seem to feel he moves better after his first canter. But one of the things that tipped the vet off this time was he was taking a funny step in the downward transition. Not the typical leave the leg behind thing you think about stifles, but more circumducting that in a way to protect it.

The vets have always felt really strongly about keeping him into work to keep the strength around the stifle but we are dropping him down a lot in workload (not that it was much.) He always has seemed to do better the more work he is in which kind of supports strength building but of course nothing is life is always linear so it can be hard to tell. And of course we were going at it more as a weak stifle then having any info about what was actually going on.

I’m not 100% clear on what they saw as far as what happened to the meniscus. It seemed to me like she thought it was an old and healed but maybe the soft cartilage is a big factor as well.

Obviously I need more answers and insight. I’m waiting to hopefully hear back from CSU to see what they think about the ultrasound and I also have a call on to my regular vet as well. It’s been a bit frustrating as most of the professionals in my life have treated me like I’m crazy and that he’s perfectly fine! But my gut told me differently.

[Lunabear1988]

The vet did seem to think that getting the inflammation under control was the biggest thing right now and not let the arthritis get much worse quickly. So either way would love insight on therapies, regardless of whether he’s in work or not.

[2tempe]

No helpful input on stifle therapy options, but with respect to work: this is a good article on both work and stretching exercises. If you know someone who is a good body work person, they can help you with getting the stretching correct before doing it on your own. https://practicalhorsemanmag.com/health-archive/3-steps-to-stronger-stifles/

[IPEsq]

Those prices sound about right for around here. Maybe they would want to do more sites in that stifle than you did with the initial PRP. It would be interesting to see what one of the surgeons has to say about it. As for which product, I’d probably lean towards Pro Stride from the description of the findings. It will help control the inflammation but might do some healing not just stop progression. But I wonder if it might need something cleaned up via scope.

[RedHorses]

There are in hand and low impact exercises that can be done in hand to strengthen stifle muscles. For example when the horse is standing still, pulling the tail directly sideways engages the stifle muscles on that side as the horse braces against the pull. Hold for 30s and repeat 5-6 times.

Also while standing still get the horse to lift a hind foot and hold it off the ground himself for 30s. Again do 5-6 reps each side. This requires a bit of training.

Walking over randomly spaced and angled poles makes the horse lift his feet higher using the stifle muscles.

Backing up straight for 30-50’ engages the stifle muscles.

Walking up a slope, or backing up a slope engages the stifle muscles. It need not be a steep slope, even a fairly gentle slope will have an effect.

My point was really that I would really be looking to give it time and not rush back. to work. My horse started with 60 days rest (with handwalking) and showed the bare beginning of healing at that point, just enough to say let’s give it another 60 days (rest with handwalking) before we rush to surgery. That third ultrasound was actually more like 75 days and the meniscus looked good, but there were some filaments in the joint space that hadn’t been there initially (they did go away in time). It was another month after that when I first introduced canter again, a week to recognize that it was affecting his trot symmetry, then a couple more weeks before trying again - which is to say seven weeks after the “looks well healed” ultrasound, six months after the initial ultrasound, and over seven months after the initial injury (which was rested almost immediately, vet called when it failed to improve, then first ultrasound after initial diagnosis of stifle ligament strain failed to show improvement in the expected timeframe). These things can take time.

Your horse is young. You have time. You have lots of time. You can give him time to heal well so he’s good for years to come.

That’s what I would do. Did do several times. He’s 24 this year and still going strong.

[Lunabear1988]

Yes I have a wonderful bodyworker who is coming out on Tuesday actually so I’m going to make sure any stretches I’m doing are correct with her. I’ve seen that article but I haven’t incorporated everything so I will ask her about some of that specifically.

[Lunabear1988]

Yes I think I just got a deal the first time but like you said, maybe there is a difference in what they are wanting to do.

After doing some research I think I’m leaning towards the Pro Stride as well. Seems like it would be the best bang for my buck given this situation.

I do have questions about the OC so I’m hoping CSU can give more insight.

[Lunabear1988]

Yes we’ve been doing a lot of that already. We really were just going at as weak stifle since that’s how the vets thought of it so now we know more, it changes things a little.

And absolutely I’m in no rush. I have other horses to ride and absolutely want to what’s best. But the current vet specifically said to keep him in work, just a few changes though. She was telling me that it’s like a stiff knee, you have to keep it moving. Although I understand what you are saying. I know there is a difference between being ridden vs hand walked though.

Thank you for your insight.

[starsandsun]

I would recommend Prostride over other options based on experience and reading up on it, and as others have recommended a longer rehab period with rest, coming back very very slowly (I’m starting with 5 minutes of walking the first week, and extending rehab out so that I’m only at 20 walk and 20 trot 2 months from now, and then I can try canter). Also exercises are great. Jec Ballou has a stifle focused program you might want to look at. Always ask your vet first.

[Lunabear1988]

Yeah it sounds like prostride might be the winner here. Thank you. Can I ask what exactly is going on with your horse’s stifle?

And I definitely will bite the bullet and get Jec Ballou program or book.

[starsandsun]

Yep … when he was 5 we removed an OCD lesion. Had some fluid removed two years ago, and then re-injected with IRAP. He was a little more comfortable afterwards. Since then, have had some challenges and a recent stay at the vet hospital gave me impetus to have it re-ultrasounded. Found some arthritis in both stifles, but slightly worse in surgical one (both still diagnosed as mild), and also some irritation of the meniscus. Vet described it as ‘mottled’ which isn’t quite helpful.

Jec’s book “55 Corrective Exercises” has been very helpful; check her out on FB for a targeted 4 week program for stifles (but keep in mind this is for weak stifles, not injured, so some of the exercises will be modified for your/my horse).

[Lunabear1988]

Well very similar to my story then although of course we are still figuring out the details from my horse. Mine is pretty sound which is what has taken so long to get a vet to take me seriously and just ultrasound it!! What really pushed me this time is he started to stand kind of funky with that leg at rest. In my mind it was him trying to relieve something. I could also see it and feel it and work but my trainers thought I was being a little paranoid/over protective. I’m so glad I listened to my gut and searched for a vet that might listen.

Best wishes for your horse. And thank you for the insight and advice.

[Lunabear1988]

I consulted my regular vet and had a quick email exchange with a vet at CSU. Both vets strongly recommended Pro Stride. My regular vet recommended dropping the canter for now. Of course he will have time off with the injection and so maybe there will be a much more backed off rehab plan?

My regular vet also recommended adequan over Legends to start with. Surpass will be continued for now.

I am hoping to see if we could have a surgeon be able ultrasounds as well at some point soon.

Feeling sad but also so glad to FINALLY have true answers.

[IPEsq]

He shouldn’t need much time off from the injections, but you will need to restructure the fitness plan. Lots of walking and trotting, with minimal circles. No canter at first. Poles, backing, and hills would be introduced before cantering as his tolerance allows to strengthen the structures that support the stifles.

[Lunabear1988]

Yep! We will slowly get him going again and hopefully keep him comfortable and sound. He gets Pro Stride next week. He had a massage and PEMF today.

We will see how it goes. Now that I know what’s going on I can be a little more in control of the work pace. It was hard because the trainers didn’t understand the seriousness of it. He wasn’t really lame. But now it’s clear!

[Lunabear1988]

We did Prostride. He gets a week totally off work then slowly start back. My vet was optimistic that if we take it slowly, he will be okay. There was a disagreement about what ultrasound showed, so I might send those up to CSU for a future plan/reassurance.

I’m gotto drop any canter work for awhile. And light work 3 days a week to start.

[Lunabear1988]

I rode him the other day and he felt really good. He was really wanting to stretch over his back in the trot. Trainers are working with me more to listen to him and give him a break or be done when he tells us.

We are mostly working in hand but once or twice a week under saddle at walk/trot only.

I still haven’t had CSU review the ultrasound yet but I will in the next week or so. He does get a rolfing session next week and chiropractic in the next few weeks. If anything that should just help me keep an eye on how the rest of his body is feeling.

[TWH_Girl]

Good report…Hope he continues to improve!