Serious frustration: Upward Fixation of Patella

[ClickMini]

My colt started seriously locking in his stifles beginning at age 1. It was very bad. He is a lovely animal with nice motion. I had bought him as a weanling breeding prospect. Once he started locking, I ended up giving him away with an agreement to geld. The people did geld him, and I ended up getting him back a year later, and last October I had bilateral patellar ligament desmotomy (ligaments cut) due to the severity of his issue. He recovered well and was put into driving training. The issue appeared to be resolved.

At times, out of the corner of my eye, I thought I would see him "catch," just a little. It was slight enough and not often enough that I couldn't convince myself that it was a figment of my imagination.

Recently, he started getting very bad again in his right hind. Not locking, but catching badly. Had the vet out yesterday and she did x-rays and ultrasound. THE LIGAMENT HAS HEALED BACK TOGETHER!!!! Very thankfully, the joint is still in very good condition. He is scheduled to have the surgery repeated on both stifles a week from Friday. Last time, he had a very lengthy lay-up and gradually brought back into work. This time, she wants to start him back in work as soon as the incisions are healed. He should wear "knockers" on his hind feet to keep him exercising it, and stay in conditioning work. No let-down periods where he is allowed to "just be a horse." Toes should stay short, and he needs to stay on neutraceutical support to maintain the joint health. If this re-occurs again, he is toast.

Has anyone else on this board had this experience? Please share. I have only EVER heard success stories from the ligament cutting. I am very disappointed, this is a very nice show quality gelding and I am praying with all my might that it works as expected this time.

 

[Riverrose28]

I'm so sorry to hear about this as I too have a colt that has a left sticky stifle, it doesn't lock but I can tell it sticks. My vet has said exercise on his own and lead him over poles, but I've been considering surgery when he is gelded after he drops. This is disheartening for you. I hope it all works out and you are not alone.

 

[LindaL]

I have never heard this before...how disappointing! I hope it works the 2nd time around!

 

[jegray21]

My vet said lots of hill work and driving helps keep the stifle strong. Sorry So frustrated...Sticky stifles are tricky

editing that hills and driving are done when he is older not when he is little.

 

[ClickMini]

Yes, he was 3yo when he got his first surgery. Now is 4yo, fully able to be in conditioning work. The thing I want to know from the vet is whether he needs to stay away from circling, etc. I know to avoid it if you are trying to get through this via conditioning alone, or even if you have done such conservative methods as the tendon splitting. But if you are trying to get the ligament to scar down without re-joining, it seems like that wouldn't be as much of a consideration. He will definitely be getting a second surgery; there is basically no chance he will return to soundness without it.

 

[cretahillsgal]

Sounds to me like they only partially cut the tendon. Enough to make hm improved for a while.

 

[bevann]

I have had several done and none ever grew back.Vet who did mine had me rest Mini for just 1 day then back out for normal exercise with the herd.Everything was fine after that.I was wondering if stall rest was lengthy maybe it started to heal from lack of motion.

 

[jegray21]

Do they do injections with minis? I had a big horse that we "blistered" the stifle and with hills and conditioning he has been fine since.

 

[drmatthewtaylor]

My experience with UFP's might be different than other Vets, but I do not see the condition in ponies and smaller breeds the same as I do in 'standard' and larger sized horses.

I agree with most Vets that surgery should be a last resort in the larger group. I also have had good success with injections and tendon stripping. I also think the larger horses have a painful lameness that accompanies the condition due to arthritis.

But, I do not see painful lameness due to UFP in smaller breeds, rather they do seem to lock more often and can be more difficult to release. I have not been as successful with other modes of treatment, so I generally recommend surgery quite quickly if conservative therapies fail. I also do not see UFP to be as closely correlated with upright stifle conformation. I do not consider the surgery to have the same risk in smaller breeds as it does in larger ones. The mass to stress ratio on the remaining 2/3 of the patellar apparatus just has not been enough to create catastrophic failure in my cases.

It is not my understanding, nor my experience, that performing a medial patellar desmotomy produces a permanently dis-joined ligament. Rather the ligament will heal itself over about 90 days, but it is longer now as the healing had to stretch the gap created by the surgery.

I have had only a rare failure. Was it because not every strand of the ligament was incised or was it because of another reason? I do not know. I do know that repeating the surgery did produce the desired results.

One last thing to consider, the traditional reason we pose animals, especially when they are being ridden or driven, is to put them in 'park'. That position locks the stifle and produces a safer situation to enter and leave the cart or top of the horse. The point is that essentially all stifles lock.

Dr Taylor

 

[ClickMini]

Thanks for the information about the surgery, Dr. Taylor. You helped me understand that it is "normal" for the ligament to grow back together, but longer.

I am wondering what I can do to optimize him healing correctly this time. Since it sounds like the first 90 days are the critical ones, at what point should he be started to be exercised again, in your opinion? The hospital that I use is one of the biggest referral hospitals in the region, but I don't know that they have the specialized knowledge of small equine that you do. I have read extensively on the web about this on various vet sites, and what they recommended to me last time followed very closely what would be recommended to a large equine client, with a 3-5 month recovery time. I do see that small equine are specifically called out as being somewhat "different" than large in many articles, including the correlation to upright hind limb conformation not being as strong. That's interesting, because I have noted that in several I know I have looked and looked at them and thought, "there is no way I could tell by looking at this horse that it would be pre-disposed to this condition." I am also glad to hear that in your experience on failures, a second surgery corrected the situation.

With my horse now, he is not locking like he was. He has a delayed release, which causes him to kind of "snatch" the foot forward.

I also was quite interested to hear why people "park" their driving horses. Sheds new light on the phrase, "park your horse!"

Thank you for sharing that fact!

 

[supaspot]

when the stifle locks is it because the ligament is too short or too long? (Im thinking its too long right?)

 

[cretahillsgal]

when the stifle locks is it because the ligament is too short or too long? (Im thinking its too long right?)

I think its the other way around, the ligament is too short.

 

[drmatthewtaylor]

Stifles lock because of conformation of the stifle, cutting the ligament makes it longer, I don't think the cause is a short ligament. Might be a minor point, but I didn't just want to say that being short 'causes' the condition.

The post surgical care is based on the large horses, not the smaller ones, and is primarily concerned with catastrophic failure of the remaining 2/3 of the patellar apparatus. As I do not see that in ponies, I do not require so much stall confinement or time off. I would like to see at least 2 weeks off and then reasonable exercise after that (let's not break them to drive immediately following and have them flip over and etc...). I think young horses can go back to normal exercise after that 2 weeks.

I do not think after care determines whether or not the surgery succeeds or fails, rather it simply protects the horse. So, more stall confinement isn't bad and there's nothing wrong with being careful.

Dr Taylor

 

[Relic]

l just wanted to comment l was there when we had a weaner done one year...as soon as the vet snipped the thing it sounded like a stretched rubber band had just snapped.

 

[drmatthewtaylor]

l just wanted to comment l was there when we had a weaner done one year...as soon as the vet snipped the thing it sounded like a stretched rubber band had just snapped.

Oh yes, and the stifle drops a few inches. It is quite unsettling when you are not used to it.

Dr Taylor

 

[supaspot]

so if its caused by poor conformation and a shorter ligament how does striating (S?) the ligament help , I thought the point of cutting into it was that the scarring would cause it to tighten

 

[drmatthewtaylor]

Reasonable question. I have seen studies on splitting the ligament, but I have been unable to find a reason why it works.

Cutting the ligament results in lengthening it. Not shorter or tighter.

Dr Taylor