Effects of Tendon Splitting on Experimentally-Induced Acute Equine Tendinitis

Racing performance of Thoroughbred racehorses with suspensory ligament branch desmitis treated with mesenchymal stem cells (2010-2019)

BACKGROUND

Suspensory ligament branch desmitis (SLBD) is a common injury in Thoroughbred racehorses. Orthobiologic treatment of these injuries is a relatively new approach, and there is limited information available on post injury racing performance in racehorses treated with mesenchymal stem cells (MSCs).

OBJECTIVES

To assess racing performance post injury in Thoroughbred racehorses with SLBD treated with MSCs.

STUDY DESIGN

Retrospective case series.

METHODS

Medical records of racehorses with SLBD treated with MSCs from 2010 to 2019 were reviewed. All horses were treated with allogeneic stem cells injected locally at the time of diagnosis and subsequently received 3-4 treatments with autologous bone-marrow derived MSCs. Ultrasonographic and radiographic images were evaluated to determine the degree of suspensory branch injury and sesamoiditis of the associated proximal sesamoid bone. Race performance was assessed by career length, class of races, number of starts and earnings post injury. Race performance of horses that raced pre and post injury were compared.

RESULTS

Of 69 treated horses, 71% (49/69) [95% CI: 59%-81%] raced post injury. Horses that had raced pre injury were more likely to race post injury (90% [18/20]) than horses that did not race pre injury (63% [31/49]; p = 0.03). Females were less likely to race post injury than males (52% [11/21] vs. 79% [38/49], respectively; p = 0.02). In the 18 horses that raced pre and post injury, the number of races, earnings and earnings per start were not significantly different pre and post injury. The average career length of all horses that raced post injury was 29.5 months.

MAIN LIMITATIONS

Retrospective study design and lack of controls.

CONCLUSIONS

Treatment with MSCs resulted in a majority of Thoroughbred racehorses with SLBD racing post treatment. Racing pre injury and being male was positively associated with racing post injury.

Autologous bone marrow aspirate for treatment of superficial digital flexor tendonitis in 105 racehorses

To evaluate a treatment protocol whereby superficial digital flexor (SDF) tendonitis in Thoroughbred and Standardbred racehorses was treated with autologous bone marrow aspirate (ABMA) obtained from the sternebrae. This treatment was combined with desmotomy of the accessory ligament of the SDF tendon (DAL-SDFT) in selected cases. Medical records of 105 horses treated using the reported protocol were reviewed. Signalment, history and details of treatment were recorded. Racing records were reviewed and performance recorded. Of Thoroughbreds, 82 per cent had one or more starts within the follow-up period and 59 per cent had five or more starts. Of Standardbreds, 76 per cent had one or more starts and 62 per cent had five or more starts. A statistically significant difference was found when comparing race starts between sexes, with females having less starts than males (≥1start P=0.017 and ≥5 starts P=0.008, respectively). The proportions of horses having one or more starts and five or more starts did not differ significantly if a DAL-SDFT was performed or not (P=0.31 and 0.63, respectively). Horses with a core lesion in the body of the SDFT have a good prognosis for return to racing following intralesional ABMA injection. Addition of DAL-SDFT to the treatment regimen did not significantly influence outcome.

Tenogenically Induced Allogeneic Mesenchymal Stem Cells for the Treatment of Proximal Suspensory Ligament Desmitis in a Horse

Suspensory ligament injuries are a common injury in sport horses, especially in competing dressage horses. Because of the poor healing of chronic recalcitrant tendon injuries, this represents a major problem in the rehabilitation of sport horses and often compromises the return to the initial performance level. Stem cells are considered as a novel treatment for different pathologies in horses and humans. Autologous mesenchymal stem cells (MSCs) are well known for their use in the treatment of tendinopathies; however, recent studies report a safe use of allogeneic MSCs for different orthopedic applications in horses. Moreover, it has been reported that pre-differentiation of MSCs prior to injection might result in improved clinical outcomes. For all these reasons, the present case report describes the use of allogeneic tenogenically induced peripheral blood-derived MSCs for the treatment of a proximal suspensory ligament injury. During conservative management for 4 months, the horse demonstrated no improvement of a right front lameness with a Grade 2/5 on the American Association of Equine Practitioners (AAEP) scale and a clear hypo-echoic area detectable in 30% of the cross sectional area. From 4 weeks after treatment, the lameness reduced to an AAEP Grade 1/5 and a clear filling of the lesion could be noticed on ultrasound. At 12 weeks (T₄) after the first injection, a second intralesional injection with allogeneic tenogenically induced MSCs and platelet-rich plasma was given and at 4 weeks after the second injection (T₅), the horse trotted sound under all circumstances with a close to total fiber alignment. The horse went back to previous performance level at 32 weeks after the first regenerative therapy and is currently still doing so (i.e., 20 weeks later or 1 year after the first stem cell treatment). In conclusion, the present case report demonstrated a positive evolution of proximal suspensory ligament desmitis after treatment with allogeneic tenogenically induced MSCs.

Evaluation of early cellular influences of bone morphogenetic proteins 12 and 2 on equine superficial digital flexor tenocytes and bone marrow-derived mesenchymal stem cells in vitro

OBJECTIVE

To evaluate early cellular influences of bone morphogenetic protein (BMP)12 and BMP2 on equine superficial digital flexor tenocytes (SDFTNs) and equine bone marrow-derived mesenchymal stem cells (BMDMSCs).

ANIMALS

9 adult clinically normal horses.

PROCEDURES

BMDMSCs and SDFTNs were cultured in monolayer, either untreated or transduced with adenovirus encoding green fluorescent protein, adenovirus encoding BMP12, or adenovirus encoding BMP2. Cytomorphologic, cytochemical, immunocytochemical, and reverse transcriptase-quantitative PCR (RT-qPCR) analyses were performed on days 3 and 6. Genetic profiling for effects of BMP12 was evaluated by use of an equine gene expression microarray on day 6.

RESULTS

BMDMSCs and SDFTNs had high BMP12 gene expression and remained viable and healthy for at least 6 days. Type l collagen immunocytochemical staining for SDFTNs and tenocyte-like morphology for SDFTNs and BMDMSCs were greatest in BMP12 cells. Cartilage oligomeric matrix protein, as determined via RT-qPCR assay, and chondroitin sulfate, as determined via gene expression microarray analysis, were upregulated relative to control groups in SDFTN-BMP12 cells. The BMDMSCs and SDFTNs became mineralized with BMP2, but not BMP12. Superficial digital flexor tenocytes responded to BMP12 with upregulation of genes relevant to tendon healing and without mineralization as seen with BMP2.

CONCLUSIONS AND CLINICAL RELEVANCE

Targeted equine SDFTNs may respond to BMP12 with improved tenocyte morphology and without mineralization, as seen with BMP2. Bone marrow-derived mesenchymal stem cells may be able to serve as a cell delivery method for BMP12.

Evidence-based musculoskeletal surgery in horses

Musculoskeletal disorders comprise a large portion of the conditions treated by equine veterinarians. Surgical intervention is the treatment of choice in many cases. The body of literature describing and exploring surgical correction of musculoskeletal disorders in horses is steadily growing but still lacking. At this juncture, we can use what information we have with the understanding that as the quality of research advances, we should apply stricter standards to the evidence we use to answer our clinical questions.

Superficial digital flexor tendon healing: ultrasonographic evaluation of therapies

Until recently, it was difficult to critically evaluate tendon healing in vivo. Superficial digital flexor tendon injuries were considered healed when the injured tendon was cold, non-painful, adequate time had passed for tendon healing to occur, and no recurrence of the injury was detected when the horse returned to athletic work. This article discusses how ultrasonography has revolutionized the diagnosis, treatment, and management of tendon injuries.

Exercise intolerance and poor performance in western performance and sprint horses

This article deals with the presenting histories, clinical examinations, and therapies of the causes of poor performance and exercise intolerance in the western performance horse and the sprint racehorse. The veterinarian's ability to diagnose and treat various pathophysiologic conditions that affect these horses is crucial to the major goals of a return to optimal performance and a long athletic career. Although these horses are a significant portion of most veterinary practices, there exists a minimal amount of information on their clinical evaluation and treatment. This article intends to fill this void.

Transection of the accessory ligament of the superficial digital flexor tendon for treatment of tendinitis: long term results in 61 standardbred racehorses (1985-1992)

Medical records and lifetime race results were obtained for 61 Standardbred racehorses treated consecutively from 1985 to 1992 with transection of the accessory ligament of the superficial digital flexor tendon (AL-SDF) for tendinitis of one or both forelimbs. A clinical diagnosis of tendinitis was confirmed in all cases by ultrasonographic examination. After surgery, 50 (82%) horses raced and 42 (69%) completed 5 or more starts. Eight horses (13%) failed to start and/or complete 5 or more races due to a recurrence of tendinitis. Six (10%) horses did not start and/or complete 5 or more starts for reasons unrelated to tendinitis and 5 (8%) horses were lost to follow-up. The median time between surgery and the first post operative start was 39 weeks. Fifty-seven per cent of those horses to start after surgery completed 20 or more starts and 40% raced on 40 or more occasions. Of the 42 horses to complete 5 or more races, the median number of post operative starts was 37 at time of follow-up. Thirty-two of 50 (64%) horses to start after surgery established or lowered lifetime racemarks. Thirty-six horses had raced prior to surgery. Thirty-one of 36 (86%) horses returned to racing after treatment of SDF tendinitis with accessory desmotomy (AD) and 27 horses (75%) completed 5 or more starts. Median earnings per start decreased 25% after surgery. Twenty-five horses had not raced prior to surgery. Nineteen (76%) horses in this group were age 2 years at time of injury.(ABSTRACT TRUNCATED AT 250 WORDS)

Treatment of superficial digital flexor tendinitis

This article reviews the research and clinical findings relevant to the treatment of acute tendinitis in the horse. The goals of treatment are to reduce inflammation, minimize scar tissue formation, and promote restoration of normal tendon function. A wide variety of treatments have and still are being used to treat tendinitis, which indicates that there is no uniformly successful way to return a horse to full athletic function after injury. Therapy depends on the severity of tendinitis and duration of injury and can be divided into treatment during the inflammatory, repair, and maturation phases of healing.

Practical management of superficial digital flexor tendinitis in the performance horse

The authors of this section represent a broad range of practice experience with horses that perform in rigorous and varied sport competitions. Each breed and performance application represent unique challenges of diagnosis and uncompromising demands on rehabilitated tendon injuries. This article will serve to guide, stimulate, and encourage veterinarians to apply scientific criteria to the evaluation of tendinitis therapy in the years to come so that we can arrive at a more valid consensus as to the "best" means of tendon and ligament injury management.

Standing musculoskeletal surgery

Indications for performing orthopedic surgery on the standing horse include inability to tolerate general anesthesia, risk of worsening an injury during recovery from anesthesia, and cost. The surgeon should be aware that performing surgery in the standing horse can be more demanding and require more experience than the same procedures when the time and convenience of general anesthesia are available. Improved sedatives and analgesics have allowed more latitude because the horses now are more tolerant than when older agents were used. Common sense should be applied to each situation before the decision is made to do a procedure, because every horse and problem is unique.