Stifle Meniscus Injury *UPDATE*

[luv2lope]

Looking for advice and insight on dealing with a stifle meniscus injury.

Horse is a 3 year old, vet thinks he injured himself somehow in his stall or out in the field. Vet can’t tell on the ultrasound if he has torn the meniscus or just injured it…this vet admitted she has not dealt with this very much before and she can’t really tell. Vet’s course of action is 2 months of stall rest plus an aggressive rehab plan of PRP, shockwave, rest, and whatever else my insurance will cover. Her prognosis for the horse is fair to good. I have outlined that the horse is a resale project and she reassured me that he should recover just fine.

Has anyone dealt with this before? Would doing an MRI on his stifle find more answers, or would it be a waste of money? I feel so uncertain in her diagnosis and am wondering if a second opinion by a specialist would be beneficial, or if we’re on the right track with my vet’s instructions?

Looking for others to chime in!

[Simkie]

Years ago, my vet told me of a case with a very bad meniscus injury (she described it as a bomb going off, iirc) and that horse came sound enough to go back to it’s lower level eventing job with IRAP.

If your vet isn’t very well versed in interpreting stifle ultrasound, it’s worthwhile to see someone who IS.

Can MRI even be used to image a stifle? That’s a big joint to get into the machine! I’d prioritize getting a really good ultrasound before considering anesthetizing for MRI.

[WavyRider]

We did Arthramid on my horse’s meniscus injury. He was not a surgical candidate at the time. We took rehab very slowly and he made a full recovery. We had tried PRP and steroids before diagnosing the actual meniscus injury with some improvement but the Arthramid was the real silver bullet. He’s back in full work.

[Bonnie2]

Agree with Simkie. First you need to get an expert with the ultrasound to look at the horse. Ultrasounds are very difficult to interpret properly. Many laymen here in the forums can give a pretty good idea what is on an X-ray but u/s is very difficult. Get a better diagnosis, then move forward with treatment and prognosis. Good luck!

[2tempe]

If the vet said prognosis is “fair to good” and then said “he should recover just fine” - that alone would be enough to send me for a more knowledgeable evaluation. I would want a diagnosis that is as accurate as possible.
MRI’s are possible but you may have to shop around for clinic that has the equipment/expertise to do them. They are pretty pricey; I did an MRI/myelogram on horse with cervical issues; it ran me about $4500; should have been cheaper w/out the myelogram.
Read this to get an idea how they do it. https://thehorse.com/1118186/mris-of-the-equine-stifle-complicated-but-very-useful/

[NaturallyHappy]

So….I don’t really have advice. We had one w a stifle problem. The vet recommended a mild blister to start w. We did that but it didn’t help. Our osteopathic body worker was and looked at him. She said it was a flipped meniscus, fiddled w his stifle and he was fine. I doubt this is helpful but thought I’d share, just in case.

[2tempe]

OP - are you located reasonably near any equine hospitals or larger clinics?

[luv2lope]

There are a few clinics that offer a specialist’s opinion…I would need a referral from my vet for them to see me. I guess it gets down to how much do I want to spend? My horse is insured but not all costs will be covered. My bill is almost 2k for 3 vet appointments to try and diagnose this lameness. Let’s just say if she did the ultrasound on appointment #1, my bill would be much less.

[TWH_Girl]

Have you done the PRP yet? I think the treatment plan sounds reasonable and I would proceed. I’d maybe switch out PRP for IRAP though. Other than that, regenerative medicine and rest is probably your best bet besides arthroscopic surgery.

[luv2lope]

Just a small update to those that were interested…

I did not get another opinion as A) I was worried about too much conflicting advice from another vet B) financially I didn’t want to rack up more vet bills C) more time spent taking days off work and running around to a clinic with a young horse that is bouncing off the walls

So it has been over 2 months of complete stall rest and hand grazing for this dude. Vet came and ultrasounded him, things are healing and looking better (fingers crossed they keep going that way!). There is a small amount of inflammation and fluid, but vet suspects it’s either from not using himself/ standing around in confinement or from him kicking the absolute shit out of the walls. Horse is sound at the trot.

On the other end, my horse has had enough and is coming undone, his topline is terrible, he’s lost some weight, and he’s miserable (ears back when you go to grab him) from being stalled for the past 60 days…vet says “we can’t keep him on stall rest anymore” and then tells me he can be hand walked 5 mins a day but no turnout until “he can prove he’s not an asshole and not run around” Not sure what 3 year old is not going to lose its shit after being cooped up for months… Walking him is ok with the help of Ace, but he was still a little hyped up.

Go to the barn to walk him on the weekend, and he is LOSING IT in his stall…double barreling the stall walls, rearing up, spinning around like crazy to the point of almost falling down. He has other horses in the barn with him, and it was a nice calm day. He has been getting more pent up by the day, even though he’s getting loaded up with tranq. At this point, I am at wits end. Load him up on Ace and it helps a bit but he is still agitated and circling the stall. Barn owner and I agreed that he was going to hurt himself or tear the barn down by keeping him in and decided to put him out in the small indoor arena…yes, totally against the vet’s plan. My barn is not set up for medical/ restricted turnout and this is the best we can do.

I was holding my breath and cringing the entire time he was out. My horse had a few bucks and ran for less than 30 seconds before going over to some hay and just chilling out or sauntering around the arena at a walk. He’s happy hanging out in the arena, and can see outside to keep himself entertained. Barn owner and a few others are keeping eyes on him and to my knowledge he is still sound after a few days of regular arena turnout.

At this point, I’m leaning towards Dr. Green. Maybe I’m wrong in my approach and I am questioning my decision about going against what the vet wants, but in my mind he’ll either be sound or he won’t.
Mentally he cannot handle being cooped up anymore. Thankfully he has never been the kind to run around like an idiot, but would rather just watch things intently for mental stimulation. I hope that with lots of time he’ll be ok.

[IPEsq]

Well, spinning in the stall is definitely not great on the stifle. I’d personally do a round of IRAP given the latest images. Are there any rehab barns in your area that could accommodate him for a little while? Ideally one with a treadmill?

[luv2lope]

Any rehab places are very limited and will be $$$$ which I do not have. My insurance has been useless on this as well, and I am now out of coverage on this claim Vet said she would get me a cost on therapies we could do on him as well as a written out rehab program…she said that last time and has yet to produce either. I’ll be blunt-- I’m getting turned off of this vet. I’m getting pissed that there is no follow up despite me asking for it. I feel left in the dark and more confused by her explanation after every visit. I feel she has somewhat unrealistic ideas (ie. putting stall mats on the walls, wanting a boarding barn to configure areas to accommodate my horse’s limited turnout). Fun times!

[stargzng386]

Honestly what your vet is asking for is really standard for rehabbing a horse. Do you want this horse to be rideable or are you ok with a pasture pet? If rideable suck it up save up and get them to a rehab farm for 1-2 months. Have the rehab farm get your horse back to turnout safely. It’s a completely different atmosphere at a rehab farm. They’re in a stall but they come out half a dozen times a day. A good place should do core exercises, handwalking, targeted pt exercises, laser therapy etc. all the horses are in the same routine and usually less sedation is needed. I get that the cost really sucks but is a couple grand now worse than paying for a pasture pet for the next 20 years or longer? Or euthanizing?

[WavyRider]

Anecdotally, mine lived in a 50x90 foot run during his rehab. He was around 8 at the time and could be trusted not to be an idiot, and my vet was ok with it.

[luv2lope]

I absolutely understand what you are saying, but the truth is that I don’t have $2k+ per month to spend on rehab. It hurts spending money buying insurance only to find out pretty much none of it is covered at this point. Of course I want this horse to be rideable, but I also have to be truthful with what I can and can’t afford. The barn I have him at does get a few turnouts and is very quiet as it is a smaller private boarding facility. Barn owner is keeping a watchful eye on him, and is around the arena when he is out there. Thankfully he’s being very good and staying calm, but he is still a young horse at the end of the day.

When the vet was first investigating this injury, the topic of euthanasia was brought up by me as she thought he was showing neurological signs, so don’t think it hasn’t crossed my mind. I will say that this vet understands that I don’t have oodles of money lining my pockets and is trying to be as cost prohibitive as possible.

[luv2lope]

@WavyRider

Anecdotally, mine lived in a 50x90 foot run during his rehab. He was around 8 at the time and could be trusted not to be an idiot, and my vet was ok with it.

That’s promising to know! I’m happy that mine is more inclined to eat and stare at the other horses rather than run around-- fingers crossed that he can hold it together.

[stargzng386]

Understood the whole situation sucks and I know it’s expensive. My personal experience was I went with a cheaper treatment for a 3 year old with hock issues and he’s now perfectly happy pasture sound but can never be ridden. If someone had sat me down and explained the pros and cons of ALL treatment options I would have made a different decision. What saved me a couple thousand dollars is now costing me 5k minimum a year for cheap pasture board, vet, trims, dental and I’m 5 years in to supporting an injured horse that is only 8 years old. So total of 25,000 for an incredibly cute friendly happy “lab” living in a field. I’m also paying for a second riding horse so add in his purchase price and monthly upkeep. I cannot and no vet would euthanize him because he’s comfortable and not lame enough to put down. I can’t give him away he would most likely end up at a slaughter house. The added weight of a rider is the only thing he can’t tolerate. I regret every day I go see him and pet his nose and give him treats that I didn’t go with the more expensive option. I went with the multiple vets saying if you do this he most likely and should be trail sound which was all I wanted.

My cousin has a rehab facility and watching what she can do with truly lame and injured horses is amazing. They thrive in the environment. They come back from far worse injuries than they should. Sometimes a quieter atmosphere is worse because it makes them more stir crazy in a stall.

[luv2lope]

Thank you for sharing your experience-- it certainly puts things into perspective for sure and I totally understand where you are coming from with that experience.

[IPEsq]

A meniscus injury is pretty serious. I think you need at least a second opinion.

With young horses, the patient compliance piece can be the hardest part. On top of any challenges you are already dealing with in terms of how a boarding barn can accommodate special needs.

Why isn’t insurance helping? Has too much time passed?

[LazyA1]

I have an older horse who, when he was 16 or so, “blew up” (vet’s words) his meniscus. He was on a lease, so I do not have details on what happened. I shipped him home and turned him out in an 8 acre field with a run in shed and one other horse. I thought he would just be retired. He did not look that bad at the trot but his canter was really bad.

After about two years, maybe three, I watched him one day and thought “that horse is sound”. I put him back to work doing nothing more than xrails. He was 18 or 19 or so, so that was appropriate for his age. He to this day is toting beginners around and seems to like that job and is sound.