It might involve intra articular stifle injections but there’s a lot of things to try first!
mostly you’re looking at a slow consistent program building up exercise. Hills are great but stretchies are good, backing up is good, but you need to recognize that has limitations with performance horses. You don’t want to just run them backwards but well trained good backwards steps are always good. The other thing you need to work on consistently is engaged transitions transitions transitions and when you’re done do some more transitions!
The other really critical thing to work on is your program with exercise and pain management. because the challenge with upward patellar fixation aka loose stifles is that as the horse trips he can develop inflammation in the joint. It is stress on a joint but unfortunately the only way to get past the problem is to work through it so it becomes a judicious cycle of exercise and exercise with your NSAID of choice. Too many people back off when the horse is sore, and that’s understandable because you do have to carefully monitor the horse to make sure it isn’t something else. This is where somebody who is experienced in riding and lameness is helpful if you are not capable of identifying stifle lameness reliably.
My CDE pony suffers from this condition, and it’s pretty clearly conformation based. I have worked for over 2 years to really strengthen his stifles, and I’m happy to report that once I pick him up into contact and get him engaged he has exactly zero problem with his stifles. But because the head of his femur is somewhat flat, that makes it easier for the patella to slip up over the head when he’s relaxed and doing a little downhill pokey trot. I’m okay with that, I can manage that although when you’re out on marathon you do do a lot of that type of trot! But I’ve noticed it’s never really a problem there. If anything he’s down to having a few incidents of slipping when he’s at home and super relaxed and just really on the forehand or when he’s very, very tired.
I did do stifle injections last year as we were heading into the season, but that’s because I know that getting fit as a CDE horse can really make a horse sore. It’s a hard job and fitting them up, it’s a tough couple of months of work, so I wanted to give him a leg up, so to speak. This year as we were heading into the season I went and had his stifles x-rayed for the first time in 24 months just to see where we were, in case he had developed he was starting to show some changes. His stifles were exceptionally clean and he passed his lameness exam with flying colors and I deliberately worked up to a couple of consecutive hard works. This tells me all the homework I’ve been doing has been paying off.
Because about the worst thing you can do for the stifles is to get them sore, stop working then start working again when they are sound and ride them till they’re sore again. All you’re doing is setting up that stifle for repeat cycles of inflammation/rest and inflammation in the joint is ultimately going to lead to a deterioration of the synovial fluid, which will in turn lead to arthritis in the joint. That’s why the consistent exercise program followed with an appropriate level of treatment with either/or NSAIDs and some type of joint management like adequate might be the thing your vet suggests, but they will all recommend that slow consistent exercise program! and honestly if you can find a place that has 24/7 turnout, if that works with your program, that will also greatly improve your outcomes.
