Regenerative therapies for the treatment of joint disease and soft tissues injuries have been introduced in the field of equine surgery over the past decade. Specifically, equine veterinarians use stem cells, IRAP, and PRP to stimulate and work with the immune system to promote healing. In the horse, the focus of regenerative medicine lies primarily in the musculoskeletal system, originally for the treatment of over-strain tendon injuries. Regenerative medicine is an active area of ongoing research with many potential future applications in the treatment of a broad spectrum of disorders.
Regenerative therapies have been used in equine surgery for multiple indications including:
- Joint disease (osteoarthritis, synovitis, capsulitis)
- Tendon, ligament and meniscal injuries
Osteoarthritis is a common cause of lameness in horses. Clinical signs include lameness, joint effusion (swelling), stiffness, or poor performance. The pain associated with osteoarthritis may result from cartilage damage within the joint, inflammation of the joint lining (synovitis), or associated subchondral bone pain.
Tendon and ligament injuries typically cause lameness of the affected limb, as well as focal swelling or heat, or sensitivity to palpation associated with the site of injury.
Your veterinarian can help you decide whether your horse will benefit from one of the regenerative therapies. Determination of which biologic therapy is most appropriate will depend on several factors, including the primary disease process, chronicity of disease, and response to previous treatments (e.g. nonsteroidal anti-inflammatory medications, intra-articular corticosteroid injections). Your veterinarian may perform the following in order to determine the appropriate therapy for your horse:
- Physical examination including musculoskeletal palpation
- Lameness evaluation, including flexion tests and diagnostic anesthesia (perineural or intra-articular) in order to localize the source of lameness
- Radiographs to assess bony structures
- Ultrasound to examine soft tissue structures, including ligaments and tendons, intra-articular structures or the joint capsule for presence of synovitis or capsulitis
- Surgical arthroscopy of the joint may be indicated and beneficial to better determine prognosis
Infection or ‘flare’ are uncommon complications following injection of regenerative therapies. As with any joint injection, it is important to monitor carefully for signs of infection (heat, swelling, or increased lameness) following injection of regenerative therapies.
Following evaluation and continued treatment, your regular veterinarian will be able to provide specific instructions for exercise and rehabilitation, depending on the primary disease being treated. Typically stall rest with a controlled exercise and rehabilitation program is recommended following implementation of biologic therapies. Prognosis for return to previous level or future athleticism will also depend upon the specific diagnosis and chronicity of the disease process.
Development of regenerative therapies (IRAP, PRP, stem cells) have allowed for the treatment of equine musculoskeletal disorders that may previously have limited performance. Consult your veterinarian to determine if your horse would benefit from one of these therapies.