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  Discussion on Prognosis in stifle lameness?
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New Member:
jvolkar

Posted on Friday, Oct 3, 2008 - 3:17 pm:

My 11 year old gelding is a show horse for western pleasure/hunter under saddle and has been in daily training for the past six months and doing well. He is pastured in an individual paddock to which he is hand walked daily. Six weeks ago, he appeared to be acutely lame in the left hind when being trotted under saddle, not so much a visual lameness, but rather a feeling that he had a flat tire on the left and that his left hip was collapsing. He was given a week of stall rest,a visit form the farrier which was negative, and then a week of turnout only.He got no better but no worse.
I then took him to the vet for a thorough lameness exam. He was 3+ lame at the trot, worsening with flexion at both the pastern and stifle, but mainly the stifle. He had a mild to moderate effusion of his stifle joint, with no associated heat. Nerve/joint blocks had no effect on his lameness in the fetlock/suspensory/pastern area but vast improvement when the stifle was blocked. Radiographs showed some mild arthritic damages in the stifle. He received steroid/HCA injection in the stifle and went on bute for 5 days,, off all work but continued to be turned out. It is now one week later and I was to start working him in straight lines of trotting.Unfortunately,he still has that same flat tire feeling under saddle and still appears to be off.
The recommendation was to continue this program for another 7 days as I was told joint injections can take that long to fix the problem.

However, at this point I am dejected. I understand that arthritic changes on radiograph do not necessarity correlate with severity of disease (i.e that horses can be sound and have xray changes and can be unsound and have no changes) But my worry is that since this appeared to be an acute change in soundness, that this is not an arthritis issue at all but rather an injury to ligamentous tissue.
If this does not work, I believe my next step would be arthroscopy versus prolonged stall rest. My understanding is that nuclear scans and ultrasound are fairly nonspecific. So my questions are

Can arthritic changes show up so acutely? (He was never off before in the two years he I have owned him)

If this is a ligamentous injury rather than just arthritis,

Are MRI tests of any value?
if there is an injury such as an ACL tear, what is the prognosis with surgical repair?
if there is an injury such as an ACL tear, what is the prognosis with stall rest alone?
Moderator:
DrO

Posted on Saturday, Oct 4, 2008 - 8:57 am:

Welcome Judith,
While it is true that nuclear scans are fairly nonspecific, ultrasound can be a very useful tool with proper equipment designed for this type study and a experienced operator. The problem with ultrasound is that it cannot visualize some areas of the stifle joint so may miss some lesions.

Yes lameness from arthritis can show up quickly. Think of it this way: the joint goes along degenerating but able to recover following exercise. One day it gets to where it cannot recover and that is the day the lameness begins and it can be fairly remarkable. I agree with you however that the history is more consistent with an acute injury.

I don't know anyone with an MRI big enough to do a stifle and if they do it would require general anesthesia. Why not just do the surgery where you can get a diagnosis and the potential for specific therapy.

Concerning cruciate ligament tears the prognosis will depend on the nature of the tear(s). Right now I am traveling so don't have access to my library where I might be able to give you more complete information but in general smaller single lesions have a good prognosis of returning to the show ring with surgery and debridement of damaged tissue. We don't have much specific information on non-surgical cruciate ligament tears since they are usually diagnosed during surgery but it is felt that leaving the damaged portions of the ligament in the joint perpetuates the desmitis and can lead to osteoarthritis.
DrO
New Member:
jvolkar

Posted on Saturday, Oct 4, 2008 - 10:10 am:

Thank you for your rapid response. I am a physician so any links to journal articles etc would be appreciated.I just want to do the right thing. I am willing and able to pay for surgery if necessary but I do not want to incur the expense if the success rate is minimal.I am willing to be patient and try stall rest for 4-6 months, but again I do not want to do that if by waiting I am making the process worse or at the end of 6 months I am exactly where I am now.
I understand that there are no guarantees regardless of the course chosen and that medicine is often more of an art than a science, but I am just trying to clarify my decision making process.
If arthroscopy is the choice, i assume this is best done in a university setting, correct?
Moderator:
DrO

Posted on Monday, Oct 6, 2008 - 8:34 am:

Certainly we don't send every acute stifle lameness to the knife without giving it some time to recover and I have waited 6 months for a stifle to recover from acute injury was still lame and then waited 3 more months with stall rest and hand walking and the horse eventually recovered had no further problems. This case was easy to decide as surgery was not an option back in the mid 80's. That is the problem: how long do you wait while possible intraarticular instability and inflammation may be taking you down the path to osteoarthritis. How long to wait will depend on a decision between your veterinarian and you. While waiting the one IA steroid, stall rest, and NSAID's all will help minimize the risk of increasing the degeneration in the joint.
DrO
Member:
scrupi1

Posted on Sunday, Dec 14, 2008 - 10:34 am:

Hi Judith,
I too have a horse with a stifle injury and was wondering if you decided to have the arthroscopic surgery done or opted for the stall rest and what your results have been. Thank you!
New Member:
jvolkar

Posted on Sunday, Dec 14, 2008 - 5:31 pm:

I opted not to pursue arthroscopy. I spoke with at least three different vets at OSU who recommended I not pursue it as the chance of successful surgery in his stifle joint was almost zero. They suggested stall rest, and so we rest (though not happily!) with hand walking only. Their prediction was dismal, that he would perhaps be able to be used as a trail horse with walking and minimal trotting until such time as he became increasingly arthritic and would need to be put down. His chance of resurrecting his show career was nil
Member:
digger89

Posted on Sunday, Dec 14, 2008 - 6:06 pm:

I have a 9 year old quarterhorse/thoroughbred cross who tore his posterior cruciate ligament - about a 30% tear as seen with arthroscopy. He went through months of stall rest, hand walking, light riding etc. 2 years later he is still pasture sound, but only able to be ridden at the walk. He will trot under saddle only if forced to, with very short steps. He doesn't seem to be in any pain, just not feeling comfortable with the weight of the rider. We use him for very short rides on flat or well cushioned ground only. According to his surgeon this is a GOOD result for his type of injury :-(
Member:
scrupi1

Posted on Monday, Dec 15, 2008 - 6:25 am:

Not such great news. Judith, how did the vets make their predictions about your horses future? Was is based on the arthritic findings alone or did you have other testing done? I have not been able to find one good outcome after stifle injury on all the searches of this website. X-rays of my geldings stifle were clean as were the ultrasound of the mcl and medial meniscus, I did have the bone scan done because I knew I would not be able to afford surgery and all it showed was increased uptake where the ACL attaches which lead the vet to believe it was a strain of the ACL, no way to tell if an actual tear occurred without surgery. I too am following the rest and hand walking protocol and he is sound at the walk and at the trot in hand (trotting only to assess) so I guess I still have hope.... Thanks for sharing your experience.
New Member:
jvolkar

Posted on Monday, Dec 15, 2008 - 11:57 am:

Susanne

Hope things work out better for you. He had multiple XRays, then a nuclear medicine scan and ultrasound. The nuclear medicine scan was less than helpful, with no particular areas highlighting. The ultrasound, however, showed a meniscal tear as well as a probable partial tear of the ACL. I think you may have some hope as yours does not sound quite as bad. Apparently horses are the only animal that attempt to commit suicide 24/7. He was in an individual paddock, free of things he could hurt himself on and he was hand walked to it!
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