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Does your horse have that notorious "sticky" stifle? Did your trainer say that your horse "just isn't right" or has a "hitch in their giddyup"? We may have heard these statements, but what may be truly occurring is an upward fixation of the patella (UFP).
The patella is located in the stifle at the intersection of the femur and tibia. The patella rests on the medial trochlear ridge of the femur which is important for the passive stay apparatus. This unique feature allows the horse to rest standing with minimal effort. The problem exists when the patella does not disengage properly from the medial trochlear ridge and the leg appears "stuck" or "sticky" and the limb may even remain in extension.
We have seen mild to severe UFP in dressage horses. Mild UFP has jerky movements due to a delayed release of the patella or severe which can be seen as an extension of the limb behind the horse because of a locked patella.
The precise cause for UFP is not completely known but one study suggests that it is the spasmodic or tonic activity of the vastus medialis of the quadriceps femoris muscle. We do know that the risk factors for upward fixation of the patella can include poor conformation, poor conditioning, genetics, and poor foot conformation (high, medial hoof wall height and long toes). The condition is most commonly identified in young, untrained horses and adult horses that may be out of work and losing muscle rapidly. Surgery is most common in warmbloods (31.8%) followed by Standardbreds (18.%), Arabians(11.8%), Icelandics(9.4%), Thoroughbreds(7%), ponies(8.3%) and Fresians(4.7%). The same study identified a median age of seven years, and the most common disciplines were pleasure (48.2%)followed by dressage (17.6%)(1) .
Upward fixation of the patella may occur as a unilateral or bilateral hind limb condition and can be either intermittent or permanent in nature. Conservative and surgical treatments have been studied and applied to horses.
Conservative treatment usually is instituted if the condition is not creating a lameness and is intermittent. Treatments include corrective shoeing and trimming (CTS), conditioning, chiropractic, acupuncture/aquapuncture, prolotherapy, pharmaceutical intervention (anabolic steroids and chondroprotectives), and iodine-containing counterirritants.
Conditioning can include hill work both diagonally and perpendicular in direction. Corrective trimming and shoeing may involve shortening the toe to improve a negative plantar angle, correcting medial-lateral balance, elevating the lateral heel, and rounding the medial toe. Pharmaceuticals are estrogen compounds (hormonal therapy) given in the muscle and can theoretically increase the tension of the supporting soft tissue structures helping to change the position of the patella.
As a veterinarian, I will generally start with a combination of conservative treatments, especially in a young horse prior to maturation. If the conservative treatment is not providing the success that is desired, surgical options can also be provided.
Surgical treatment includes a minimally invasive surgical treatment named a medial patellar ligament splitting (MPLS) /fenestration which can be completed in a standing position. A more invasive surgery is the medial patellar ligament desmotomy (MLD) which is typically completed under general anesthesia. In either case, a two week rehabilitation may be needed for improvement or resolution after surgery. A recent retrospective study found that surgery (recumbent or standing) provided a 97.6% complete resolution either immediately or up to two weeks of rehabilitation. No short or long-term complications were reported.
Upward fixation of the patella can be a concern in your dressage horse but know that a myriad of conservative and ultimately surgical options can be provided with good success. It is always important to have a proper diagnosis from your veterinarian prior to instituting any therapy. Many successful dressage horses have overcome UFP and can yours.
Justin Sobota, MS, MSM, DVM is an equine veterinarian in Middletown, MD for South Mountain Equine. He is interested in using the whole horse approach, which includes chiropractic, acupuncture, and imaging, to diagnose and treat horses.
We our proud to introduce our new veterinarian Caitlin Cosentino! Dr. Cosentino will begin seeing appointments on October 1 for routine examinations, emergencies, and she has a keen interest in ophthalmology. Please welcome her to our South Mountain Equine Family.
Please call us at 240-818-5971 or 240-356-3355 (office) or send us an email email@example.com
I just want to take this time to say THANK YOU for finally giving me some answers regarding Denver's lameness.
Since March/April 2015 until now (December 2015), we have been getting mixed diagnosis as to why he would be off, but you came and gave us hope. More importantly, I want to THANK YOU for your patience and amazing 'bedside' manner. Not only did you provide me with solid information and demonstration of compression, and how his conformation defect was affecting his way of going, but you were meticulous in your explanation of the benefits of acupuncture for Denver. You explained everything in such a way, that I would be able to not only understand but remember, and then be able to explain it to all those at our barn who were genuinely concerned about how he's doing or how the Vet visit went. You made me feel very much at ease, like my opinion as his owner mattered, as you would say, "That's good information. Thank You for that" Now, that's a first; the VET Thanking me!! Never once did you make it seem like my questions were irrelevant. You gave us your undivided attention as if we were your only clients that day, and I know we were not because Jessica reminded/alerted you of the time, but you never flinched, never took your eyes off of me as you were explaining everything you did with Denver, and never once appeared rushed. The whole experience of your visit left me committing to making you our Vet of choice. Denver means a lot to me, and the way you treated him, made me think he was more than just a client/horse to you. I can't THANK YOU enough Dr. Sobota!
Ps. By the way, Jessica is an Awesome assistant, and Danielle is Grrr8!!
Dr. Justin and his staff have been our vets for several years now. He has done everything from pre-purchase exams and lameness evaluations to dentals. Each and every time, he and his staff are timely, knowledgeable, and considerate. Their passion for the horses as well as consideration of the owners and barn management is unmatched.
Finally, after looking for years, we found a farm vet with the sophistication and feel for lameness of the vets at the big national-caiber ship-in clinics and equine hospitals. Dr. Justin (Sobota) has great instincts and is well versed in the cutting-edge aspects of equine veterinary medicine, as well as a host of alternative therapies like acupuncture and chiropractic treatments. He asks important questions of and listens well to those who know the horse best, always offers a range of therapeutic options, and thoroughly explains his expectations for treatment results. Perhaps most refreshing, however, is how friendly, helpful and accommodating Dr. Justin and his staff are. We feel lucky to have Dr. Justin as an important part of the Finer Points Farm family.
Dr. Justin Sobota, and his team at South Mountain Equine, are highly skilled, professional, courteous, and helpful. Dr. Sobota has managed our mare in several very difficult clinical situations where diagnosis and treatment were not immediately obvious. He worked diligently to find the source of the problem, spending whatever time necessary with the horse and listening patiently to her owners, until the diagnosis was clear and treatment in place. This is the first practice I’ve dealt with that followed up until the problem was resolved. The follow up extends to routine visits, such as vaccines, as well. South Mountain and Dr. Sobota are always quick to respond to emergency or routine concerns. This level of skill and caring provides a level of support for an owner that results in peace of mind.
Dr. Justin Sobota and South Mountain Equine offer horse owners peace of mind. They are easily accessible to reach for concerns and always willing to talk with owners. Dr. Sobota and his staff are knowledgeable and caring, including their efforts when it comes to follow-up care. After a recent surgical procedure, Dr. Sobota checked in everyday for the first week and still checks in weekly. I would recommend South Mountain Equine to any horse owner.