Contrast‐enhanced computed tomographic evaluation of the deep digital flexor tendon in the equine foot compared to macroscopic and histological findings in 23 limbs

Hamel, Sébastien; Bergman, H. J.; Puchalski, Sarah M.; Groot, Mark W. de; Weeren, P. R. van

doi:10.1111/evj.12129

Cited by 26 publications

(17 citation statements)

References 24 publications

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“…This not only supports our hypothesis that widespread tendinopathy may explain the increased likelihood of future problems in tendons after injury[ 19 – 21 ] but also raises concerns about the sensitivity of ultrasound as a diagnostic technique. This equine SDFT model offers an excellent opportunity to test newer imaging techniques suggested to be superior in detecting tendon pathology, such as magnetic resonance imaging[ 41 ], ultrasound with tissue characterization[ 42 ], contrast-enhanced computed tomography[ 43 ], multi-detector computed tomography[ 44 ] and multimodal 2-photon microscopy[ 45 ].…”

Section: Discussionmentioning

confidence: 99%

Focal Experimental Injury Leads to Widespread Gene Expression and Histologic Changes in Equine Flexor Tendons

et al. 2015

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It is not known how extensively a localised flexor tendon injury affects the entire tendon. This study examined the extent of and relationship between histopathologic and gene expression changes in equine superficial digital flexor tendon after a surgical injury. One forelimb tendon was hemi-transected in six horses, and in three other horses, one tendon underwent a sham operation. After euthanasia at six weeks, transected and control (sham and non-operated contralateral) tendons were regionally sampled (medial and lateral halves each divided into six 3cm regions) for histologic (scoring and immunohistochemistry) and gene expression (real time PCR) analysis of extracellular matrix changes. The histopathology score was significantly higher in transected tendons compared to control tendons in all regions except for the most distal (P ≤ 0.03) with no differences between overstressed (medial) and stress-deprived (lateral) tendon halves. Proteoglycan scores were increased by transection in all but the most proximal region (P < 0.02), with increased immunostaining for aggrecan, biglycan and versican. After correcting for location within the tendon, gene expression for aggrecan, versican, biglycan, lumican, collagen types I, II and III, MMP14 and TIMP1 was increased in transected tendons compared with control tendons (P < 0.02) and decreased for ADAMTS4, MMP3 and TIMP3 (P < 0.001). Aggrecan, biglycan, fibromodulin, and collagen types I and III expression positively correlated with all histopathology scores (P < 0.001), whereas lumican, ADAMTS4 and MMP14 expression positively correlated only with collagen fiber malalignment (P < 0.001). In summary, histologic and associated gene expression changes were significant and widespread six weeks after injury to the equine SDFT, suggesting rapid and active development of tendinopathy throughout the entire length of the tendon. These extensive changes distant to the focal injury may contribute to poor functional outcomes and re-injury in clinical cases. Our data suggest that successful treatments of focal injuries will need to address pathology in the entire tendon, and that better methods to monitor the development and resolution of tendinopathy are required.

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Section: Discussionmentioning

confidence: 99%

Focal Experimental Injury Leads to Widespread Gene Expression and Histologic Changes in Equine Flexor Tendons

et al. 2015

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“…Mesenchymal stem cells (MSC) are used for treatment of equine tendinous and ligamentous injuries . Direct intralesional injections is the technique of choice for larger core lesions of tendons, however this technique is poorly adapted to other lesions such as peripheral tears with disruption of the paratenon, diffuse degenerative lesions or hyperemic lesions without core lesions or tears that are identified with contrast enhanced computed tomography or doppler ultrasound . Direct intralesional injections can cause iatrogenic damage to the tendon or ligament, due to transection of the tendon fibers by the needle leading to focal hemorrhage and formation of granulation tissue …”

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confidence: 99%

Scintigraphic Tracking of Allogeneic Mesenchymal Stem Cells in the Distal Limb After Intra‐Arterial Injection in Standing Horses

et al. 2016

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Intra-arterial injection of MSC can be performed in standing horses under sedation and successfully distribute MSC to the distal limb. A risk of periarterial injection was identified but can be reduced with proper sedation, local anesthesia, and increased experience. Partial venous thrombosis was observed as a complication, but did not cause changes of clinical importance, other than rare transient swelling.

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“…However, no contrast angiography was performed, which could have provided more information on lesion severity and perfusion. Indeed, contrast angiography would have allowed us to distinguish between the normal fat and muscle tissue at the origin of the suspensory ligament and a lesion of the ligament ( 26 – 28 ). This would have provided more detailed information on the extent of the soft tissue lesion and should be considered for diagnostic and treatment evaluation in future studies.…”

Section: Discussionmentioning

confidence: 99%

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

Vandenberghe¹,

Broeckx²,

Beerts³

et al. 2015

Front. Vet. Sci.

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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.

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Contrast‐enhanced computed tomographic evaluation of the deep digital flexor tendon in the equine foot compared to macroscopic and histological findings in 23 limbs

Abstract: CECT is an effective adjunct to the more commonly used diagnostic techniques in equine foot pain.

Cited by 26 publications

References 24 publications

Focal Experimental Injury Leads to Widespread Gene Expression and Histologic Changes in Equine Flexor Tendons

Focal Experimental Injury Leads to Widespread Gene Expression and Histologic Changes in Equine Flexor Tendons

Scintigraphic Tracking of Allogeneic Mesenchymal Stem Cells in the Distal Limb After Intra‐Arterial Injection in Standing Horses

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

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