Left front suspensory + Right Stifle. Any chances of recovery?

[Whoosh]

Short version: Horse has been diagnosed with left front chronic suspensory desmitis and right stifle meniscal tear inflammation. How likely is it that I’ll ever be able to meaningfully ride her again?

Long version: Mare is 16 years old, registered APHA. Bought her in spring of 2018 as my first horse as a late-in-life beginner rider. She had been working as a beginner lesson horse, so perfect for me as an inexperienced equestrian. PPE at the time showed that she was mildly stiff in her hind end. We had X-rays and the vet said she’d probably have some hock injections in her future, which didn’t bother me since she was so perfect otherwise.

We had about eighteen months of good rides. She was in light to medium work, with some low-level (think less than 2’) jumping every week or two.

Last August she came up lame in her hind end. I’d say a 3/5 at the absolute worst. First we injected hocks, which helped for a month or so. Months went by and we tried chiropractor, Lymes disease treatment, etc often with a little improvement but never much. We did a big lameness workup in January with blocks and she blocked to the right stifle.

This February I took her for a bone scan. The stifle lit up the most, but we were surprised to see the left front get bright as well. Results are as follows, copied from the report:

LF Proximal Suspensory - On ultrasound examination the cross sectional area is moderately enlarged ( 1.0-1.3 cubic centimeters) and DP measures 1.1 cm in length. There is moderate bony proliferation off the planar aspect of the proximal metacarpus suggesting chronicity. The fiber pattern is grade 1-2 (75% normal fibers). There is some bright echogenicity suggesting chronicity and scarring.

RH Stifle - All the patellar ligaments appear normal. No cartilage lesions are noted in the area that could be imaged. The lateral meniscus appears normal. The joint capsule is thickened in the media femorotibial joint. On longitudinal view, the medial meniscus dorsal border appears blunted and irregular. On cross-sectional view there is an area of intense bright echogenicity suggesting scar tissue and or calcification

Vet said we could consider an arthroscopic surgery for the stifle or inject Prostride. I opted for the Prostride. Then she had eight weeks of stall rest with some in-hand walking.

Well, this past Monday the vet came to do her eight week checkup and she is still lame. A little better, but not 100%. Now she’s 1/5 in the left front and 2/5 in the right hind.

Vet says I can start riding her at the walk, 15 minutes a day and adding five minutes a week for another two months and then we’ll see if we can start trotting. Mare will be living in a small paddock during the day and stalled at night until further notice. Vet also gave me some Adequan to start, but how much that will actually help and how much had to do with me looking heartbroken is hard to say.

My vet was kind of guarded about her long term prognosis. She said it was realistic to think that I might one day be able to canter her. But she also said we’re looking at a future of stifle injections, Adequan and Equioxx. Mare also has four shoes with pads and gets Smartflex.

I am going to go ahead and proceed with her rehab plan, because I really am thrilled to be able to ride her again, even at the walk for only 15 minutes. But it’s hard for me to stay motivated with the possibility looming that my wonderful girl will need so much medical help just to stay trail sound. If I thought there was a chance she would eventually be meaningfully sound (read:cantering and jumping) I’d walk barefoot through glass for her. But if these kinds of injuries never really heal, and I’m holding out for the impossible, I really just want to know.

Unfortunately, as someone who got into horses later in life, I just know so little about these kinds of injuries beyond what I’ve learned with my own personal horse. Will my long, slow rehab pay off? And if you have ever heard or seen of this sort of thing before, do you have any advice? And are there any other therapies or diagnostics we could try that might benefit her? I’m really just hoping to hear some other thoughts and opinions from different horse people. So what say you, COTH?

[joiedevie99]

I have not dealt with a torn meniscus, so I won’t speak to the stifle. That said, I’ve dealt with quite a few suspensory and other soft tissue injuries. What treatment was done for the LF? Was an ultrasound done at the 8 week check-up to confirm healing? Is she currently on any pain meds that would make her seem sounder (bute, banamine, equioxx/previcox) regardless of what healing has taken place? Was she on those when the vet jogged her?

Tack walking a soft tissue horse is one of those things people disagree about. Some vets keep horses tack walking throughout recovery. Others wait until the horse ultrasounds clear and trots sound.

That said, for reference, suspensory injuries are typically in the 4-8+ months of rest category, and acute injuries tend to respond better to treatment (PRP, IRAP, stem cell, shockwave) than chronic ones. The only suspensory injury I have had that was meaningfully healed at the 2 month mark was a sprain (swelling but no fiber disruption).

[Whoosh]

@joiedevie99

I have not dealt with a torn meniscus, so I won’t speak to the stifle. That said, I’ve dealt with quite a few suspensory and other soft tissue injuries. What treatment was done for the LF? Was an ultrasound done at the 8 week check-up to confirm healing? Is she currently on any pain meds that would make her seem sounder (bute, banamine, equioxx/previcox) regardless of what healing has taken place? Was she on those when the vet jogged her?

Thanks for the reply. We didn’t do any active treatment for the LF. When the vet came out at eight weeks, she did re-ultrasound the LF and said it looked virtually unchanged from previous. No better, no worse. She brought her shockwave equipment with her but didn’t feel it would do any good because of the chronic nature of the injury. And no, she hasn’t received any painkillers of any sort.

If it takes 4-8 months of fifteen minutes of walking a day, or whatever, that’s doable to me. Weirdly she never had any swelling at any point.

I feel like the vets just keep saying that word: chronic chronic chronic, over and over. It gives me the impression that there’s nothing we can do at this point besides hope and very slow rehab with an extremely small likelihood of her returning to full work. I’d hate this to be true, but that’s what I feel like I’m looking at.

[ndirish07]

My friend’s horse tore her meniscus and she was able to be brought back to soundness at WTC. The original injury happened before I met her so I only knew the horse when she was still coming back into work. It’s my understanding that she was told the horse wouldn’t be sound again, but her recovery took a very long time (18 months I’d estimate based upon my memory of the timeline and how long I knew she was working to bring her back). For the chronic suspensory, I’d ask your vet and farrier about using a suspensory shoe that has a piece of metal across the toe, and squaring off the toe as much as you can. That’ll help encourage more breakover and prevent the toe from digging in-- look up denoix suspensory shoe.

[tipzythegreat]

I also can’t speak to the stifle injury, but I’ve dealt with a hind suspensory. As @joiedevie99 said – you’re looking at months of lay up. But, there’s hope!

YES there is hope for a long rehab! BUT prepare for it to be really, really long and to have lots of ups and downs. Honestly, my horse feels 10000% better than he did before I figured out his suspensory injury. I also have my horse on adequan and I definitely feel the difference.

My horse had a CHRONIC proximal hind suspensory injury. It took about 14 months before I was able to jump tiny jumps. It took probably 10 months before I was cantering. I really baby him now. I ice his suspensories, I poultice them, I rest him if he even feels slightly off. I had his farrier work all changed and he now wears special hind shoes. But I can tell he feels good.

I’d suggest sending your imaging to dr. carol gillis: https://equineultrasound.com/

I really think she’s superb and I think you’ve got a real good chance if you’re willing to invest a year into backing down and some money into treatment (like shockwave)… at least for the front suspensory.

In my experience, local vets don’t give the suspensory the amount of time it actually needs to recover.

[SharonA]

I have a mid-20s fella with chronic suspensory desmitis in right hind, as well as a blown check ligament in that leg. Unlikely to ever be really sound, but after a few months of doing nothing but being out 24/7, he is serviceably sound (meaning, not truly sound, but comfortable and willing) for light flatwork and easy trailriding. I elected not to do months of stall rest and aggressive treatment etc. because at his age, I am more focused on quality of life and on a reasonable financial investment than on his ability to be in full work. He is more lame/stiff when he has not been in regular work, because that right hind just gets weak. We are working on getting strong enough to canter under saddle, but that may not happen with my irregular schedule. This is fine because work/family life is too busy for me to ride with a real agenda anyway, and I’m sufficiently infatuated with this horse’s personality to be content with very low level work.

Your horse is much younger, but, if she can’t do what you have dreamed of for the two of you, I will just say that there is no shame in retiring her someplace lovely, and possibly getting another horse.

[Whoosh]

@ndirish07

For the chronic suspensory, I’d ask your vet and farrier about using a suspensory shoe that has a piece of metal across the toe, and squaring off the toe as much as you can. That’ll help encourage more breakover and prevent the toe from digging in-- look up denoix suspensory shoe.

18 months sounds about right from what I’ve heard. While 18 months of rehab doesn’t sound exactly FUN to me, it does sound doable. I’m someone who loves to follow directions so I don’t mind doing things the slow and correct way as long as there’s a chance of light at the end of the tunnel.

And yes, I will be mentioning the corrective shoeing to my farrier! She’s getting new shoes in about two weeks so he will be able to look at her and decide a new shoeing situation then. He’s very amenable to it. I’m happy to try something different with her feet if it has any chance at all to improve her comfort and prognosis.

Honestly, my horse feels 10000% better than he did before I figured out his suspensory injury. I also have my horse on adequan and I definitely feel the difference.

I’d suggest sending your imaging to dr. carol gillis: https://equineultrasound.com/

This makes me feel a lot better I doubt my mare is going to ever feel 10000% better (you must be an excellent caretaker!) But I like hearing that it’s possible she could be happy in work if I follow the rules and give her some extra TLC.

I have actually considered this. The only reason I’ve hesitated is because the rehab program Dr. Gillis recommends is almost identical to the one my vet has given me for my mare. So I guess I would feel silly contacting her only to be told what I already know. Then again, there’s never anything wrong with another opinion, especially when you haven’t got much to lose.

This is fine because work/family life is too busy for me to ride with a real agenda anyway, and I’m sufficiently infatuated with this horse’s personality to be content with very low level work.

This sounds like us. I love this mare. She’s made me happy in a way I couldn’t have imagined before I rode horses. So if trails and walking is all we can ever do, I’ll be satisfied knowing that I did right by my girl. But I also want to give her every chance I can because she does like having a job, and really is a fine riding horse. And since I can only afford to own one horse, I’d be heartbroken to give up on riding so soon into my equestrian life.

Thank you all for your kind and helpful comments! This board is a wealth of knowledge.

[Pally]

Big hugs. I know there are a range of emotions that go with lameness, especially when it is your one and only, very special horse. So whatever follows, remember, deep breath and take it one step at a time. Try not to stress yourself out with trying to know what will happen 18 months from now. Doing research and asking for second opinions is great. It’s a sign of an engaged, responsible, and caring horse owner. However, none of us – or even your vet, honestly – can know with 100% certainty how she will respond to rehab. But that is OK, really. She’s comfortable enough to try, so carry on with your vet’s plan.

So, with all that and the caveat that COTH can’t actually diagnose or treat your horse…

For one thing, you’re on the right track now because at least you know the issues you are dealing with. I’m not terribly surprised you keep hearing “chronic”. Both the injuries you describe can easily linger in the “not quite right” category rather than “oh, she’s lame”. Then, you add in the fact that the two issues are in compensating limbs (that is, the leg they would like to offload some weight to is also sore), it can make it hard for even experts to detect. So be glad you have an actual diagnosis now, and can make a rehab plan and know what you need to look out for as setbacks.

Suspensories do heal. They may not heal perfectly and probably not “as good as new” but there are lots of horses with old suspensory injuries out there working (at various levels, both lower and higher than your goals).

My one experience with a meniscus issue did end in that horse’s retirement. I can’t remember all the details but there was another issue alongside the meniscus problem… a bone spur maybe? And we didn’t find the issues on the first try… think more like 4th. Anyway, it was also reasonably “easy” for the owners to retire this mare. We had already tried multiple times to rehab her before we even figured out the actual problem. The owner still had many others to ride and compete, and breeding season was starting, so, it was a nice transition for her. Honestly, as the one who did most of her rehab riding, I have little doubt she’d have been fine as a walk/trot trail horse (She was kind but “vocal” about here comfort, lol. Most of the setbacks happened somewhere around starting cantering, and that was without targeted treatment to the problem, since we were chasing everything else).

Finally, I have one more tidbit of advice. I know this is heartbreaking news for you partly because of your mare, and partly because you feel it will stop your riding progress in it’s tracks. That’s not true! Sure, you might not free to do whatever you please with her, but there are still so many ways to improve even on a restricted program. I put a lot of hours into rehab riding at one of my jobs. Even as an experienced rider, I still found these slow, “boring” rides to be a blessing. I was able to work on a lot of the little details and consistency. Am I straight? Are my reins even? Shortening and lengthening reins smoothly. Steady transitions without using my hands. Etc etc. Take advantage of forced slowness to get really correct and confident.

All in all, best of luck, and I’ll say it again…one day at a time.

[RedHorses]

My horse tore his meniscus last February (2019). It was initially diagnosed as a sprained stifle but when it failed to improve the subsequent ultrasound showed the tear. I handwalked and long lined until mid July. He can happily WTC now. My Equestic clip told me he was even in rhythm, push off and landing late last fall (early November here) but is now landing softer on that diagonal again while still being even in rhythm and push. Fitness may be part of it, and right now there’s not much riding going on so I haven’t classed it as needing an emergency vet appointment. I was going to have him assessed at one of the spring vaccination appointments, but then COVID-19 happened. He is 22 and I will be content if he can be comfortable hacking out.

The same horse injured a suspensory in a hind leg about 11 years ago. He had shockwave therapy begin within ten days. It was over a year before he was back to the same level of work. In the last ten years he has had no issues doing WTC, jump, 2nd-3rd level dressage, 20mile rides, drag hunting.

I knew a mare who had a hole in a front suspensory, became a broodmare, had at least one foal, failed to catch again for a couple of years, then had shockwave treatments, healed the hole and after rehab went back to full work which meant jumping for her.

[Whoosh]

@Pally

Big hugs. I know there are a range of emotions that go with lameness, especially when it is your one and only, very special horse. So whatever follows, remember, deep breath and take it one step at a time. Try not to stress yourself out with trying to know what will happen 18 months from now. Doing research and asking for second opinions is great. It’s a sign of an engaged, responsible, and caring horse owner. However, none of us – or even your vet, honestly – can know with 100% certainty how she will respond to rehab. But that is OK, really. She’s comfortable enough to try, so carry on with your vet’s plan.

All in all, best of luck, and I’ll say it again…one day at a time.

Your entire post was wonderful and full of kind words and advice. You’re 100% right that the best thing I can do now is go one day at a time. It was a beautiful spring day today and I was able to go out and tack her up and have a lovely low-key walking ride in the sunshine and it really helped put things in perspective.

You’re also definitely right that her injuries being across from one another was what made the diagnosis so difficult and niggly. It was so much harder to look at this back when I didn’t know what was wrong, just that she was NQR.

So I will try to take care of her and work on myself as a rider. I bought an Equicube a while back and so this is probably a good time to start using it!

[Whoosh]

@RedHorses

My horse tore his meniscus last February (2019). It was initially diagnosed as a sprained stifle but when it failed to improve the subsequent ultrasound showed the tear. I handwalked and long lined until mid July. He can happily WTC now. My Equestic clip told me he was even in rhythm, push off and landing late last fall (early November here) but is now landing softer on that diagonal again while still being even in rhythm and push. Fitness may be part of it, and right now there’s not much riding going on so I haven’t classed it as needing an emergency vet appointment. I was going to have him assessed at one of the spring vaccination appointments, but then COVID-19 happened. He is 22 and I will be content if he can be comfortable hacking out.

The same horse injured a suspensory in a hind leg about 11 years ago. He had shockwave therapy begin within ten days. It was over a year before he was back to the same level of work. In the last ten years he has had no issues doing WTC, jump, 2nd-3rd level dressage, 20mile rides, drag hunting.

I knew a mare who had a hole in a front suspensory, became a broodmare, had at least one foal, failed to catch again for a couple of years, then had shockwave treatments, healed the hole and after rehab went back to full work which meant jumping for her.

This is great to hear! I like to hear stories from other folks who have gone through something similar. Makes me feel like I’m not the only person trying to navigate the mess of having a “broken” horse. Your boy sounds like he’s had a great career! I would be thrilled if my mare comes back half as healthy I know that there’s no way to know how my mare will end up, but it’s nice to know that it’s possible I could still be riding her at 22.

The shockwave thing is still something that’s confused me. My vet acted like there was no point in doing shockwave for my mare because the injury had “healed” and was only scar tissue. Is shockwave only effective while the tissue is damaged? I though the function of it was to break up scar tissue.

I don’t want to be second-guessing my vet, because I really do trust her, but it seemed like it might have been worth a shot. Maybe it’s something we’ll try down the road if things get worse…

[Renn_aissance]

I’m not familiar with the nature of the stifle injuries, but my experience is that when a front end and a hind end lameness co-present, in the absence of acute trauma, the one end is usually caused by overuse and compensation from the other end. Which also means that since you’re healing two things at once, and the horse is lame all over and not able to load any of his legs correctly, these injuries can also take longer to heal.

I’ve rehabbed a combination of sacroiliac (left side,) front suspensory lesion (right side,) and pedal osteitis (both front feet) that probably started with the back end and affected the front end after several months of successful compensation. Took about a year to be back to 100%, including several months of turnout and walking only, monthly visits to the vet for chiropractic and PT for the SI joint and shockwave for the suspensory, and updated corrective shoeing.

On that note- if your vet and your farrier are not talking together about this horse, they should be! One of the best things you can do for an injured horse is to pay close attention to the foundation.

Turnout and tack walking will keep the rest of her muscles in appropriate shape. It’s not surprising that she’s still lame- you rested the angry soft tissue as was called for, but the rest of her body is now unfit and can’t support the joints and injured ligaments effectively, so some of what you’re seeing is a consequence of that. The Adequan isn’t a bad idea. I’m personally a fan of shockwave for suspensories to break up scar tissue and to increase circulation to the area to help healing, but different animals respond differently, and it’s possible your vet hasn’t found it to be effective in her practice. If your vet gives a recommendation that you don’t understand, you should feel eminently free to ask for clarification. You’re not second-guessing, you’re learning.

I haven’t seen your horse or her images, but your description of what’s going on doesn’t scare me for a middle aged horse with an undemanding career, and who has an owner who so clearly cares deeply about keeping her well and who is willing to put resources and TLC into her health. Soft tissue can take a year to heal correctly, sometimes more, particularly when it’s complex. Be patient, ask your vet questions until you understand. Lots of horses- mine included- live long, happy, and healthy lives with regular HA injections and daily Previcox. Just like many people take a couple Advil every morning.

[RedHorses]

Shockwave therapy sort of “shocks” the body’s healing system by irritating the injured area - kind of a “help needed here” flag. It’s valuable in areas with less blood flow like tendons and ligaments. It can help old injuries, but like every treatment it doesn’t work on all injuries.

You could get a second opinion if your vet can’t give you a satisfactory explanation. Do be aware that it’s not cheap - well, it wasn’t eleven years ago. I spent around $200 for each of four treatments. Not including call fee.

[NaturallyHappy]

Hi there! Hugs to you and your pony, who is lucky to be loved and cared for. You’ve gotten great advice so I’ll just add a couple of things I’ve learned. I have a horse in my barn with a healed hind suspensory injury. It took some time to heal and from what I understand, his owner may not have gotten the best advice at the time. Fast forward years later, a very good body worker ( not a massage therapist or chiropractor) came to work on her horse and said he was severely out of alignment due to how he moved when compensating for the soreness while recovering. The difference after this horse received body work was appreciable. Are you able to find someone like that while she recovers?
We are also having the suspensory ultrasounded as there is some speculation part of the pain is that it healed and is too thick for the sheath encompassing it. I think there is treatment for that- a neurectomy? This owner will not do that due to complications but it will help her decide on going care. Her lovely horse is a very sensitive guy. I wonder if that could be the case for your nice horse. I hope this is helpful somehow.

[Whoosh]

@Renn/aissance

I’m not familiar with the nature of the stifle injuries, but my experience is that when a front end and a hind end lameness co-present, in the absence of acute trauma, the one end is usually caused by overuse and compensation from the other end. Which also means that since you’re healing two things at once, and the horse is lame all over and not able to load any of his legs correctly, these injuries can also take longer to heal.

I’ve rehabbed a combination of sacroiliac (left side,) front suspensory lesion (right side,) and pedal osteitis (both front feet) that probably started with the back end and affected the front end after several months of successful compensation. Took about a year to be back to 100%, including several months of turnout and walking only, monthly visits to the vet for chiropractic and PT for the SI joint and shockwave for the suspensory, and updated corrective shoeing.

On that note- if your vet and your farrier are not talking together about this horse, they should be! One of the best things you can do for an injured horse is to pay close attention to the foundation.

Turnout and tack walking will keep the rest of her muscles in appropriate shape. It’s not surprising that she’s still lame- you rested the angry soft tissue as was called for, but the rest of her body is now unfit and can’t support the joints and injured ligaments effectively, so some of what you’re seeing is a consequence of that. The Adequan isn’t a bad idea. I’m personally a fan of shockwave for suspensories to break up scar tissue and to increase circulation to the area to help healing, but different animals respond differently, and it’s possible your vet hasn’t found it to be effective in her practice. If your vet gives a recommendation that you don’t understand, you should feel eminently free to ask for clarification. You’re not second-guessing, you’re learning.

I haven’t seen your horse or her images, but your description of what’s going on doesn’t scare me for a middle aged horse with an undemanding career, and who has an owner who so clearly cares deeply about keeping her well and who is willing to put resources and TLC into her health. Soft tissue can take a year to heal correctly, sometimes more, particularly when it’s complex. Be patient, ask your vet questions until you understand. Lots of horses- mine included- live long, happy, and healthy lives with regular HA injections and daily Previcox. Just like many people take a couple Advil every morning.

What you’re describing - her being off in one part of her body and compensating in another - sounds exactly correct and seems to fit what we’ve observed so far. I think that we are trying, at least, to treat both things at once. Prostride and Adequan for the stifle and long rehab for the suspensory. As I understand it, anyway. Glad to hear we’re on the right track!

She does really seem to be happier than she was, which I hope means that things are moving forward. I’m also relieved to hear that it’s not shocking that she was still lame. I was afraid it meant we’d made a mistake along the way!

I may still call my vet up in the next few weeks and just ask what her reasoning was for forgoing the shockwave. I’m sure she has a good reason, but I’d like to hear it in my case. I love to learn about these things, coming into it later in life as I did.

And thank you for your kind words. She is a good horse and deserves the best I can give her.

[Whoosh]

@RedHorses

Shockwave therapy sort of “shocks” the body’s healing system by irritating the injured area - kind of a “help needed here” flag. It’s valuable in areas with less blood flow like tendons and ligaments. It can help old injuries, but like every treatment it doesn’t work on all injuries.

You could get a second opinion if your vet can’t give you a satisfactory explanation. Do be aware that it’s not cheap - well, it wasn’t eleven years ago. I spent around $200 for each of four treatments. Not including call fee.

This was my thought as well! That’s a great explanation of it. I had a good friend who’s mare underwent shockwave for both hind legs and said that it helped one and not the other, for no reason that anyone could discern, so you are probably right that it’s not a sure thing.

Price might have come into it as well. I’m not for certain what the going price is in our area but I’ve heard it’s close to that. I’ll keep the shockwave in my back pocket in case things plateau. Thank you!