TREATMENT FOR PROXIMAL PATELLAR HESITATION

Now that we've gotten your horse fit and the problem is still persisting we can consider further treatment in the form of surgery. At The Atlanta Equine Clinic we combine two surgical techniques in an attempt to alleviate stubborn cases of proximal patellar hesitation and intermitent upward patellar fixation. Both techniques are performed in the standing (sedated) horse in the field (e.g. at the barn).

The first technique is called fenestration or splitting. As you may know, the technique involves splitting or separating the ligament fibers within the medial (inside) and middle distal patellar ligaments. This creates defects within the respective ligaments which fills in with scar tissue. As the scar tissue matures and organizes, it contracts, thereby shortening the ligaments and repositioning the patella (or kneecap) further proximad (higher up) on the limb.

The second technique involves infusing a counterirritant (or blister) to irritate the tissues and hasten further contraction of the ligaments. As originally described, the technique consisted of infusing the counterirritant (usually 2% iodine in almond oil) adjacent to the medial and middle distal patellar ligaments. With irritation/ inflammation of these tissues we inevitably cause the formation of scar tissue. With maturity, the scar tissue contracts thereby shortening the ligaments and surrounding tissues. The patella is repositioned in a location whereby patellar interference is less likely to occur.

We have had the most success performing a technique that combines the splitting and blistering strategies. Rather than split the fibers with a scalpel blade, we simply split them using an 18-gauge 1.5-inch needle. Appropriately, no external (skin) incision is required. As we remove the needle from between the ligament fibers we infuse a small amount (or trail) of counterirritant into the remaining defect or tract. This stimulates the developing scar tissue to contract even further than it would on its own.

Please CLICK HERE to review our postoperative care instructions for horses undergoing surgical fenestration and counterirritation of the distal patellar ligaments.

If you’ve already tried the treatment strategies highlighted in STEP ONE, STEP TWO and STEP THREE and/or your horse is elderly then you may want to PROCEED TO STEP FOUR.

If you haven't yet tried the treatment strategies highlighted in previous steps, then we would suggest that you GO BACK TO STEP ONE.