Cruciate ligament injury

[Dottie]

Hello everyone! I'm new.

My mare has been diagnosed with this injury on her right hind stifle. (Apparently it is the same injury that Micheal Owen sustained in the world cup last year!) I was just wondering if anyone had any experiance with this- i cant seem to find much about it!
She has had it medicated and is currently on six weeks box rest. She is 22 years young(!) and was just a rather lively happy hacker so i'm not expecting to go round Badminton with her any time soon!
Any help or advice greatly appreciated!
xDotx

 

[Lynne21]

Hi Dottie *waves* and welcome!
Have no idea about cruciate ligament damage but someone should be able to help soon - good luck.

 

[KatB]

Hiya,

We had a 17.2hh heavyweight hunter that sustained this injury. The prognosis wasnt great because of his size and just geeting up and lying down put pressure on it, and he was severely lame. However, although the vet wasnt hopeful, his owner gave him the benefit of the doubt, and gave him 18mnths off, and he was back hunting 2x a week after that without a problem. So eventhe most severe injuries to this area are definitely healable! What has your vet said? They tend to air on the side of doom and gloom with this injury....

 

[puddicat]

Any idea which cruciate ligament and how badly injured ?

 

[kcgibson]

hi, the cruciate ligament is the ligament within the stifle that prevents the joint from moving medio-laterally (i.e. the joint can only move forwards and backwards and not side to side. The same as our knee!). When the ligament is ruptured, the joint is able to move side to side causing discomfort/pain and sometimes prevents use of the leg. It is the ligament that footballers commonly rupture. It is called the cruciate ligament because it forms a 'X' shape within the joint and offers a huge amount of stability. Id ont know what it means for her in terms of treatment and her being in work as i am only used to dealing with dogs with ruptured cruciate ligaments at work and we just repair them by placing a false ligament in and around the joint (the false ligament is much like fishing wire and i understand that some vets actually use fishing wire in dogs!). I dont know if this operation is done in horses or if it would be recommended in a horse of 22 years. Good luck with her though, hope all goes well whatever her treatment!

 

[puddicat]

kat_g's description of cruciate ligament is incorrect so in the interests of accuracy I'll explain what they do.

First, there are 2 of them (not one) that cross each other at approx. right-angles (hence 'cruciate'). Rupturing one of them is more serious than rupturing the other which is why I asked which one was damaged. Sudden braking, a manoeuvre that occurs in sports such as rugby, puts strain on the posterior cruciate ligament (called the caudal cruciate ligament in a horse) so perhaps your vet was implying it is the caudal cruciate ligament that is damaged. Unfortunately that's the one that matters, however it may not be badly damaged!

Cruciate ligaments do not stop medio-lateral movement, that is not their purpose. They prevent cranio-caudial (forwards-backwards) translation (sliding) of the joint. Stifle joints with ruptured cruciate ligaments are said to exhibit cranio-caudal "draw" which is the term used to describe that type of abnormal movement between the femur and the tibia.

The stifle is a complicated joint and the cruciate ligaments are just one of several structures that stabilise the joint. The reason cruciate ligaments get a bad press as opposed to say the collateral ligaments is just that it is quite hard to think of what you might be doing to rupture a colateral ligament of the stifle but there are plenty of situations in which you can imagine a horse or dog braking sharply or awkwardly.

 

[aran]

In humans it is the ACL which is the most frequently torn not the PCL (not sure in horses). The ACL is the most important structure in providing joint stablity (supposedly over 90%). It and the MCL are the most frequently injured. In humans they reconstruct the ligament with great success with the majority returning to normal activities within 6 months.

 

[puddicat]

Ha, yes true, I said it wrong way around! That was very careless, thanks for saying

Yep it's supposedly CCL in horses same as dogs and cats although I think it's an unusual injury in horses. In fact, if the damage wasn't severe I wonder how you would obtain a definitive diagnosis - anyone know the answer to this ? arthroscopy ? ann-jen ?

 

[aran]

From the bit I know then the caudal cruciate ligament assits in supporting the medial aspect of the femorotibial joint and limits outward rotation of the tibia. The Cranial CL is more often the one affected in the horse.

Lame horses that have torn the CaCL, usually also have torn the medial menisus. Vets isolate the lameness to the stifle using manipulative tests (for the cruciate test the affected limb is weight bearing. the head of the tibia is pushed caudally and then released 5 times. the horses is then trotted. Laxity and lameness is exacerbated if cruciate injury exists), then radiograph the stifle to assist the diagnosis and arthroscopic examination shows the ligament injury or rupture (if an injury is located then the is debrided of loose tissue - which as I'm aware is the only intervention performed in the horse).

you can ultrasound the stifle however the cruciates are hard to image due to alignment issues and so you can only see a small length - the stifle must be flexed. With both CaCL and cranial CL injury/rupture then you can also get avulsion fractures of the tibial spine (CaCL) or of the medial intercondylar eminence (CrCL) - therefore scintigraphy can also be performed.

 

[puddicat]

"assits in supporting the medial aspect of the femorotibial joint and limits outward rotation of the tibia"

Yep that's my problem, statements like that crop up all the time but the first bit means nothing and the second bit could easily not be true. I think its a question for Jean-Marie Denoix it is exactly his sort of thing.

My point was that the joint is so inaccessible that I wonder how many diagnoses of CL rupture in horses are confirmed. You've mentioned the usual imaging techniques but I'm not so sure how useful they are:

How useful is manipulation I wonder? I'm not sure I believe you can make any difference to laxity or lameness by manipulating the joint - it's a very big joint, if you could, the horse would be hopping lame anyway. There's a big difference between the loads you can apply by manipulation and those experienced during gait, I wonder how wide the range of damage is between the horse going lame and the vet not being able to elicit a response by manipulation and the damage being serious enough for the vet to be able to elicit a response manually. I'm happy to be convinced otherwise I've just never seen this.

Radiography isn't going to help identify CL rupture unless you're very lucky.

You can only do a cranial view ultrasound, so you only really see the origin of the CCL, plus you are at an angle to it so the image is compressed lengthways which will mask damage. So to say ultrasound isn't very useful either is probably an understatement.

so I think that leaves arthroscopy but the access is still poor and I was just interested in whether it was good enough to obtain a definite diagnosis.

MRI would be great but you'd need a big scanner.