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Sticky stifle and the dressage horse - need advice

FWIW, my horse’s stifle issue only showed up when he was trotting r/h circles. His stifle never really hung up, but he would bring that leg forward more slowly in an attempt to avoid the discomfort and sensation of the patella momentarily catching on the femur. He also tended to sometimes want to swing that hindleg out a bit as he brought it forward. Many people never even noticed it, but the consequence was that when pressed to get quicker with that hind leg going to the right, he would fall into canter. It used to be much, much worse when he was in a different program where he got little to no turn-out, was lunged for 15-20 minutes 5-6 days a week, but got very little actual riding. I moved him last year to a different place where he is getting about 5 hours of turn-out every day on a hilly pasture, is no longer being lunged at all (I think the lunging we did after his stifle procedure was the first we had done since I moved him). He is also now getting ridden 45 - 60 minutes at least 4 times a week, so he is much fitter and stronger, and the stifle issue doesn’t bother him nearly as much.

We wanted to do this procedure last year, but the vet wanted him fitter before we proceeded, so we spent this past year building the horse up. He has some really nice butt muscles now, and his topline looks SO much better, he looks like a different horse. So we went ahead with the stifle procedure to address the very slight “hesitation” he had with that one hind leg, in hopes it would make him more confident bringing that leg forward. Again, we are only 3 weeks in, but we are pleased so far.

[QUOTE=CJBean;6996429]
Denali, I am curious what is the recovery time frame for the horse when you have this procedure done? My mare has been having sticky stifles for quite sometime, I almost gave my vet the go ahead to perform this procedure a couple of years ago but then I backed down. I find that my mare’s sticky stifle is holding us back from really advancing through the levels.

Circles are difficult for her and I have found my mare also develops anxiety when we ride where she thinks her stifle is going to catch.

I would appreciate any info on what the recovery time period is like on that procedure.[/QUOTE]

The recovery was fairly quick for a surgery. 6 weeks. One month stall rest (I think, maybe just 3 weeks?) and then 2-3 weeks of turnout. Then returned to work, we just eased her back as you would any horse who is returning to work, from a fitness consideration, not a soundness one.

I know typically sticky stifle horses need to stay moving. However I believe the thinking was we needed to absolutely minimize any chance of her catching so that the tendon’s would not have any excess pull on them while healing, to encourage them to tighten down as much as possible.

It was unbelievable how much difference it made it this mare. I really wish I had done it earlier in her career.

[QUOTE=Helicon;6996961]
I appreciate all the great input, especially the success stories.

Denali, which vet at A & M? Please feel free to PM if you prefer. I like the idea of it being a standing procedure. How long ago did you have it done? Was it a one time treatment?

I have heard blistering has to be repeated - Blumefarm did you only have to do it the one time?

Downyonder, did you have your procedure done at Atlanta Equine? I read they do something similar. Can you share who was your vet? I asked my vet about this procedure but he was not familiar with it.

My vet did mention tendon splitting but he said in his opinion that blistering was equally effective and easier. I wonder if blistering makes fenestration more difficult to do later…?

Has anyone tried Estrone, especially on a mare?

Anybody out there doing upper level dressage with a horse that has recovered from a sticky patella?[/QUOTE]

Dr. Kent Carter is my veterinarian at TAMU. He is who I worked for while there for almost 4 years. Dr. Carter did the work up and evaluation. Surgeons Dr Chad Marsh and Dr Justin McCormick (sx resident) did the actual procedure.

Dr. Carter is now the Vice President of AAEP and can be difficult to get an appointment with. I would have no hesitation in taking my horses to Dr. Marsh. He is also excellent. (and fwiw I am not blindly loyal to the vet school. I use other clinics and only see ‘my’ veterinarians there).

RE: blistering - IF in the terrible, rare, circumstance that the blistering agent gets in or near the actual joint capsule… there will be no coming back from that. I have never seen or heard of it happening, but that risk scared me. As someone who worked in vet med, I tend to have the ‘bad juju insane .01% chance’ stuff happen with my horses!

We had the fenestration done ONE time. I had not seen her catch one single time after the surgery until she had her teeth floated. Then I heard them pop once or twice while she was under heavy sedation.

The mare is an eventer, but is schooling 3rd level dressage now.

Hope this helps! I am happy to answer any other questions, and can PM if needed :slight_smile:

-Sarah Denham

Outcome of Medial Patella Ligament Splitting On My 4yr old Filly

I had the ligament splitting operation done on my 4yr old in early March 2013. It made her sticky stifles much worse to the point that they were sticking on every stride - even the ‘good’ leg.
She was so bad that she couldn’t travel in a trailer as she couldn’t unlock them to balance.
The Vet came here and did the complete severing of the medial patella ligament at home - it was her only hope of recovery at all.
When he opened up the stifle he found that the medial ligament was too TIGHT and this was preventing it from disengaging from the groove. This had been her problem all along, so no wonder that the operation made her worse as it had tightened them even more!!
So, a word of warning. If your horse has sticking or locking problems (my horse stuck out behind before the first op and both out behind and when the leg was forward after the op), make sure whether the problem is caused by too loose OR too tight ligaments BEFORE you opt for splitting, injections, etc as you may make the problem 10 times worse.
You can read a diary of my horse’s progress with her sticky stifles and medial patella ligament desmotomy by clicking on the link.

Thank you for your story wastetech. That is sobering. It’s so hard to know what to do.

I have wondered if my mare’s stifles were too tight, but I was not sure if that was possible? Mostly her symptoms are similar to DownYonders horse. What is different is that she never shows the classic sign of getting stuck - or momentarily caught - out behind while attempting to bring the leg forward. In stead, she seems to get stuck when I ask her to back up. When she tries to step backwards she lifts the hind leg up but then it hesitates in the air and steps down into nearly the same footprint. The other thing that is odd is that so far the symptoms have gotten worse as she has gotten fitter.

The issue seems to be on her left side, but both sides can buckle when I lead her down a steep hill.

I was worried about it being shivers, but two vets have diagnosed her as having a sticky stifle. Her stifle joint radiographs and ligament ultrasounds are clean. One of the vets said that his clinic sees about 300 cases per year and that 80% resolve with simply blistering of the ligaments.

Sarah - thank you for sharing your good experience and the vets you worked with at A&M. That is so encouraging to hear what it did for your horse! Have you ever heard of stifles being too tight vs. too loose? Do you know, does blistering make fenestration more difficult to do later?

Don’t blister a medial patella ligament that is too tight

Hi Helicon, Your horse sounds like her medial patella ligaments are also too tight, especially as she is getting worse as she gets fitter. Getting fitter shortens the ligament, which, if it is loose, makes it improve but if it is too tight, makes it worse. DON’T get her blistered as this only thickens the ligament and makes it tighter, the same as ligament splitting.
My Vet is the oldest one on the practise and has been a Vet there for 33 years. The younger Vets refused to cut the ligament due to recent veterinary papers on some fractured patellas as a result. However, as he said, he had no fears about it as he has done hundreds during his lifetime and only one ever showed any patella changes and that one, he said, he was sure had other issues with the patella itself before the operation, but the owner refused X rays due to cost. He also said that the papers were flawed - too few a sample and the horses that were on the trial were NORMAL, not ones with the problem and would have had different patella conformation. In his opinion, if they had used horses that had upward fixation or sicky stifles, they would have seen totally different results. Interesting eh??
I am delighted so far with Fred’s improvement. She is striding out, much more confident to back-up now (she was very reluctant before and worried as well) and she seems so much happier in herself. She trotted round the small turnout area yesterday with an action that I had never seen before. I almost cried at the power from behind!!

I have never heard of horses having patellar ligaments that were too tight. Because of the biomechanical action required for their stifle to ‘lock’ (which is natures way of allowing them to sleep upright) I can’t quite see how that would happen? I am not saying I don’t believe you, I just have never seen one.

The cadaver models that I have looked at, the loose ligament allows the patella to slide too far over the top of the trochlea of the femur, where it hits a somewhat flatter spot, which causes the patella to be ‘wedged’ too far back. That is when the stifle is ‘stuck’.

If the ligaments are too tight… I don’t see how the patella would ever get back to this point. I suppose the ligament being too tight would mean that the patella gets stuck without ever sliding too far back. It ‘locks’ in the normal position.

Ligament cutting was done routinely on the track for years. There are retrospective studies which have looked at the long term effects of the operation… so horses who were not normal,they were ‘sticky stifle horses’, who had the ligaments cut and were re examined radiographically later. They felt that cutting the ligament caused instability in the stifle joint resulting in both patellar fractures and osteoarthritis of the stifle joint. I’m sorry, I no longer have my university log-ins to be able to find the papers and they are not in the ones that I have stashed around the house…

wastetech - I am really glad that you have found a solution for your horse! It is SO frustrating when we want to help them and can’t figure out how!

OP- It was nice to meet you, and I hope that you find a solution for your horse. My best advice is to find an experienced veterinarian who you feel comfortable with and trust them to help you figure out what is bothering your horse! Please PM me if I can help any more :slight_smile:

My mare’s get caught, not stuck, usually on straight lines.

The problem disappeared when she was foxhunted. Afterward, a conditioning program did the trick for us (about 15 minutes of trot poles three times a week). I did it faithfully all winter and then lapsed for a couple of months this spring for various reasons and her stifle is sticky again.

Could someone please explain what is meant by the term “sticky” stifles? If it is locking patella, I do understand that phenomenon.

If you are riding alone, how do you determine your problem is “sticky” stifle, and not just some other issue? I honestly have never witnessed a horse with its hind leg momentarily, or even longer, stuck out behind it, so am trying to get educated here.

My horse, when first riding, will seem to catch a hind toe occasionally. Or, that is what it feels like… a little ‘trip’ behind. Is THAT, in fact, sticky stifles? I’ve put this ‘habit’ down to his general stiffness in his hind end, and that his joints are not yet warmed up and bending that well.

It comes and goes, and seems to go away with fitness. It is interesting how often I hear (for his host of little issues) to work him more days a week than less. Usually, I get him done 4 days week, and try hard for 5.

Txs for any info!

Sticky stifles

[QUOTE=cyberbay;7018372]
Could someone please explain what is meant by the term “sticky” stifles? If it is locking patella, I do understand that phenomenon.

If you are riding alone, how do you determine your problem is “sticky” stifle, and not just some other issue? I honestly have never witnessed a horse with its hind leg momentarily, or even longer, stuck out behind it, so am trying to get educated here.

My horse, when first riding, will seem to catch a hind toe occasionally. Or, that is what it feels like… a little ‘trip’ behind. Is THAT, in fact, sticky stifles? I’ve put this ‘habit’ down to his general stiffness in his hind end, and that his joints are not yet warmed up and bending that well.

It comes and goes, and seems to go away with fitness. It is interesting how often I hear (for his host of little issues) to work him more days a week than less. Usually, I get him done 4 days week, and try hard for 5.

Txs for any info![/QUOTE]

Hi, It does sound as if your horse may have a sticky stifle. When it catches, it feels like they ‘trip’ or sometimes, that they have collapsed slightly on that side, but only for a stride. On the lunge, you can see it very well.

I had a horse with a locking stifle. It began when he was a 3-4 year old, and only when standing, actually. We tried the conditioning route for about 6-8 years, and nothing changed. He would still lock when standing, being groomed or tacked. Finally we tried the Estrogen injections - I believe it was once a week for 4-5 weeks? Total cure, and he has not had any more of a problem for years.

[QUOTE=Denali;7017906]
I have never heard of horses having patellar ligaments that were too tight. Because of the biomechanical action required for their stifle to ‘lock’ (which is natures way of allowing them to sleep upright) I can’t quite see how that would happen? I am not saying I don’t believe you, I just have never seen one.

The cadaver models that I have looked at, the loose ligament allows the patella to slide too far over the top of the trochlea of the femur, where it hits a somewhat flatter spot, which causes the patella to be ‘wedged’ too far back. That is when the stifle is ‘stuck’.

If the ligaments are too tight… I don’t see how the patella would ever get back to this point. I suppose the ligament being too tight would mean that the patella gets stuck without ever sliding too far back. It ‘locks’ in the normal position.

Ligament cutting was done routinely on the track for years. There are retrospective studies which have looked at the long term effects of the operation… so horses who were not normal,they were ‘sticky stifle horses’, who had the ligaments cut and were re examined radiographically later. They felt that cutting the ligament caused instability in the stifle joint resulting in both patellar fractures and osteoarthritis of the stifle joint. I’m sorry, I no longer have my university log-ins to be able to find the papers and they are not in the ones that I have stashed around the house…

wastetech - I am really glad that you have found a solution for your horse! It is SO frustrating when we want to help them and can’t figure out how!

OP- It was nice to meet you, and I hope that you find a solution for your horse. My best advice is to find an experienced veterinarian who you feel comfortable with and trust them to help you figure out what is bothering your horse! Please PM me if I can help any more :-)[/QUOTE]

Another interesting point made by my Vet is that every one of the horses whose ligaments were severed, if they had been done for several years before they died and if he was lucky enough to be able to do an autopsy on them, he found that the ligament had re-joined again, only, this time, at the correct length, hence no sticking!!

Thanks, Wastetech! … So, does the term ‘sticky’ mean a locking patella of a mild variety?

I think I might try Estrone, given Fairview’s experience, mostly b/c it’s not too expensive and it might be the ticket for my horse’s mild symptoms?

Here is a link to the customer education library of my sports medicine vet.
http://www.atlantaequine.com/pages/client_lib.html

Look for Proximal Patellar Hesitation Treatment. The site describes four levels or types of treatment - from getting the horse fit, to estrogen therapy, to fenestration/blistering, to Medial Patellar Desmotomy. Some treatments work better in some cases than others, and you can get a fair idea from reading the descriptions of what the different treatments consist of.

And, FWIW, we are now 5 weeks post-fenestration/blistering on my horse, and he is doing really well - feels much stronger with that leg and he is getting much more confident about stepping up underneath himself with it. :smiley:

I had the fenestration done on my gelding about 4 years ago, after trying hill work, poles, and Estrone for about a year. All helped a little but not enough–and he was being worked almost daily. However, Fenestration is not an exact science, in that my gelding evidently scarred/shortened too much, and despite all the diligent care and PT I did as recommended afterward–he was not able to extend his leg enough to track up–which he could easily do beforehand. This caused stressed on the other leg and opposite shoulder, so more issues have ensued. Wish I had never had it done, for what it is worth.

My PSG horse has a locking stifle. When I bought him as an almost 4 yo both stifles locked, we did the blistering and it worked 100% on the left stifle but didn’t stop the right one from locking, although it did improve it. His stifles only ever lock at rest and when he first starts to walk. I decided against the surgery and I am happy with my decision as at 17 he is still sound and showing PSG, schooling I1. Any of the issues we have had with not moving past this level are related to lack of resources for coaching and also this horse has some dental difficulties which affect him far more than his locking stifle. I have used Adequan starting at a young age as I figure the only thing it would hurt would be my wallet.
The one exercise I found that really seems to help reduce the amount his stifle locks are reinbacks.
Good luck with your horse, I would say for mine, that IF his locking stifle has impacted his ability to do his work, it is minimal.

Blistering is fairly old fashioned and does cause pain/discomfort. I went to Dr. Langer at Wisconsin Equine and he perforated the stifle ligaments in a short procedure and we went home the same day. As the scar tissue grows in it shortens the ligaments. Blistering is not always effective and it puts your horse in discomfort. Perforation usually always works. He has also had routine joint injections into the stifle about twice a year–we are doing IRAP now–as they are his weak spot, but he has not gotten stuck since the procedure.