Brandy's Stifle Surgery: Medial Patellar Ligament Splitting

When Brandy was young and growing, every time her hind legs grew longer than her front ones she would have problems with her stifles locking until her front legs caught up.  (For those of you who aren't horse people, the stifle is the part of the horse that would be where our groin is, although it's really like our knee joint in structure.)  My vet at the time thought the stifle ligaments were being stretched too tight by her rapid growth, but after she got to be about two, she outgrew the problem. 

Then she and Angel were stolen (see Nov. 18 post), and Brandy apparently skidded and slid around in the trailer.  Once she healed in her sliced-up right front foot and wasn't limping there, I could see that she was having problems with her stifles locking again.  This time the problem was that her stifle ligaments had been stretched too loose (I believe, by scrambling for footing and falling) and were hanging up on the "kneecap" in her stifle joint.  My new vet, Dr. Mike White, suggested waiting to see if with more maturity and muscle development she might outgrow the problem.  But two years after her injury and at age four and a half, it has become obvious that she's getting worse, not better.

She has a difficult time backing up or stepping sideways with either hind leg.  While riding her, I've seen that her stifles can lock up on her even going forward.  This scares her, makes it difficult for her to walk downhill, and makes it hard to do her flat walk or running walk while I'm riding.  It's time to do something to help her.

The traditional surgery for this problem would be to cut the medial patellar ligaments in both hind legs.  Unfortunately, after this surgery horses can never sleep standing up again.  It also predisposes them to arthritis in the stifle joints.

Dr. White, who is a strictly equine vet, offered to perform a newer type of surgery on Brandy.  During this surgery the medial patellar ligament is exposed with an incision, then stabbed multiple times with a scalpel.  These multiple tiny stab wounds are then irritated by working the horse actively every single day for 6 weeks.  The irritation of work causes the formation of scar tissue in the ligament which pulls it up tight again.

In horses that have severe problems, Dr. White would just perform the older surgery, not feeling this new method could offer improvement.  However, although Brandy's problem is quite serious, he feels that it could benefit her.  He feels it would be better to avoid the problems of the older surgery by giving this surgery a chance to help her.

After getting detailed explanations from Dr. White, doing research on the internet, talking to several horse people, and praying about it, I felt that it was the right thing to proceed with the surgery.  So Dr. White came early this afternoon to do it.  He gave Brandy a sedative, and she quickly "zoned out," letting Herb hold up her head.  Dr. White injected plenty of local anesthetic in each stifle, made about a 1 1/2" incision across the ligament, reached his fingers inside to isolate the ligament, and made about 40 small vertical stabs in each ligament.  Then he stitched her up and sprayed each wound with a protective coating.  An intravenous injection of an anti-inflammatory, Bute, should keep her comfortable overnight.

Here are the incisions post-op.  Brandy was too woozy to allow her to eat, so I tied her up in the sun while I got her stall nice and clean.  After she was "sober" again, she had dinner in her stall, and then I let her into the barnyard so she could move during the night and not get too stiff.

Tomorrow Herb and I start a rigorous regimen of riding her an hour a day.  He has offered to ride Angel and accompany me so I don't have to worry about Brandy going crazy when I rider her out of sight of Angel!  Since I haven't been riding Brandy all that long, we'll start each session in the round pen doing some circles and longe line work to get her warmed up both physically and attitude-wise! We will also have to climb lots of hills (and of course come back down) as well as ride in straight lines.  Improvement will obviously not be immediate (results were dramatic with the older surgery) because the scar-tissue formation will be gradual, but I hope to have some good news to report before too long.

Medial patellar ligament transection - In this procedure, the medial patellar ligament is cut all the way through. This procedure has fallen from favor with most veterinarians because of the potential for development of arthritis in the joint and/or fragmentation in the patella due to rotation of the patella relative to the trochlea. This is the treatment of last resort for most veterinarians, reserved for those rare severely affected horses that become completely locked and do not resolve with other treatments.


Here is a good description of the two surgeries from a website I found:
Medial patellar ligament transection - In this procedure, the medial patellar ligament is cut all the way through. This procedure has fallen from favor with most veterinarians because of the potential for development of arthritis in the joint and/or fragmentation in the patella due to rotation of the patella relative to the trochlea. This is the treatment of last resort for most veterinarians, reserved for those rare severely affected horses that become completely locked and do not resolve with other treatments.
Medial patellar ligament splitting - In this newer procedure, instead of cutting through the ligament, multiple very small incisions are made into the ligament parallel to the fibers. This procedure is considered much safer for the joint than complete transection. This procedure was initially only done under general anesthesia, but some veterinarians prefer to perform the procedure with the horse standing under sedation.
http://www.equestmagazine.com/v4s2/article03-02-c3.php

After we got the animals all settled for the night, we decided to check on the garden.  The peas are all frozen despite the protection we offered them, so we munched on the few pods that survived the freeze.  The "early" broccoli is just forming some small heads, the beets are forming small beets, and the brussels sprouts and later broccoli seem to be malingering.  But to my delight, the baby Nantes carrots are ready!  We pulled a bunch of them for supper.

They smelled absolutely heavenly, like REAL carrots!  And they taste delicious, too--so good that we couldn't bear to cook them and just ate them raw.  If you don't find carrot sticks particularly appealing, you should try a just-pulled baby Nantes carrot straight from your garden.  I was ridiculously pleased with them, although I didn't do anything besides plant the seeds and water.  The past month we haven't even needed to do that, but they seem to have prospered under my regime of benign neglect.

We also picked the last of the lettuce which was clearly not going to survive much longer under a fleece blanket.  The arugula is still doing well, so we had nice mixed salads along with our burritos, plus--believe it or not--fresh chopped heirloom German Pink tomatoes and chopped yellow peppers!  Both are from green fruits I brought in before the first frost which have now ripened to provide us with fresh vegetables in December!

In my enjoyment of our fresh produce, I spared a thought for poor Brandy and saved her a carrot to take her in the morning.  I think she deserves it!