Don't Be Stopped By A Stifle Injury Part 2

Discussion Topic Created:
Tuesday, June 27, 2017
“In this day and time, it’s becoming increasingly important to consider using ultrasound examination of the joint. Not every veterinarian has the technical expertise to do this.
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With a stifle injury, the owner or trainer of the horse needs to request consultation with a veterinarian who possesses expertise in examining this joint,” said Mitchell.

“With ultrasound you can look at a number of the ligaments, the medial andlateral menisci, the synovial membranes, the surface of the end of the femur, etc. This can rule in or rule out soft tissue problems,” he added.

This technology might help determine a treatment plan that could include injecting the joint.

Treatment Options

“If there’s no evidence of radiographic abnormality and lameness has been located accurately to the stifle joint and is a grade 2 or less, I don’t think it’s irresponsible to go ahead and treat the horse—and just assume it’s a soft tissue injury. It can be treated with an intra-articular injection and systemically with anti-inflammatories to try to reduce the inflammation,” Mitchell said.

If it is indeed a soft-tissue injury, this may be all the treatment that’s needed. Sudden lameness with joint swelling often responds to rest, cold therapy (ice or cold water hosing), systemic use of non-steroidal anti-inflammatories such as phenylbutazone or topical anti-inflammatory medication.

“In the event it fails to respond to anti-inflammatory therapy or responds temporarily, followed by return of lameness, then you need a consultation—realizing that the horse might need surgery. It is best, however, if you can try to determine the first time around, if possible, what is actually going on in the joint. In any event, if the horse responds to therapy with a return to lameness, don’t just keep treating it. Go a little farther with diagnostics to try to figure out exactly what’s going on,” he said.
Arthroscopy is the gold standard for determining what’s going on in the joint. “It’s the only way to definitively determine what’s in there—short of doing a postmortem examination,” said Mitchell.

Thus arthroscopy must be considered as a diagnostic as well as a therapeutic tool.

“My philosophy is that if you’ve identified a stifle problem and ruled out gross soft tissue abnormalities (the problem is not apparent on ultrasound), you’ll treat the joint, and if it does well, that’s the answer. If the horse responds well but subsequently becomes lame again, it’s a candidate for arthroscopy,” he said.

Most of the things your veterinarian will look for with arthroscopy in a sport horse—especially a middle-aged sport horse—involve soft tissue problems. These include damage to the articular cartilage, damage to the menisci, and/or damage to the ligaments that support the joint.

“If we can identify the area of damage, it’s possible to sometimes treat or modify those tissues by cleaning up the debris and the injury by trimming the torn ligament or trimming and cleaning up the torn meniscus just like we do in human knee surgery. You take the irritating things out of there,” said Mitchell.

What the veterinarian finds in the joint and how it is cleaned up (how much debris or damaged tissue must be removed) also determines how much recovery time the horse will need.

After diagnosing and possibly deciding upon arthroscopy, this must all be put into perspective regarding the age of the horse.

“Is this a young horse, or is he 19? Where are we, in trying to salvage the athletic future for this horse?” asked Mitchell. “What level of work can he be returned to? This determination may also depend on how long he’s been lame. If he’s been lame a short time, the older horse may merely have a soft tissue injury that’s just as easily repaired as in a 4-year-old.”
In addition to the surgeries being done, there is also some work now involving stem cells placed in the joint to encourage healing of the damaged tissues after they are cleaned up. Another alternative to injecting the joint with corticosteroids and/or sodium hyaluronate is use of autogenous conditioned serum.

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