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Stifle injury & PRP (long!) *Update - not stifle

Horse Care
#1

Does anyone have any experience with PRP for a stifle injury? We had the vet out today as our trainer thought our young, hot house flower, horse had some back pain. Horse is not noticeably lame, tho vet noticed right hind lameness while lunging. Flexed positive for stifle which was confirmed by blocking. Ultrasound showed inflammation but no abnormalities. (We have clean radiographs less than a year old and a good vetting in December). Vet suggested PRP, joint injections or scoping but we jointly decided to do PRP (administered today) and reassess in a few weeks.

Anyway, the horse has not fallen - that we know of! He’s not one to act up in turnout, is turned out alone. He had some hoof issues (arrived barefoot, feet weren’t holding up on the hard Texas dirt) but has been shod all around and feet are looking much better. And some back issues due to saddle fit but he was fitted and has a new saddle. I know horses will be horses, but I’m at a loss as to what happened! He had been going really well but about a month ago, tripped himself by stepping on his bell boot while trotting (right hind caught right front) and sort of (maybe) hyperextended his right hind? Could that have caused this?

Does anyone have advice or experience with PRP? We’ve had horses for years in a past life but this is an injury I have no experience with!

TIA!

#2

You chose to do PRP and administered it on the same day? Was horse in the clinic already? That was fast.

The thing about PRP is that it might not actually do anything - or it might. All it may do is promote/ speed healing. It’s often hard to know if the PRP actually did anything versus just the body naturally healing an injury, but it shouldn’t hurt him so sometimes worth a try. (I have athlete friends that have had it done for soft tissue injuries, and I may consider it for osteoarthritis - it correlates with improvements but not really possible to conduct studies to prove it’s effectiveness.)

What is your post-procedure rehab plan? Presumably some rest, then some light use only?

#3

Vet was out to the barn for his regular visit and has PRP equipment on his rig.

For the next 2 weeks, stall rest, turnout in a medical paddock and hand-walking. Reassess after the 2 weeks are over

#4

I do!

9yo gelding was lame in the stifle, swelling in the joint was obvious. Did steroids with minimal improvement, then PRP. PRP did not seem to make much difference. Put treatment on hold for a few months due to another condition, horse continued to be stiff / lame (was out of work). Ultrasounded the joint six months after initial injury and confirmed some kind of damage to the meniscus - likely a tear, grade unknown. Surgery was too risky at the time because of the other health condition, so Arthramid was recommended. Saw results within two weeks and horse is now sound (though with an undermuscled stifle) and I got the ok to slowly rehab and bring him back into work.

If given the option between PRP and Arthramid / Noltrex, I would choose Arthramid / Noltrex every time. It made a huge difference in my horse’s comfort, much more than the PRP did.

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#5

I have one experience with ProStride (basically a combo of PRP and IRAP) and it’s probably not a fair comparison. One of my geldings has “navicular” (but clean rads at the time) and we tried ProStride in leu of the regular steroid cocktail. I can’t say it really worked any better so I returned the regular (and cheaper) steroids next time.

However, if you want to avoid steroids, then PRP is certainly a valid option and may help reduce the inflammation faster than stall rest alone.

Obviously, something made your guy’s stifle sore, whether it be a misstep or strain or whatever. I supposed about like if you sprained your ankle mildly. Soft tissue inflammation primarily needs to time to heal.

I think your plan is appropriate.

I will add in there to get him a bunch of PEMF sessions if you have someone in your area that does that! I’ve had great success with it for stifle problems.

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#6

Thanks! Would the degree of lameness correspond with the severity of the injury?

#7

I do IRAP for that sort of thing. But I never inject something therapeutic the same day as a block was injected …

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#8

Why is that? re: not injecting the same day as blocking?

#9

I would say that each does some damage to the tissue on its own; injecting anything into the body is a foreign substance - even if it is your own platelets. It can cause inflammation.

My friend had PRP on her piriformis. She was so sore she needed crutches for a day. It is helpful, but it causes a tissue injury that also needs healing.

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#10

Understood. We live in central Texas, so the vet’s coverage range is huge. I would imagine it would have been a few weeks before he’d be able to get back for a non-emergency.

#11

Because you’ve already put something into the joint that day, and the numbing stuff can be irritating in itself.

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#12

No vet will inject a joint the same day you did a nerve block in that area. You will always have to come back later.

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#13

Given that the PRP was done on the same day as the block, how much improvement would you expect to see after 2 weeks? And then how much after 4 weeks - last 2 of which have been stall rest with hand walks?

We’ll find out tomorrow as he’s going to the clinic for recheck and possible scope but I would love a baseline so I can set expectations. I know, of course, that every case is unique but any additional information is helpful

#14

I also had way better résults on stifles with arthramid than prp.

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#15

Sooooo, not stifle. Doing more blocks today to see if the lameness can be isolated.

#16

Blocked sound for hock. Rads, ultrasound and a CT scan later, no fractures and suspensory appears normal, rads showed a teeny tiny bone spur and CT showed a possible small bone bruise. Injected Arthramid for the hock spur to see if that was the cause of the lameness but only 75% improved at the 2 week check. Now assuming it is a bone bruise and poor guy is definitely entering the baby dragon phase of this layup.

Any experiences with a bone bruise are appreciated!

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#17

My horse had one, and they are SLOOOW to heal. He recovered fully, but drugs were our friend.

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#18

My mare had one on her cannon bone from being struck (we think) by another horse. It bruised the periosteum of the bone. She made a full recovery but it took a long time, too.

#19

My horse had a mystery lameness a couple of years ago. I have a farm and multiple riding horses, and it’s my usual policy to just turn them out. When they are sound at pasture, I do a soundness check. Mine was fine after about five months (probably sooner but I was not in a rush). Vet says likely a bone bruise.

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#20

Thanks for the insight - I appreciate it! It’s only been 2 months so far but feels like forever! I’m sure for him , too.

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