It is a dramatic sight for us as owners when our own horse suddenly cannot bend its hind leg and can barely walk. In many cases, the kneecap dislocation resolves itself and the horse runs normally again. If the dislocation does not resolve, a veterinarian must remedy the situation by skillfully manipulating the horse and leading it backwards or sideways so that it can walk normally again. A brief digression into the anatomy of the knee joint provides a simple explanation for this phenomenon.
This complex joint consists of two joint compartments and the largest sesamoid bone in the horse's body, the kneecap (patella). The kneecap is responsible for facilitating the muscle movements of the thigh. Embedded in the middle straight patellar ligament, which emerges from the end tendon of the thigh muscle, it slides in the groove between the outer and inner condyles (semicircular protrusions at the end of the thigh bone). It is held in position by two further straight patellar ligaments, which run from the inside and outside of the kneecap to the lower leg.
The horse's knee is unique in that the kneecap is deliberately hooked onto the inner roll of the thigh bone, allowing the leg to be loaded without muscle power. This allows the horse to stand relaxed for long periods of time, doze, and at the same time relieve the opposite leg. If the horse now changes its standing leg, the kneecap is released again by muscle tension. If this release no longer works correctly and the kneecap remains stuck on the inner roll ridge, this is referred to as kneecap displacement or, in permanent cases, even patella fixation. The horse can no longer bend the affected leg because the kneecap no longer slides on the rollers. The veterinarian can now remedy this condition by leading the horse backwards or manually releasing the patella, but this is only a temporary solution, as the problem may recur. In cases of permanent displacement, however, it is usually not possible to return the kneecap to its original position.
Patella displacement describes the condition of temporary or permanent displacement of the kneecap from its natural position. The following forms of patella displacement occur in horses:
Upward displacement:
Outward displacement:
The temporary upward displacement is often congenital, but usually only becomes apparent at the age of 2 to 3 years. Accidents or injuries can cause permanent displacement. Severe wedging, slipping, jumping, or overextension backward can cause permanent upward displacement of the kneecap.
The lateral displacement of the kneecap is triggered by severe overstretching or tearing of the medial patellar ligament due to injuries or accidents. The kneecap is no longer stabilized and shifts outward over the lateral condyle. Shetland ponies in particular show a congenital form of lateral displacement. In this case, the outer roll is too flat, causing the kneecap to slide outwards and the knee to lose stability.
When shifting upward, the knee and ankle joints remain extended, with the toe joints flexed. The horses drag the front wall of the hoof across the ground. If this condition persists, significant wear of the hoof tip can be observed. By moving the horse backwards or sideways, the kneecap can slide back into its natural position, accompanied by a distinct cracking sound. However, in most cases, forced movement cannot remedy permanent displacement.
In the case of lateral displacement of the kneecap, the horses buckle with the affected leg during the weight-bearing phase and appear to collapse because the knee and hock joints can no longer be extended. This can lead to atrophy of the thigh muscles. If this displacement is only temporary, the kneecap jumps outwards when the horse puts weight on its leg and then jumps back in after a short time.
Any form of patella displacement requires immediate veterinary examination. Although the appearance of the condition is often clear, other knee joint diseases should always be considered and ruled out. Further X-ray examination is therefore recommended in most cases.
In some cases, upward displacement of the kneecap can be corrected by turning the horse backwards. If this does not work, surgical intervention or reduction under anesthesia may be necessary. Regular exercise to build up the muscles in a controlled manner and appropriate hoof correction are further important components of treatment. Affected horses have a very good chance of a complete recovery and can, in most cases, return to full use.
In cases of temporary upward displacement of the kneecap, good results can be achieved with targeted muscle building and regular hoof correction. Medication can be used to support muscle building and muscle toning. However, surgery may also be advisable if the symptoms do not disappear. Despite different surgical methods, there is a risk that the condition will recur. Therefore, please always discuss with your veterinarian which treatment is appropriate and promising in each individual case. The prognosis in these cases is somewhat more cautious than in cases of stationary displacement.
Surgical treatment is recommended for horses with permanent lateral displacement of the kneecap. This is a major operation in which the groove of the thigh bone is deepened and the joint capsule is tightened. Despite a certain chance of success, the prognosis is rather cautious. Functionally, the joint mechanism can be restored, but it is questionable whether the horse will be rideable again.
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