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Salz RO, Elliott CRB, Zuffa T, Bennet ED, Ahern BJ. Treatment of racehorse superficial digital flexor tendonitis: A comparison of stem cell treatments to controlled exercise rehabilitation in 213 cases. Equine Vet J 2023; 55:979-987. [PMID: 36604727 DOI: 10.1111/evj.13922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 12/22/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Overstrain of the superficial digital flexor tendon (SDFT) is a common Thoroughbred racehorse limb injury requiring treatment. OBJECTIVES To determine whether treatment of SDFT lesions in flat Thoroughbred racehorses with autologous bone marrow-derived mesenchymal stem cells (BM-MSCs) or allogenic adipose-derived mesenchymal stem cells (A-MSCs) is associated with improved likelihood of returning to racing, when compared to racehorses managed with a controlled exercise rehabilitation program (CERP) alone. STUDY DESIGN Retrospective cohort study combining clinical treatment records with race records. METHODS A total of 213 Thoroughbred racehorses were identified. All were prescribed the same 12-month CERP and 66 also received intralesional BM-MSC and 17 A-MSC treatment. Follow-up was a minimum of 2 years after return to full race training. Multivariable logistic regression models were used to investigate associations between the treatments and the likelihood of returning to racing and completing five or more (C5+) races post-injury. RESULTS Compared to CERP alone, BM-MSC treatment was associated with increased odds of returning to racing (OR 3.19; 95% CI 1.55-6.81) and C5+ races post-injury (OR 2.64; 95% CI 1.32-5.33). Older age and increasing lesion length were associated with a reduced likelihood of returning to racing. Male sex and increased number of pre-injury starts were associated with increased odds of returning to racing. There was no observed increased likelihood of return to racing or C5+ races associated with treatment with A-MSCs compared to CERP alone. MAIN LIMITATIONS Due to the retrospective nature of the study it was not possible to ascertain how strictly the CERP was followed. Due to the novelty of the method, the A-MSC treatment group included a limited number of horses. CONCLUSIONS In the study population, intralesional BM-MSC treatment was significantly associated with an increased likelihood of returning to racing and C5+ races post-injury compared to CERP alone. Intralesional A-MSC showed no significant association between treatment and the two investigated outcomes.
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Affiliation(s)
- Rachel O Salz
- REC Equine Specialists, Sydney, New South Wales, Australia
| | | | - Tomas Zuffa
- Bristol Veterinary School, University of Bristol, Bristol, UK
| | - Euan D Bennet
- School of Biodiversity, One Health and Veterinary Medicine, University of Glasgow, Glasgow, UK
| | - Benjamin J Ahern
- School of Veterinary Science, University of Queensland, Gatton, Queensland, Australia
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Iimori M, Tamura N, Seki K, Kasashima Y. Relationship between the ultrasonographic findings of suspected superficial digital flexor tendon injury and the prevalence of subsequent severe superficial digital flexor tendon injuries in Thoroughbred horses: a retrospective study. J Vet Med Sci 2021; 84:261-265. [PMID: 34937842 PMCID: PMC8920721 DOI: 10.1292/jvms.21-0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The onset of severe injury to the superficial digital flexor tendon (SDFT) is extremely
difficult to predict from slight changes in ultrasonographic findings in cases with no
apparent clinical signs. This study investigated the relationship between an increased
cross-sectional area (CSA) or edema in the subcutaneous tissue around the tendon and the
subsequent onset of severe SDFT injury in Thoroughbred racehorses. Horses were classified
into three groups based on ultrasound diagnosis (USD) findings: Group A included cases
with enlarged tendons; Group B included cases with tendons of normal size but with
prominent edema in the peritendinous tissue; and Group C (control group) included cases
with no abnormal USD findings. The incidence of subsequent severe tendon injury was
significantly higher in the horses in Groups A (25.7%, 28/101) and B (28.3%, 65/212) than
in those in Group C (4.9%, 2/41). There were no significant differences in the median
period and the median number of races from the first examination to the subsequent tendon
injury between Groups A (140 days, 1 race) and B (120 days, 1 race). The results of this
study revealed that horses with increased CSA and peritendinous edema are likely to suffer
a subsequent severe tendon injury. Also, these two USD findings, i.e., increased CSA and
peritendinous edema, indicate the risk of onset of severe SDFT injury.
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Affiliation(s)
- Mai Iimori
- Racehorse Clinic, Ritto Training Center, Japan Racing Association
| | | | - Kazuhiro Seki
- Racehorse Clinic, Miho Training Center, Japan Racing Association
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The Use of Platelet-Rich Plasma for Treatment of Tenodesmic Lesions in Horses: A Systematic Review and Meta-Analysis of Clinical and Experimental Data. Animals (Basel) 2021; 11:ani11030793. [PMID: 33809227 PMCID: PMC7998797 DOI: 10.3390/ani11030793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/01/2021] [Accepted: 03/09/2021] [Indexed: 11/23/2022] Open
Abstract
Simple Summary Tenodesmic injuries are key problems for sport horses. Several therapies have been developed over the years, including platelet-rich plasma (PRP), an autologous product that should stimulate tissue regeneration with its high concentration of growth factors. Nowadays, there are conflicting reports concerning the effect of PRP in tenodesmic lesions. The aim of our systematic review was to determine the effect of PRP on tendons and ligaments healing through a meta-analysis, a process to determine consensus from across published studies. The meta-analysis is the quantitative component of a systematic review, a statistical synthesis of the published data about a topic. We selected studies that evaluate PRP therapy in vitro or in vivo, most of which had a high risk of bias. The results found there is no evidence that PRP enhances the healing of tendon and ligament injuries. In the future, further unbiased, blinded, and controlled studies are needed to clarify the efficacy of this platelet concentrate in the treatment of equine tendon and ligament injuries. Abstract The use of platelet-rich plasma (PRP) to enhance tenodesmic lesion healing has been questioned over the years. The aim of this study was to evaluate current literature to establish the effectiveness of PRP for treating tenodesmic lesions through a systematic review, in accordance with the PRISMA guidelines, and a meta-analysis. Studies comparing PRP with placebo or other treatments for horses with tenodesmic injuries or evaluated PRP effect on tendon and ligament explants were included. Outcomes were clinical, ultrasound, histologic, molecular evaluation, and adverse effects. Two authors independently extracted data and assessed each study’s risk of bias. Treatment effects were evaluated using risk ratios for dichotomous data, together with 95% CI. Data were pooled using the random-effects model. The quality of the evidence for each outcome was assessed using GRADE criteria. Twenty-four trials met inclusion criteria for systematic review, while fifteen studies were included in the meta-analysis. Results showed no significant differences in the outcomes between PRP and control groups. Finally, there is no definitive evidence that PRP enhances tendons and ligaments healing. Therefore, there is a need for more controlled trials to draw a firmer conclusion about the efficacy of PRP as a treatment for tenodesmic lesions in the horse.
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Kovac M, Litvin YA, Aliev RO, Zakirova EY, Rutland CS, Kiyasov AP, Rizvanov AA. Gene Therapy Using Plasmid DNA Encoding VEGF164 and FGF2 Genes: A Novel Treatment of Naturally Occurring Tendinitis and Desmitis in Horses. Front Pharmacol 2018; 9:978. [PMID: 30233367 PMCID: PMC6127648 DOI: 10.3389/fphar.2018.00978] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 08/08/2018] [Indexed: 11/30/2022] Open
Abstract
This clinical study describes the intralesional application of the plasmid DNA encoding two therapeutic species-specific growth factors: vascular endothelial growth factor (VEGF164) and fibroblast growth factor 2 (FGF2) in seven horses to restore naturally occurring injuries of the superficial digital flexor tendon (SDFT) (tendinitis) and in three horses with suspensory ligament branch desmitis. Following application all horses were able to commence a more rapid exercise program in comparison to standardized exercise programs. Clinical observation and ultrasonic imaging was used to evaluate the regeneration rate of the tendon and ligament injury recovery and to confirm the safety of this gene therapy in horses, throughout a 12 month period. Follow-up data of the horses revealed a positive outcome including significant ultrasonographic and clinical improvements in 8 out of 10 horses with SDFT and suspensory ligament branch lesions, with return to their pre-injury level of performance by 2–6 months after the completion of treatment. The ninth horse initially presenting with severe suspensory ligament branch desmopathy, showed no significant ultrasonographic improvements in the first 2 months after treatment, however, it improved clinically and became less lame. The final horse, presenting with severe tendinitis of the SDFT returned to their pre-injury level of performance, but experienced re-injury 6 months after treatment. This data is highly promising, however, further research in experimental models, with the histopathological, immunohistochemical and gene expression evaluation of the equine tendon/ligament after gene therapy application is required in order to fully understand the mechanisms of action. This treatment and the significant clinical impacts observed represents an important advancement in the field of medicine.
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Affiliation(s)
- Milomir Kovac
- Moscow State Academy of Veterinary Medicine and Biotechnology, Moscow, Russia
| | - Yaroslav A Litvin
- Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
| | - Ruslan O Aliev
- Moscow State Academy of Veterinary Medicine and Biotechnology, Moscow, Russia
| | - Elena Y Zakirova
- Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
| | - Catrin S Rutland
- School of Veterinary Medicine and Science, Faculty of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Andrey P Kiyasov
- Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
| | - Albert A Rizvanov
- Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
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Tamura N, Nukada T, Kato T, Kuroda T, Kotoyori Y, Fukuda K, Kasashima Y. The use of sonoelastography to assess the recovery of stiffness after equine superficial digital flexor tendon injuries: A preliminary prospective longitudinal study of the healing process. Equine Vet J 2017; 49:590-595. [PMID: 28083881 DOI: 10.1111/evj.12665] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 01/04/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND The objective assessment of the mechanical properties of the superficial digital flexor tendon (SDFT) could provide useful information for the rehabilitation of horses with SDFT injuries. Assessment of strain ratio (the strain of a standard reference divided by that of lesions) is a quantitative method in sonoelastography for evaluating tissue stiffness in vivo. As yet, no longitudinal studies have used strain ratio to evaluate the progression of stiffness in SDFT injuries. OBJECTIVES To test the hypothesis that strain ratio can evaluate the recovery of stiffness during the healing of SDFT injuries. STUDY DESIGN Prospective and longitudinal study with observer-blinded evaluation. METHODS Ultrasonography, including sonoelastography, was performed in seven Thoroughbred horses with naturally occurring SDFT injuries at five time points: within 20 days of the injury, and at 2, 3, 6 and 9 months after the injury. Blinded sonoelastographic images were independently evaluated by two veterinarians to assess interobserver agreement. The recovery of stiffness and echogenicity in lesions were evaluated using the strain ratio and grey-scale ratio (echogenicity of lesions divided by that of the surrounding area), respectively. RESULTS Interobserver agreement was assessed as 'almost perfect'. Strain ratios were significantly higher at 9 months after injury than at the other time points (all P<0.05). Strain ratios at 6 months after injury were significantly higher than those at earlier time points (P<0.05). Grey-scale ratios within 20 days of injury were significantly lower than those at the other time points (all P<0.05). MAIN LIMITATIONS Validations of SDFT status were evaluated only by recovery of the echogenicity in lesions and not by histopathological examination. CONCLUSIONS Although further studies are needed to validate the relationships between injured SDFT status and sonoelastographic findings, this preliminary study shows that strain ratio may provide a means to monitor the recovery of stiffness in lesions during rehabilitation, even when the grey-scale ratio remains unchanged from a few months after SDFT injury. The Summary is available in Chinese - see Supporting Information.
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Affiliation(s)
- N Tamura
- Rehabilitation Research Centre, Equine Research Institute, Japan Racing Association, Fukushima, Japan.,Clinical Science and Pathobiology Division, Equine Research Institute, Japan Racing Association, Tochigi, Japan
| | - T Nukada
- Rehabilitation Research Centre, Equine Research Institute, Japan Racing Association, Fukushima, Japan
| | - T Kato
- Rehabilitation Research Centre, Equine Research Institute, Japan Racing Association, Fukushima, Japan
| | - T Kuroda
- Clinical Science and Pathobiology Division, Equine Research Institute, Japan Racing Association, Tochigi, Japan
| | - Y Kotoyori
- Clinical Science and Pathobiology Division, Equine Research Institute, Japan Racing Association, Tochigi, Japan
| | - K Fukuda
- Clinical Science and Pathobiology Division, Equine Research Institute, Japan Racing Association, Tochigi, Japan
| | - Y Kasashima
- Clinical Science and Pathobiology Division, Equine Research Institute, Japan Racing Association, Tochigi, Japan
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Ricco' S, Renzi S, Del Bue M, Conti V, Merli E, Ramoni R, Lucarelli E, Gnudi G, Ferrari M, Grolli S. Allogeneic Adipose Tissue-Derived Mesenchymal Stem Cells in Combination with Platelet Rich Plasma are Safe and Effective in the Therapy of Superficial Digital Flexor Tendonitis in the Horse. Int J Immunopathol Pharmacol 2013; 26:61-8. [DOI: 10.1177/03946320130260s108] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- S. Ricco'
- Department of Veterinary Science, University of Parma, 43126 Parma, Italy
| | - S. Renzi
- Istituto Zooprofilattico Sperimentale della Lombardia e dell‘ Emilia Romagna, 25121 Brescia, Italy
| | - M. Del Bue
- Department of Veterinary Science, University of Parma, 43126 Parma, Italy
| | - V. Conti
- Department of Veterinary Science, University of Parma, 43126 Parma, Italy
| | - E. Merli
- Department of Veterinary Science, University of Parma, 43126 Parma, Italy
| | - R. Ramoni
- Department of Veterinary Science, University of Parma, 43126 Parma, Italy
| | - E. Lucarelli
- Osteoarticular Regeneration Laboratory, Rizzoli Orthopaedic Institute, 40136 Bologna, Italy
| | - G. Gnudi
- Department of Veterinary Science, University of Parma, 43126 Parma, Italy
| | - M. Ferrari
- Istituto Zooprofilattico Sperimentale della Lombardia e dell‘ Emilia Romagna, 25121 Brescia, Italy
| | - S. Grolli
- Department of Veterinary Science, University of Parma, 43126 Parma, Italy
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Muttini A, Valbonetti L, Abate M, Colosimo A, Curini V, Mauro A, Berardinelli P, Russo V, Cocciolone D, Marchisio M, Mattioli M, Tosi U, Podaliri Vulpiani M, Barboni B. Ovine amniotic epithelial cells: in vitro characterization and transplantation into equine superficial digital flexor tendon spontaneous defects. Res Vet Sci 2012; 94:158-69. [PMID: 22954787 DOI: 10.1016/j.rvsc.2012.07.028] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 07/03/2012] [Accepted: 07/28/2012] [Indexed: 01/17/2023]
Abstract
In vitro expanded and frosted ovine amniotic epithelial cells (oAECs) were evaluated for their phenotype, stemness and attitude to differentiate into tenocytes. Fifteen horses with acute tendon lesions were treated with one intralesional injection of oAECs. Tendon recovery under controlled training was monitored. In vitro expanded oAECs showed a constant proliferative ability, a conserved phenotype and stable expression profile of stemness markers. Differentiation into tenocytes was also regularly documented. US controls showed the infilling of the defect and early good alignment of the fibers and 12 horses resumed their previous activity. Histological and immunohistochemical examinations in an explanted tendon demonstrated the low immunogenicity of oAECs that were able to survive in the healing site. In addition, oAECs supported the regenerative process producing ovine collagen type I amongst the equine collagen fibers. Considering our results, oAECs can be proposed as a new approach for the treatment of spontaneous equine tendon injuries.
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Affiliation(s)
- A Muttini
- Department of Comparative Biomedical Sciences, University of Teramo, Italy.
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WATTS AE, NIXON AJ, YEAGER AE, MOHAMMED HO. A collagenase gel/physical defect model for controlled induction of superficial digital flexor tendonitis. Equine Vet J 2011; 44:576-86. [DOI: 10.1111/j.2042-3306.2011.00471.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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9
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Georg R, Maria C, Gisela A, Bianca C. Autologous conditioned plasma as therapy of tendon and ligament lesions in seven horses. J Vet Sci 2011; 11:173-5. [PMID: 20458161 PMCID: PMC2873820 DOI: 10.4142/jvs.2010.11.2.173] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
This case report describes the intralesional application of autologous conditioned plasma (ACP) in seven horses as treatment of severe tendinitis of the superficial digital flexor tendon, deep digital flexor tendon, or desmitis of the inferior check ligament. Follow-up data of the horses revealed a positive outcome in 10 to 13 months post injury. All horses treated with ACP were either performing in their previous work-load or were back in full training. Further studies with long-term follow-up will have to be performed to support these clinical intermediate-term observations.
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Affiliation(s)
- Rindermann Georg
- Equine Clinic, Faculty of Veterinary Medicine, Freie Universitat Berlin, Oertzenweg 19b, 14163 Berlin, Germany
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Boehart S, Arndt G, Carstanjen B. Ultrasonographic morphometric measurements of digital flexor tendons and ligaments of the palmar metacarpal region in Haflinger horses. Anat Histol Embryol 2010; 39:366-75. [PMID: 20545636 DOI: 10.1111/j.1439-0264.2010.01003.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The aim of the study was to determine morphometric values of the superficial and deep digital flexor tendon, the inferior check ligament and the suspensory ligament in the palmar metacarpal region of sound Haflinger horses using ultrasonography and to assess the influence of different factors on them. The findings were compared with the literature. A total of 30 sound Haflinger mares aged 4-20 years were used. Transverse ultrasound images were obtained with an 8-10 linear MHz transducer and the cross-sectional area, the circumference and the dorsopalmar and lateromedial width were determined for each structure at six regions of interest (ROI) in both forelimbs. The coefficient of variation was <3%. The structures were compared between each other and the values of each structure at the ROIs. Age, height at the withers, body mass index, diameter of the Os metacarpale III and the circumference of the mid-metacarpal region showed significant influences on some of the parameters. Reference values for the tendons and ligaments in the palmar metacarpal region in sound Haflinger mares were obtained and the influence of different factors was tested. Description of the dimensional relationship between the structures and comparison of the data with the literature provide knowledge required for adequate veterinary care.
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Affiliation(s)
- S Boehart
- Equine Clinic, Faculty of Veterinary Medicine, Freie Universität Berlin, Oertzenweg 19b, 14163 Berlin, Germany
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Boesen MI, Nanni S, Langberg H, Boesen M, Falk-Ronne J, Bliddal H, Torp-Pedersen S. Colour doppler ultrasonography and sclerosing therapy in diagnosis and treatment of tendinopathy in horses-a research model for human medicine. Knee Surg Sports Traumatol Arthrosc 2007; 15:935-9. [PMID: 17323097 DOI: 10.1007/s00167-006-0245-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2006] [Accepted: 11/09/2006] [Indexed: 10/23/2022]
Abstract
Sclerosing therapy has in recent studies showed promising results in patients with clinically and ultrasonographically diagnosed tendinosis in Achilles and patellar tendons. The aim of this investigation was to study the presence of intratendinous colour Doppler (CD) flow in horses with clinically diagnosed chronic tendinopathy and to test if experience from human studies could be extrapolated to horses. Special interest was focused on the treatment with sclerosing therapy and whether we could obtain the same successful peroperative findings as in humans. Four horses with clinically diagnosed unilateral chronic tendinosis in the forelimbs were examinated with both grey-scale ultrasonography (US) and CD. The horses were to be euthanised according to standard procedure is such cases. The US findings were used for guidance of sclerosing therapy. All horses showed abnormal findings on US, especially intratendinous neovascularisation in the affected limb but not in the contralateral limb. The CD findings had the same appearance as seen in human Achilles tendons with chronic tendinopathy. In all cases the intratendinous neovascularisation was successfully "shut down" peroperatively. The horses showed no signs of discomfort or worsening of symptoms during the short follow-up period after the procedure. The results indicate that the promising results from human medicine might be transferred to treatment of horses with chronic tendinopathy. In the future it will hopefully be possible to use the model from overused tendons in the horse to determine the best treatment of overuse injuries in humans as well. The animal model will allow experimental studies including substantial tissue sampling for mechanical and molecular biological analysis.
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Affiliation(s)
- Morten Ilum Boesen
- Parker Institute, Frederiksberg Hospital, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark.
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