Stifle Injuries and Operations...experiences?

[CanteringCarrot]

My gelding is scheduled for surgery on Friday to repair some ligaments in his stifle. This is a terrible description, but it is the ligament (one on each side) that controls lateral movement of the joint. Not the main three ligaments that are on the front of the joint. Apparently this is one of the more uncommon ways that a stifle can be injured. Of course, why would I expect anything ordinary?

This injury presented itself yesterday when my horse could only walk on three legs and drag his rind hind along until it eventually released. Sometimes it gets stuck when he is asked to move backward. He showed no signs of anything until yesterday, so I brought him straight to the clinic. He can walk normally sometimes.

He is kind of upright in the back and tends to stand under himself. He is a PRE and I find this type of hind end conformation to be quite common in that breed. He passed a very extensive PPE just one month ago, but this is a horse, so here we are.

The idea is to scar the ligaments so that they become thicker and can stabilize the joint. Standard, really. It is the recovery that will be tricky, and my paranoia of it happening again.

Have you experienced stifle surgery in any capacity? What was it like (the procedure, type of injury, recovery, etc.)?

Mostly looking for experiences while I attempt to not stress too much. It was either opt for the operation or euthanize, and I hope that I made the right choice.

[JB]

What exactly is the injury? How is it known that those ligaments need help?

You’re describing upward fixation of the patella (UFP) where the patellar ligaments hooks over the patellar hook, as it should for sleeping standing up, but then fails to unhook during a normal movement. This results in the stifle locked in place, unable to flex, leaving the leg to drag if the horse moves forward. It can range anywhere from a mild catch/release, to having to be creative with some massage work, backing, turning, etc, to get it unlocked.

Clearly something happened if this came up literally out of the blue. But I’m not sure I understand why surgery is being scheduled so quickly. What diagnostics were done?

This only just happened. Was there no discussion on using some quiet turnout, some bute to help with inflammation, some icing, etc?

Surgery to thicken the ligament works if the ligament is too lax. It’s not going to solve anything if the issue is a “shortened” ligament due to current inflammation and swelling around the area.

[CanteringCarrot]

Video for curiosity sake: https://youtu.be/Ws0_MZBjKNU

Doesn’t capture how bad it was/can be though.

[CanteringCarrot]

@JB

What exactly is the injury? How is it known that those ligaments need help?

You’re describing upward fixation of the patella (UFP) where the patellar ligaments hooks over the patellar hook, as it should for sleeping standing up, but then fails to unhook during a normal movement. This results in the stifle locked in place, unable to flex, leaving the leg to drag if the horse moves forward. It can range anywhere from a mild catch/release, to having to be creative with some massage work, backing, turning, etc, to get it unlocked.

Clearly something happened if this came up literally out of the blue. But I’m not sure I understand why surgery is being scheduled so quickly. What diagnostics were done?

This only just happened. Was there no discussion on using some quiet turnout, some bute to help with inflammation, some icing, etc?

Surgery to thicken the ligament works if the ligament is too lax. It’s not going to solve anything if the issue is a “shortened” ligament due to current inflammation and swelling around the area.

It is known from a diagnostic exam at the clinic this morning. Ultra sound and radiographs. It is the medial ligament IIRC. The ligament is indeed too lax. There is no swelling in the area or signs of trauma, so I am even more uncertain as to how this occurred. This is not something that could just be cured without surgery, I think. Trust me, I do not want to have surgery on a horse that is not yet covered by insurance if I can avoid it. Well, he does have an active policy but they do not cover accidents and/or operations for the first 4 months.

When the joint locks, the vet is able to manually manipulate the joint to unlock.

[JB]

It’s definitely UFP.

I would say some sort of insult to the area sounds most likely for it to come on suddenly. But I still can’t wrap my head around why surgery is even being considered this quickly.

[JB]

@CanteringCarrot

It is known from a diagnostic exam at the clinic this morning. Ultra sound and radiographs. It is the medial ligament IIRC. The ligament is indeed too lax. There is no swelling in the area or signs of trauma, so I am even more uncertain as to how this occurred. This is not something that could just be cured without surgery, I think. Trust me, I do not want to have surgery on a horse that is not yet covered by insurance if I can avoid it. Well, he does have an active policy but they do not cover accidents and/or operations for the first 4 months.

I still don’t understand why surgery is being recommended so soon. How in shape is the horse? Does it happen with brisk walking? Is he actually lame, outside of the locking? Sore to palpate?

Which surgery? Blistering?

[CanteringCarrot]

*lateral collateral ligaments not medial.

I looked over the paperwork and anatomy that was shown to me. So that is why the vets claim it is not so typical of UFP because normally that involves the medial ligament.

[CanteringCarrot]

Surgery was considered after watching him yesterday and today. It may seem a bit soon but the “locking” is more frequent and he will hop along on 3 legs for the equivalent of 4-5 strides and sometimes could not unlock without the vet. I rather him be at the clinic for closer monitoring. The problem seems to present itself as fairly severe and he is young (5) so we are hoping that the ligaments can regenerate/thicken well. His ankle has a little bit of swelling today from dragging it around/abnormal pressure I imagine. So again, needs monitoring.

Of course we have until Friday, so if there is improvement, worsening, or remaining the same, that can effect whether or not we move forward.

[syreino]

My then 4 year old, now 9 year old, mare tore her medial collateral ligament by running through a fence. She was unable to put weight on that leg for approximately 24 hours, but it took awhile to diagnose the issue since nobody really thought to ultrasound and check the ligaments (xray showed she’d not broken anything). Surgery was NEVER suggested by the several vets who conferred on her ultrasound. In fact euthanasia was suggested by a world renowned surgeon.

What we did - strict stall rest for 2+ months, some Previcoxx early on. On recheck, she was clinically much better, ultrasound didn’t show much of a change unfortunately. We went with what she clinically looked like as our guide and worked up to a small paddock turnout and hand walking over the next several months. And the vets were all amazed at how “good she looked”.

Approximately ten months after her injury I got on her back for the first time. It’s been a long road, but she healed and her dressage lessons, hill work, ground pole work, etc has taken her “sound but asymmetrical gate” to “sound”. I can tell when she’s had enough work by her attitude now, but she’s basically a “regular” horse now.

I was told she was a young horse and regenerative therapies would really be a waste of money as she was young and her body would do the regeneration.

Good luck with your boy!

[CanteringCarrot]

So, with correct exercise or rest (which one is it?) the ligaments can tighten and strengthen on their own without surgical intervention?

[JB]

@CanteringCarrot

So, with correct exercise or rest (which one is it?) the ligaments can tighten and strengthen on their own without surgical intervention?

Can, yes. Will? Entirely depends on the individual situation.

If the ligament was injured to the point where it tore a little, thereby effectively lengthening it, then healing will create scar tissue all on its own.

what, exactly, is the diagnosis? Not just which ligament is involved, but what happened to it?

In the time that the UFP has worsened, has he been more confined?

[CanteringCarrot]

@JB

Can, yes. Will? Entirely depends on the individual situation.

If the ligament was injured to the point where it tore a little, thereby effectively lengthening it, then healing will create scar tissue all on its own.

what, exactly, is the diagnosis? Not just which ligament is involved, but what happened to it?

In the time that the UFP has worsened, has he been more confined?

Lateral Patellar Luxation is the exact diagnosis. So not quite a common UFP case if I understand correctly.

I have no idea how it happened. I rode him lightly the day before and he was fine.

It was the same after being confined in a stall at the clinic.

[JB]

Yes, sorry, my “what happened to it” question was really about “what exactly is the damage to the ligament” and not “what did he do to injure himself” LOL

Lateral patellar luxation to me says - he displaced his patella, and did so laterally (which is how it usually displaces, if it’s going to). Essentially, a dislocated knee cap.

I wouldn’t think he’d be able to straighten his stifle - it would be protectively flexed at least a little. That doesn’t seem to jive with the symptoms which are, as far as I can tell, a UFP issue.

[keysfins]

I have nothing substantial to offer. But OP, I hope that you will not proceed with any surgery until you:

1. Understand what the diagnosis is, and likely reason that an injury occurred (could it happen again to the other hind?)

2. Understand what the prognosis for recovery is, and to what degree the horse may continue its intended use (what will recovery look like? Timeline? Return to work? Rehab schedule?)

3. Understand all options available for treatment, from the least invasive to the most (presumably surgery)

4. Understand all potential risks and benefits for each treatment option (will the opposite hind be stressed while the injured limb is recovering? What can be done to support it? What happens in surgery, what risks are there to surgery?)

5. Can make an informed decision for the wellbeing of your horse (you don’t have to answer to anyone here, of course! There is a wealth of experience here that you may find useful as you make decisions, though.)

and finally

6. Have utmost trust and faith in the ability and experience of your surgical vet if you end up deciding on surgery (how many times has the surgeon performed this particular surgery, and what were the outcomes? Are there different procedures to treat this?)

If at any point you do not understand something, or if you feel unsure, uneasy or just have a bad gut feeling, WAIT. It is absolutely ok to tell any vet that you want to take some time to think about what treatment plan to pursue. Please don’t feel pressured to do ANYTHING before you are comfortable.

Making a decision in haste, or without full understanding of potential outcomes, does NOT have to happen. With very few exceptions, there are ALWAYS options in treating injuries and/or lameness.

I get the sense from your posts that you are not completely sure what and how any particular treatment may help your horse, and if there are options/alternatives that have not been discussed. It is understandably distressing to see your horse in the video, and you want the horse to be comfortable as quickly as possible. Ask if there are other things you can try before heading to surgery. Ask if surgery is the preferred treatment, and why it must be done immediately.

And do not hesitate to get a second or even third opinion! If you care to share your location, someone here may be able to suggest sources/vets/hospitals for an additional consultation.

Good luck, please update when you can. You will make the right decision for your horse!

[CanteringCarrot]

Ok, I am not making a completely uneducated decision…

I did forward all of his info to another clinic. I was also educated on the prognosis, what recovery looks like, and what realistic chances are of returning to work. I am not attempting to make an uneducated decision. Maybe I should have elaborated more but I am looking to see what others have experienced who have actually had a stifle injury on their horse. Just anecdotes, really. I suppose those are pointless though because all horses are different.

I think that I seemed too black and white in my post. This vet thinks sugery. So he is on the schedule for Friday. I can cancel that by the end of the day today. I am conducting further research to get a better consensus on what to do. It’s hard because even I wanted to jump to sugery after seeing how bad it is getting for the horse. It is hard to imagine a recovery without it, but it doesn’t mean it’s impossible I suppose.

Today I speak with another clinic that has one of the best surgeons in Germany, and also another in Belgium to get their input. I am considering bringing the horse home and treating in a conservative manner if recommended and I have a vet that is on board. I hope to know by the end of today what the definitive plan is.

I do not know if this type of injury can heal on its own or if surgical intervention is needed. All I know is that the horse hops around on 3 legs currently, is damaging his ankle by not being able to always stand on his hoof, and is difficult to trailer/unload in this state. I think that is why the vet jumped to surgery since he believed that is the quickest way to alleviate the problem. Within 100 meters the joint locks/malfunctions 5-6 times and it isn’t just lock, step, lock, step. It is taking a few strides to unlock or having someone unlock it only to lock again.

I am going to see the horse today and see if there is any improvement or worsening because that will also have an influence on the ultimate decision.

I’d love to manage in a conservative manner and the go to surgery is that fails, but the frequency and length of the locking of the joint is concerning. I do not want to stress other parts of the body longer than necessary. I know healing from surgery will also have stresses. So out of 3 opinions today, I hope to arrive at a reasonable conclusion.
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[CanteringCarrot]

I received 3 other opinions. No one wants to jump to an operation quite yet. They have not seen the horse, but I am opting to bring him to another clinic. I will pick him up tomorrow and bring him directly to the other clinic. This surgeon has a good reputation, and I want to make sure it is done correct. If he says surgery also, then we will move forward. For now I hope he trailers well tomorrow and maybe there is a less invasive way.

Also, I don’t know why this vet wanted to do the surgery with the horse laying on his back. I am only familiar with standing stifle surgery. I am not a vet though.

[keysfins]

Thanks for the additional information. I did not mean to suggest you were uninformed, and I apologize if my post sounded like that.

It is difficult to share experiences with injuries and treatments, it might be comparing apples and oranges if the injuries are different. I think that may be the reason for the questions about the nature of the injury.

I know of a couple of horses that had stifle surgery for the UFP issue. Results were decent with the “splitting” type surgery, and specific rehab exercises as the horses recovered, sort of like physical therapy in humans. But it did take several months of careful assessment regularly before the horse was back in work for dressage, around 6+ months. Surgery was pursued when other options were not successful. But again, this was for UFP, which may be different from your horse’s case.

I hope you will share what you learn with the other consults, as that may be helpful for others here in the future.

[MYalterID]

My horse with UFP came out of his stall with a similar locking one day after being stuck in his stall for a couple of weeks due to torrential rain, and was also not being worked during that time because I was on vacation. Blistering with an iodine solution took care of the issue the same day, and we resumed normal work the next day.

[JB]

The advice and questions are coming from not understanding what the issue actually is.

Lateral patellar luxation is a dislocated patella. Surgery is pretty much the best way to handle that, especially if the best chance for soundness involves deepening the groove that holds it in place. The sooner the better. That surgery would be with him on his back.

The video shows UFP, which is not at all the same thing. That surgery - though VERY early to think about it IMHO - is a standing surgery where the ligament has a few 45* slices made through it.

The video, and your description, say UFP. That is entirely different from LPL. That’s why we’re all confused and all over the place with questions and suggestions.

[CanteringCarrot]

Yeah, I don’t know what to tell you. The diagnosis from the vet literally says Lateral patellar Luxation.

I agree it sounds and looks like UFP.

The only things I can think which lead the vet to believe otherwise (not UFP) is perhaps the feeling when he manipulates that joint AND the fact that the usual ligaments that effect/cause UFP look perfectly fine according to him and the diagnostic imaging that was conducted.

I have decided to go to another clinic, but the closest one will be 2-3 hours. I am unsure about trailering a horse in this condition for that amount of time. Is it a concern? The vets didn’t say anything, and we are stopping every 45 min for a check and water because it may be warmer tomorrow.