Ultrasonic debridement with stem cell therapy of suspensory branch desmitis in an equine patient

Abstract

Ultrasonic debridement as a treatment for tendinopathy and desmitis is a relatively new approach in orthopedic surgery. Previously only used in limited cases, this procedure shows promise for treating ligament-bone and tendon-bone interface injuries. We present a case study of a 2-yr-old thoroughbred male horse, unable to train due to recalcitrant symptoms after extensive conservative management of suspensory branch desmitis. It was then treated with ultrasonic debridement and concurrent manubrial stem cell autograft injection, to treat the ultrasound visualized lesion. Post-surgically, the patient recovered quickly, began training within 16 wk, and went onto win several races. Repeat ultrasound imaging reveals a complete restoration of the internal fiber architecture of the ligament. With a 3-yr follow-up, there has been consistent training and race performance with no re-injury. This study is the first to document the successful outcome of ultrasonic debridement with concurrent stem cell injection in the treatment of equine desmitis.

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

“…In vitro studies have shown that equine flexor tendon and suspensory ligament explants do not respond equally to orthobiologic treatments 35,36,40,41 and as such direct extrapolation from MSC treatment of tendon injuries onto suspensory ligament injuries should be made with caution. Limited case series on different injuries to the suspensory ligament (proximal, body and branches) in horses of different breeds and disciplines have shown promising results with stem cell treatment 12–14,21,23 . Horses in our study received a minimum of 20 million cells per treatment with allogeneic umbilical blood derived cells being used initially, followed by autologous BM‐MSCs in subsequent treatments.…”

“…Various orthobiologics have been described for management of SLBD, including platelet preparations, 3,11 and bone marrow‐derivates 12–14 . Surgical management for selected injuries has also been described 15,16 .…”

“…To date, neither experimental nor large scale clinical studies evaluating the efficacy of MSCs on suspensory ligament injuries in horses have been published in peer‐reviewed literature 1 . Favourable outcomes have been reported in smaller case series in horses of various breeds and disciplines 14,19–23 …”

“…Various orthobiologics have been described for management of SLBD, including platelet preparations, 3,11 and bone marrowderivates. [12][13][14] Surgical management for selected injuries has also been described. 15,16 The goals of orthobiologic treatment are to improve the quality of healed tissue and reduce reinjury rates; however, such effects have yet to be fully investigated.…”

“…1 Favourable outcomes have been reported in smaller case series in horses of various breeds and disciplines. 14,[19][20][21][22][23] The primary objective of this study was to assess race performance in Thoroughbred racehorses after SLB injury treated with MSCs. Measures of racing performance examined were ability to race, number of races, earnings and earnings per start post treatment.…”