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Discussion on Arthritis and calcified lateral meniscus
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Member:
dvjl
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Posted on Monday, May 11, 2009 - 12:34 pm:
My 10 y/o dressage horse turned up lame with a hitch in the left hind about 3 weeks ago. Because I had "this feeling" for a long time already I asked the vet to x-ray stifles and hocks and sure enough the left stifle show significant arthritic changes. Upon further exploration on a high resolution screen and consulting the equine surgeons my vet told me that my horse's lateral meniscus has more or less entirely calcified and it's like bone on bone now.
We discussed the options of joint injections, IRAP, surgery, but none of it sounded promising. I have the rads with another vet for a fourth opinion.
Obviously my horse's dressage career is over and he is too difficult a horse to be given away a pasture pet. I am struggling though with the ultimate decision........
My questions is:
Have you ever experienced that a horse with this sort of damage becomes riding sound again with whatever treatment? And if so, what kind of treatment and how often were they necessary.
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Moderator:
DrO
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Posted on Tuesday, May 12, 2009 - 8:17 am:
Hello Delia,
There are several points that are important here when discussing the prognosis of stifle disease. You need to have
1) a accurate description of all the lesions
2) a good idea of the severity of the degenerative changes.
I am uncertain we have the whole diagnosis as these lesions are often inapparent on radiographs. and I don't know how severe your lesions are. If there truly is bone on bone there will be permanent lameness but with the horse only lame 3 weeks this sounds like a bit of hyperbole, perhaps done to make a point.
It is almost certainty that there are soft tissue injuries that have lead to these degenerative changes and will require surgery to diagnose and possibly treat. Surgery represents your best chance at getting your horse well but I don't know what the prognosis is.
DrO
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Member:
dvjl
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Posted on Thursday, May 14, 2009 - 12:51 pm:
Dear Dr. O.,
Thank you for your quick response. I have asked myself how could it get this bad this fast.
As background information though, my horse has had warm up lameness off and on, just not enough to be locatable. He has had troubles with certain dressage movements which has given me "this feeling" that something is wrong for a long time and I thought about getting him x-rayed just for that, but again, nobody was sure which joint is causing it. I think now it finally manifested itself in a real noticeable lameness.
Another indicator for pain is his change in behavior. He started turning unpredictably aggressive over the winter. He is on bute now and seems much happier again, but that’s not a long term option as he already had ulcers in the past. Surgery is not really an option because he can’t be stall rested as he jumps and paces in his stall the second the barn door opens. Only option seems Depo injections or IRAP, but if none of these will get him sound again one really has to question it.
I attached some x-rays, but with this low resolution I don’t know how much you will see. The vets and surgeon looked at it on a high res screen. What do you think?
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Moderator:
DrO
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Posted on Monday, May 18, 2009 - 11:24 am:
Delia, in the first image I do think the opacity that spans the front of the joint just cranial to the tibial tuberosity could represent a mineralized cranial border of the meniscus but I would want a radiologist to review this as it is not a lesion I have seen before and I cannot find an example of it in any of the references I have. It also has an irregular of "fibrillated" appearance. We also see several osteophytes (bone spurs) and the one on the proximal tibia has been associated with chronic meniscus injuries.
Most of these cases do have a poor prognosis without surgery and even with surgery to debride torn tissue and possible suture any partially torn ligaments the prognosis is improved but still guarded.
DrO
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Member:
dvjl
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Posted on Monday, May 18, 2009 - 8:52 pm:
Thank you Dr.O,
The radiologist and the surgeon at our university clinic reviewed these x-rays and were the ones who told my local vet that the lateral meniscus is entirely calcified.
We all think that my horse must have had an injury in his early years. I have owned this horse for 3.5 years and he certainly didn't incur this injury during that time. He came to me in very poor condition from some backyard breeder who had neglected him, hence I didn’t get a PPE done and never had him x-rayed.
By chronic meniscus injury you mean an injury that never healed up properly or an injury that keeps recurring? Looking at these x-rays – would you expect to see torn ligaments? Only way to find out is surgery, correct? Could he even have been sound for all this time with a torn ligament?
That “fibrillated” mass in front of the joint – if it’s not some sort of calcification, what else could it be?
If surgery is not really an option for previously described reasons what potential treatment would you chose and why?
Thank you again for looking at this and sharing your insights
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Moderator:
DrO
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Posted on Tuesday, May 19, 2009 - 9:37 am:
Delia,
You would not expect to see torn ligaments radiographically and yes surgery required for a better diagnosis.
Because everyone's goals, resources, and willingness to assume risk are different, I cannot make useful specific recommendations for you. Our recommendations for treating arthritis, including IRAP, are put forward in the article on Overview of Arthritis and details of most of the treatments are fleshed out in detail in their own articles which are linked to from the arthritis article. Whatever your decision is must be based on the notion that the prognosis for return to soundness is poor based on the radiographic findings. I think your history suggests a slightly better prognosis however.
Though I have not seen such an appearance I think that fibrillated mass in the cranial extent of the calcified meniscus.
DrO
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Member:
shogeboo
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Posted on Tuesday, May 19, 2009 - 1:52 pm:
Delia,
I just wanted to say that I am sorry you are having to wrestle with this issue...I am going through something similar. It is so difficult to make decisions on how far to go. I wish you and your horse the very best. 
Steph
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Member:
dvjl
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Posted on Wednesday, May 20, 2009 - 8:07 am:
Stephanie,
Thanks for your best wishes. It's heart wrenching to say the least. To everybody's surprise this horse blossomed from a neglected sad looking ugly duckling into this talented and gorgeous dressage horse and now we most likely have to end his career due to an injury he sustained before our time together. It's so hard to accept.
On a good note I had a different vet out yesterday who has some different ideas yet.
I am leaving for a 10 day trip today, but would still love to hear your story - it's always good to compare notes.
All the best.
Delia
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Member:
dvjl
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Posted on Monday, Jun 1, 2009 - 3:31 pm:
Dr. O.,
I have to ask another question.
If you were handed these x-rays for a pre-purchase exam and the horse was not lame, what would you tell the buyer about this.
I am asking because another vet didn't really think these x-rays are all THAT bad.
The x-rays have been sent to yet another equine clinic for evaluation.
Thanks.
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Moderator:
DrO
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Posted on Tuesday, Jun 2, 2009 - 7:41 am:
Delia, I would not expect a horse with such radiographs to not be lame.
DrO
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Member:
dvjl
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Posted on Friday, Aug 28, 2009 - 7:45 am:
Just an update.
After much discussion with several vets we decided to try injecting the stifle. My horse responded well to the mix we settle on, which was a double dose of Legend and a steroid. Within a few days he became riding sound and seemed very happy again.
Nevertheless his dressage career is over and he can only do light work. I managed to find him a good forever home where he will be doing exactly that. Of course he will require joint injections for the remainder of his life.
Thanks for your previous input.
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Moderator:
DrO
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Posted on Sunday, Aug 30, 2009 - 2:46 pm:
Thanks for the update Delia and glad to hear your horse has found a good placement for his abilities.
DrO
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Member:
vickiann
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Posted on Monday, Aug 31, 2009 - 10:32 am:
Glad to hear of the improvement, Delia.
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