Summary
Reasons for performing study: Mesenchymal stem (progenitor; stromal) cell (MSC) therapy has gained popularity for the treatment of equine tendon injuries but without reports of long-term follow-up.

Objectives: To evaluate the safety and reinjury rate of racehorses after intralesional MSC injection in a large study of naturally occurring superficial digital flexor tendinopathy and to compare these data with those published for other treatments.

Methods: Safety was assessed clinically, ultrasonographically, scintigraphically and histologically in a cohort of treated cases: 141 client-owned treated racehorses followed-up for a minimum of 2 years after return to full work. Reinjury percentages were compared to 2 published studies of other treatments with similar selection criteria and follow-up. The number of race starts, discipline, age, number of MSCs injected and interval between injury and treatment were analysed.

Results: There were no adverse effects of the treatment with no aberrant tissue on histological examination. The reinjury percentage of all racehorses with follow-up (n = 113) undergoing MSC treatment was 27.4%, with the rate for flat (n = 8) and National Hunt (n = 105) racehorses being 50 and 25.7%, respectively. This was significantly less than published for National Hunt racehorses treated in other ways. No relationship between outcome and age, discipline, number of MSCs injected or injury to implantation interval was found.

Conclusions: Whilst recognising the limitations of historical controls, this study has shown that MPC implantation is safe and appears to reduce the reinjury rate after superficial digital flexor tendinopathy, especially in National Hunt racehorses.

Potential relevance: This study has provided evidence for the long-term efficacy of MSC treatment for tendinopathy in racehorses and provides support for translation to human tendon injuries.

Implantation of bone marrow-derived mesenchymal stem cells demonstrates improved outcome in horses with overstrain injury of the superficial digital flexor tendon

Reasons for performing study: Overstrain injuries to the superficial digital flexor tendon (SDFT) and suspensory ligament (SL) are among the most common musculoskeletal injuries which contribute to the considerable wastage of racing Thoroughbreds. Many epidemiological studies have demonstrated the prevalence of and risk factors for tendon injury when racing but have not included those injuries sustained during training. However, since tendon injury during training is seen commonly in clinical practice, it is appropriate to determine the overall prevalence of tendon injury sustained during both training and racing. Objective: To determine the prevalence of overstrain injury to the SDFT and SL during training and racing among Thoroughbred flat racehorses in Japan in 1999. Methods: A retrospective study was performed using a sample population of 10,262 Thoroughbred racehorses. The medical information database of Thoroughbred racehorses registered by the Japan Racing Association (JRA) in 1999 was analysed for SDFT and SL overstrain injury diagnosed by a veterinarian employed by JRA during training and racing. Jump racehorses were excluded from this study. Results: The prevalence of forelimb SDFT tendonitis and SL desmitis was 11.1% (1130 cases) and 3.61% (370 cases) of the population, respectively. In the hindlimb, there were 0.06% (6 cases) and 0.14% (14 cases), respectively. Risks of SDF tendonitis in the forelimb in 3-year-olds or older horses were significantly higher than in 2-year-olds. In contrast, the risk of SL desmitis in the forelimb at age 3 and 4 years was 2.23 and 2.11 times higher, respectively, than in 2-year-olds, but this increased to 5.07 times in those age ≥5 years. Entire males were at greater risk in comparison to females and geldings. Conclusions: The results suggest that the prevalence of SDF tendonitis and SL desmitis in the forelimb was associated with the horse's age and sex. The prevalence of SL desmitis increased further with age compared with SDF tendonitis, possibly reflecting a more rapid accumulation of degeneration in this structure. Potential relevance: The age-related risk demonstrated in this study provides further support that overstrain injuries are associated with accumulated degeneration. These data provide a valuable resource for further research into the aetiology of tendon injury in the racehorse.

Prevalence of superficial digital flexor tendonitis and suspensory desmitis in Japanese Thoroughbred flat racehorses in 1999

Use of Adipose Tissue-Derived Mesenchymal Stem Cells for Experimental Tendinitis Therapy in Equines

The gross and functional anatomy of the suspensory ligament (SL) and its ultrasonographic variability are described. Injuries of the suspensory apparatus are divided into lesions confined to the proximal one third of the metacarpus or metatarsus (proximal suspensory desmitis and avulsion fractures), lesions of the body, and branch lesions. Complete breakdown injuries are also discussed. In view of the close association of the SL, the second, third, and fourth metacarpal or metatarsal bones, and the proximal sesamoid bones, associated bony lesions are also considered.

Suspensory Ligament Desmitis

Ultrasonography and MRI have become valuable tools for imaging of tendon injuries. The current study examines the histopathologic basis for the imaging abnormalities. Five injured equine forelimbs and two normal contralateral limbs were studied with high resolution real time ultrasound and MRI. Histologic sections were made and correlated with the diagnostic images. All lesions were readily seen by both modalities. Lesions characterized by hemorrhage, edma, and cellular infiltration were sonolucent on ultrasound and bright on MRI images. MRI returned to normal as fibrogenesis ensued. Ultrasound images remained abnormal until fibrillar reallgnment occured with completion of the healing process. High resolution real time ultrasound and MRI both accurately reflect the tissue abnormalities in acute tendon injuries. The injured horse does appear to be an effective model for correlative imaging studies of tendon injuries.

https://www.onlinelibrary.wiley.com/doi/pdf/10.1111/j.1740-8261.1992.tb00135.x

Magnetic resonance, ultrasound and histopathologic correlation of acute and healing equine tendon injuries

In our 3 years of clinical experience, we have found that diagnostic ultrasound provides the veterinarian with a valuable diagnostic tool. It allows the clinician to quantify morphologic change that has occurred as a result of soft-tissue injuries, even when the clinical findings are ambiguous or insufficient. In cases in which aggressive postinjury therapy has been instituted prior to presentation, diagnostic ultrasound is often the only noninvasive method that can ascertain the extent of the horse's injury. Diagnostic ultrasound provides the technology to detect injuries before they become permanently debilitating, because lesions as small as 1 mm in diameter can be detected. Prior to diagnostic ultrasound, the severity of many injuries was underestimated. In such cases, if the horse responded favorably to symptomatic therapy, the client would resume training. The result was often debilitation. Diagnostic ultrasound also enables the clinician to demonstrate visually to the client the location, size, and extent of lesions in the limb. One of the more gratifying effects of a sonographic study is the client's acceptance of the presence and extent of the injury after visualizing it. We have found that the old adage "a picture is worth a thousand words" is generally the rule in obtaining the proper course of therapy for the horse. The ability to make hard copies of sonograms enables the clinician to morphologically evaluate the rate of healing. He can accurately determine the effectiveness of a therapeutic regimen and ascertain when optimal healing has occurred. Diagnostic ultrasound can provide the researcher with an invaluable tool to document and quantify soft-tissue disease. We anticipate that, in the future, the sonographic appearance of recovered tissues will be correlated with new data on the healing process and the effectiveness of various therapies. The material presented above has covered the value of diagnostic ultrasound in major clinical situations related to equine lameness. Other applications, the discussion of which is beyond the scope of this article, include evaluation of the pastern for injuries to the SDF, DDF, and oblique sesamoidean ligament, and evaluation of the navicular bursae. Examination of muscles for hematomas, abscessations, and tears has also been accomplished ultrasonographically. Diagnostic ultrasound has facilitated study of the trochanteric and bicipital bursae, blood flow through arteries, and structures above the carpus and hock. Obviously, the clinical potential of diagnostic ultrasound is limitless.(ABSTRACT TRUNCATED AT 400 WORDS)

Diagnostic Ultrasonography of Equine Limbs

A method to quantitate as well as to document SDFT pathology has been described. This report indicates that computer-assisted evaluation of SDFT damage can improve the accuracy of prognosis in clinical practice. It would appear that a 3.8 severity rating is a limit past which prognosis for successful racing starts to worsen rapidly.

Clinical experience with quantitative analysis of superficial digital flexor tendon injuries in Thoroughbred and Standardbred racehorses.

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Diagnostic Ultrasonography of Equine Limbs

Clinical experience with quantitative analysis of superficial digital flexor tendon injuries in Thoroughbred and Standardbred racehorses.