Meniscus and Meniscal Ligament Injuries and Recovery Time/Process

[JenePony]

tldr; Does anyone have any experience with torn meniscus/meniscal ligament injuries? What was the treatment? How long was recovery? How difficult on the horse? Approximate cost?

I italicized the super relevant paragraphs to this issue.

Story

My problem child of a heart horse has once again thrust himself into the lime light. I swear, as soon as he’s over one issue he finds something else. Unfortunately, he is now 15 with a bad suspensory (no tears/holes and the pain is minimal) and I am afraid I’m starting to keep him alive for selfish reasons…

On to his latest escapade.

In Sept-Oct 2015 he abscessed horribly on both front feet. Put shoes on and he was fine. No x-rays because he had abscesses around his entire sole which drained beautifully and have not returned. However, around that time (maybe a little after, but it all blends so I’m including this), he started acting very lame in his hind left.

Now, we ultrasounded hind left suspensory before finding the abscesses and it was thickened slightly more than normal (he gets ultrasounds ~12 months for the past five years) but nothing acute.

In April the vet came out for shots/coggins (a different vet than the ultrasound/abscess but from the same practice and they work together). She suggested trailering in for a comprehensive ultrasound of the stifle. For reasons, that was not possible. We opted for her second choice which was to inject (no HA, it was his first injection ever). He had a LOT of fluid in the joint but the brief images she took did not show any other issues in either stifle or the hock. That was done in May 2016.

Still lame after injection, possibly a minor improvement but it was bad. I shipped him to my parent’s for the summer where he did very well but got a little fat. I visited every weekend and he’s have great ones and terrible ones but he always has a hard summer. We eventually moved him back at the end of October 16 and the fact that his stifle was still so bad worried me (though he’s never been off his feed or even slowed down - he is more comfortable cantering than trotting).

Vet came out for shots late November (same vet who did ultrasound/abscess diagnosis). She took one look at him at the walk and told me I was crazy because he looked great. Maybe a tiny hitch on the hind left but nothing serious. Because she trusts me, I asked her to watch him jog. He was so lame we all winced with every step. She watched in both directions and then excused herself to go back to the van to read his file (leaving me horrified and near tears).

She believes he has a torn meniscus and possibly meniscal ligaments but he has to go in for a definitive ultrasound. She offered to do it in field but said that she wasn’t trained for it and the best vet in the area (who literally wrote a chapter of a book on stifle and SI ultrasounds) could do it if he trailered in. So his appointment is on December 20 to give me time to save as much money as possible.

I’m at my wits end. He is my heart horse and he’s been in my life for 10 years (to the day on the date of the November vet visit) and I honestly can’t bear the thought of losing him. But I know he’s been in pain for most of the last six years (starting with a popped splint, through suspensory issues, etc) and I’m starting to have a difficult time justifying keeping him alive just for my sake.

He’s still alert and happy to see me. He loves his food and his hay and his pasture and his best friend. But some times when he walks off I can see the pain in his eyes. Or he’ll take a nap in the sun (which he’s done since he was 4) and he’ll triple check that I really NEED him to get up or could he have just five more minutes? He’s also gotten a little snippy with other horses. He’s very friendly (he doesn’t understand personal space at all), but sometimes he’ll reach out and bite or snap at a horse that is in his way or just annoying him.

I go out every day that I can (which is only 3 days a week most weeks) and groom him and feed him cookies and give him (and his friend) surprise hay. He is the light of my life and my best friend, even if I haven’t been able to ride him in six years.

I would give up anything for him, but I’m afraid that I’ve lost track of what is best for him. That’s not to say I won’t give him a fighting chance if it’s possible, but I don’t want to get into a long, painful recovery if his quality of life isn’t guaranteed. He deserves to be free from pain and it’s my job to do everything I can to help with that. Thus far I feel like I’ve made okay decisions, but there are a few times where I feel like taking the vet’s suggestion to end his pain would have been equally right.

So…Does anyone have any experience with torn meniscus/meniscal ligament injuries? What was the treatment? How long was recovery? How difficult on the horse? Approximate cost?

[TWH_Girl]

Hmmm, not meniscal per se, but I’ve had stifle ligament issues. Horse was thought to have some catching and then about 3 mo after the splitting procedure and receiving a stifle injection, he overdid it in the pasture and really strained the MP ligament. We have him 6 mo off and did PRP about 4 mo into his rest period. He just started walking under saddle so too early to tell how well or if he will hold soundness.

If horse is in chronic pain that you cannot control and has little to no enjoyment in life, i.e no eating or roaming around, then I would consider putting down. It does not sound like your horse is there yet, not sure as I cannot observe.

I am not sure it’s necessarily worth doing anything to treat this horse either, assuming he has meniscal tear/injury, given that you are not riding him or trying to bring him back to riding soundness. If you are- the options I would consider would be an ultraound, and then IRAP or PRP, and then extended rest to heal. You could try surgery but I honestly don’t think it would be worth the cost or rehab issues for the outcome you would get.

Best of wishes to you. If you enjoy letting him be and doting on him for as long as you can, then continue with that!

[newhorsemommy]

My gelding injured himself at the end of February or so. Off and on lame, I thought he had strained something in turnout. Long story short, after x-rays, the vet believes he “re-injured” his meniscus as well as the medial collateral ligament. He believes the initial injuries occurred years ago, long before I got him. Shortly thereafter the “good” stifle started “catching.” Grade 4/5 the day the vet saw him.

I thought I would have to put him down a few times this summer. We’ve injected his stifles 3 or 4 times this year, getting a TON of excess fluid out on the last injection about 3 weeks ago. The vet went at it from a slightly different angle because it’s been difficult to get the needle in due to narrowing of the joint space. Since that was the first time we got that much fluid, I’m hoping he hit a slightly different and particularly problematic spot.

So joint injections, esterone sulfate for the catching stifle (he needs it every 5 days or so), Pentosan, previcox and a joint supplement. The esterone provided about 50% improvement overnight because the “catching” was obviously contributing to the soreness of the “bad” stifle. It took me a while to convince the vet to let me try it because he didn’t think it would work in an older horse. The pentosan didn’t seem to be doing much so I’ve dropped that. The last joint injection and/or the addition of a small amount of vitamin E seems to have helped us turn a corner. For whatever reason, he perked up noticeably a couple of weeks prior to the last injection when I started him on a small amount of vitamin E.

He has bad days, but the vet has been quite impressed by his slow but steady improvement. This weekend he was turned out and he galloped, cantered, and trotted damn near sound which was amazing. I found it worrisome because I was afraid he would hurt himself again, but he’s been feeling better and was becoming really hard to handle in hand despite living out 24/7 in a decent sized paddock (for California). He did not seem unusually sore after his adventure.

My gelding is too old for the surgery (he’s between 22 and 24). If anyone local could do it standing I would consider it. I’ve been assuming that he’s permanently retired, but after watching him this weekend, I have a tiny spark of hope that another 6 months off or so might allow him to be ridden at the walk.

I would say that if he seems happy and the pain can be managed (my guy is on previcox) and he can get up and down without any trouble, give it a while and see what happens. I won’t be riding my gelding unless he recovers enough to have his previcox dosage reduced. I’m using Absorbine Flex-Max and he’s on his 3rd month and I intend to keep him on it, but I am also now adding a single scoop of Cetyl-M to see if I can eke out any additional improvement

Did I mention that he also has Cushings? But throughout it all he has nickered every day when he sees me, apparently cavorts around when the hay is being delivered and can get down and roll and get back up without trouble. So I’ve tried to keep him going AND comfortable enough for pasture. It’s been a really stressful year and I’m hesitant to get too optimistic, but he has looked really good the last few weeks.

Best wishes for your guy!

[TWH_Girl]

[QUOTE=newhorsemommy;8964989]
My gelding injured himself at the end of February or so. Off and on lame, I thought he had strained something in turnout. Long story short, after x-rays, the vet believes he “re-injured” his meniscus as well as the medial collateral ligament. He believes the initial injuries occurred years ago, long before I got him. Shortly thereafter the “good” stifle started “catching.” Grade 4/5 the day the vet saw him.

I thought I would have to put him down a few times this summer. We’ve injected his stifles 3 or 4 times this year, getting a TON of excess fluid out on the last injection about 3 weeks ago. The vet went at it from a slightly different angle because it’s been difficult to get the needle in due to narrowing of the joint space. Since that was the first time we got that much fluid, I’m hoping he hit a slightly different and particularly problematic spot.

So joint injections, esterone sulfate for the catching stifle (he needs it every 5 days or so), Pentosan, previcox and a joint supplement. The esterone provided about 50% improvement overnight because the “catching” was obviously contributing to the soreness of the “bad” stifle. It took me a while to convince the vet to let me try it because he didn’t think it would work in an older horse. The pentosan didn’t seem to be doing much so I’ve dropped that. The last joint injection and/or the addition of a small amount of vitamin E seems to have helped us turn a corner. For whatever reason, he perked up noticeably a couple of weeks prior to the last injection when I started him on a small amount of vitamin E.

He has bad days, but the vet has been quite impressed by his slow but steady improvement. This weekend he was turned out and he galloped, cantered, and trotted damn near sound which was amazing. I found it worrisome because I was afraid he would hurt himself again, but he’s been feeling better and was becoming really hard to handle in hand despite living out 24/7 in a decent sized paddock (for California). He did not seem unusually sore after his adventure.

My gelding is too old for the surgery (he’s between 22 and 24). If anyone local could do it standing I would consider it. I’ve been assuming that he’s permanently retired, but after watching him this weekend, I have a tiny spark of hope that another 6 months off or so might allow him to be ridden at the walk.

I would say that if he seems happy and the pain can be managed (my guy is on previcox) and he can get up and down without any trouble, give it a while and see what happens. I won’t be riding my gelding unless he recovers enough to have his previcox dosage reduced. I’m using Absorbine Flex-Max and he’s on his 3rd month and I intend to keep him on it, but I am also now adding a single scoop of Cetyl-M to see if I can eke out any additional improvement

Did I mention that he also has Cushings? But throughout it all he has nickered every day when he sees me, apparently cavorts around when the hay is being delivered and can get down and roll and get back up without trouble. So I’ve tried to keep him going AND comfortable enough for pasture. It’s been a really stressful year and I’m hesitant to get too optimistic, but he has looked really good the last few weeks.

Best wishes for your guy![/QUOTE]

This is good to hear! My guy was rip-roaring around the pasture after our first snowfall Monday, finding it seemingly hilarious to do sliding reining stops, fall and then get up to do it again. Sigh. Just what he needs. He did look okay when I jogged him so hopefully he did not undo months of rehab and rest.

[ActNatural]

My horse did something like this. Vets best guess was that she " “re-injured” his meniscus as well as the medial collateral ligament" line the poster mentions above. She always had a sticky stifle but then fell out behind going up a steep muddy hill and came up very lame. That’s when I put all the money into diagnostics only to get the recommendation to retire her. Two years out on pasture with minimal human interaction and she was sound enough for short stirrup and is a beloved school pony.

[syreino]

My horse tore her medial collateral ligament by running through a fence post in 2012. It wasn’t immediately evident so she was turned back out after about a week, and then ultrasounded about a week after that. The ultrasound “was impressive” in how badly she tore it. The best vets on the east coast conferred and in their opinion, although she was only 4 years old, she would not heal from an injury so severe.

I put her in a stall and did a repeat ultrasound two months later - no change on ultrasound, but she didn’t circumduct as badly at the walk (we didn’t try to trot) … and that’s when I was told that they were SURE this was going to be their last visit as she couldn’t possibly get better, but yet she was “better”. I kept her in for another few months and then gave her a small area and kept making the area bigger with time. After about 9 months, they told me I had to get on her and see. It’s been a slow road (mainly due to other issues than her collateral ligament), but she’s sound and doing low level dressage and endurance. She’ll never be my 100 mile horse, but it sure beats not giving her a chance to heal herself. We just build up really slowly, hill work, ground poles, dressage lessons.

The biggest thing going for her was her young age (and a stubborn mom), but it is possible to come back from a stifle ligament injury. I can tell when she’s done too much, she gets cranky and crowhoppy, but she’s generally willing to try anything at least once before saying no I can’t do this (and generally she learns she can do it).

Sometimes ignorance of how bad it truly is is a good thing. I just never thought she’d not get better … and I was stubborn enough to give her a fighting chance. And she’s a very sweet talented girl, so totally worth it for me. It would have been totally worth it if she were only pasture sound too - I just had to give her a chance.

Good luck with your horse, and plenty of time could be your best friend through rehab.

[Simkie]

I have a horse that came off the track with an MCL strain as diagnosed via ultrasound at time of purchase. Vet said “hm, should be fine with the winter off, but we can do IRAP in spring if not.”

Wasn’t fine in the spring, so we did two injections of IRAP.

Hasn’t been a problem since.

Same vet also had another client with “blown meniscus” go through IRAP and return to soundness and former job of low level eventing. I don’t know the horse, only heard about it from vet.

I would absolutely consider IRAP

[kcmel]

My guy tore his meniscus with ligament damage when he was 8. We did IRAP (he was insured) and put him on stall rest for a couple of month. The vet at New Bolton warned us that he might not even stay pasture sound for very long, but he seems quite comfortable now, going on 12. He is retired and out 24/7, but just has a small hitch in his gait. I jog him for the vet every spring when he gets his shots. She tells me I could get on him and do light trail rides, but I have two other horses so he is just enjoying a life of leisure.

[flyracing]

First you need a diagnosis and grading of the tear. That will determine prognosis (ranges from good to quite poor for athletic soundness). Keep in mind that ultrasound and even the scope can only see a portion of the joint. Being able to MRI stifles (I think there are 3-4 stifle MRI’s in the US), has shown us how much we miss and not all horses have actually needed surgery. I’m NOT telling you to do an MRI; just letting you know what we’ve learned. You’ll want to block the stifle joints to confirm the stifle is the source of the pain before making any major decisions or investing in high dollar treatments.

Depending on where you live stifle athroscopy generally ranges from $1500-3000.

[kcmel]

@flyracing;8966828

You’ll want to block the stifle joints to confirm the stifle is the source of the pain before making any major decisions or investing in high dollar treatments.

FYI, my horse’s stifle didn’t block, it was done once by Dean Richardson and once by my vet using a lameness locator (computer based gait analysis). If you have a good vet clinic near you, you can see a lot with ultrasound (as long as there isn’t a lot of swelling in the joint).

[flyracing]

[QUOTE=kcmel;8966848]
FYI, my horse’s stifle didn’t block, it was done once by Dean Richardson and once by my vet using a lameness locator (computer based gait analysis). If you have a good vet clinic near you, you can see a lot with ultrasound (as long as there isn’t a lot of swelling in the joint).[/QUOTE]

Stifles can be complicated (and I don’t have time to write a novel on my phone!). I absolutely would not skip blocks just because some instances don’t block well. Thanks for sharing you experience kcmel. I hope your horse is doing well!

[onthebit]

Meniscal tears are graded 1-4, with 4 being the worst. With my experience with my horse I was told grades 3-4 often don’t even get repaired because it is essentially pointless. My horse had a 2. My horse blocked to the stifle but showed nothing on x-ray or ultrasounds, and I had the blocking and diagnostics repeated by two different (very well known) vets. I ended up doing exploratory arthroscopic surgery and the tear was found at that point. In order to get an MRI of the stifle I would have had to ship my horse several hours (there’s only a couple of MRI’s in the country that can do a stifle) so I opted for exploratory surgery.

My horse then did stall rest followed by immaculate rehab, and ended up being sound enough only for very low level type work. That does not at all suit my horse’s personality so that led to retirement where the horse is perfectly content.

IME a torn meniscus can be a very bad thing.

[chism]

I had an OTTB gelding who who suffered a meniscal tear at the age of 6. We did stall rest and rehab, upon re-ultrasound the meniscus looked much better, but there was a medial collateral tear. We started over again with the rest/rehab, but he wasn’t ever the same, pretty much off and on sound for the next 6 years or so until we lost him to pasture accident in 2014.
Good luck to you and your boy.

[JenePony]

Thank you everyone for sharing your experiences. I actually feel a lot more hopeful after reading everything and talk to the vet (poor vet, I’ve texted and called her several times a day for the past few days).

My guy seems to be relatively comfortable at the walk but it awful at the trot and decent at the canter.

Thankfully, my vet is with a clinic that has someone very talented with ultrasounding stifles on staff. I do have to trailer him in to the clinic and after talking to my vet who consulted with one of the surgeons (not the one who will be doing the ultrasound), it doesn’t sound like surgery will be likely. For now he’s just enjoying getting extra carrots and cookies and complaining about the extra grooming (thin skinned tb, what can you do? xD )

[kcmel]

Flyracing, I agree I would certainly block. My point is if the stifle block doesn’t improve the lameness, don’t assume that means the stifle isn’t the issue. We wasted almost a year of not having a diagnosis because we thought we had eliminated the stifle. Bone scan didn’t show anything either. Yeah, stifles injuries suck!

[newhorsemommy]

[QUOTE=JenePony;8969473]
Thank you everyone for sharing your experiences. I actually feel a lot more hopeful after reading everything and talk to the vet (poor vet, I’ve texted and called her several times a day for the past few days).

My guy seems to be relatively comfortable at the walk but it awful at the trot and decent at the canter.

Thankfully, my vet is with a clinic that has someone very talented with ultrasounding stifles on staff. I do have to trailer him in to the clinic and after talking to my vet who consulted with one of the surgeons (not the one who will be doing the ultrasound), it doesn’t sound like surgery will be likely. For now he’s just enjoying getting extra carrots and cookies and complaining about the extra grooming (thin skinned tb, what can you do? xD )[/QUOTE]

My gelding is just starting to look almost normal at the trot after 10 months or so. When all of this started and for most of the summer, the leg with the stifle injury just seemed to “follow along” when he trotted. It was terrible to watch. A few weeks ago when I first saw something resembling a normal trot, it was the first time I’d seen that leg “participating.” That’s really the best way to put it He’s finally trying to use that leg at all gaits, which is a vast improvement.

It’s been slow. I expect at least another 6 months before I could even consider putting someone on him again, even if he continues to improve at his current rate. And it will probably be walk only. But if he can handle a rider at the walk I think it would really help build back up some muscle.

[JenePony]

Yeah, my guy’s leg at the trot is definitely quite a bit less active than his other legs. It’s been like that for a while, and another vet injected and got out a lot of fluid. He’s a hard case because he’s also got a bum suspensory (although that’s finally as good as it’s ever been).

I’d LOVE to get him sound to walk. I board somewhere that the barn owner goes out on trails ~1x a week and she only walks so it would be great for him. I was hoping to do that when all of this started.