Veterinary Treatment of Tendon & Ligament Injuries in Horses

Question 1

What are the aims of first aid in soft tissue injuries?

Answer 1

Prevent injury becoming worse.
Reduce pain.

→ Reduce inflammation
→ Provide stability
→ Reduce tendon loading

Question 2

What does first aid consist of in soft tissue injuries?

Answer 2

• NSAIDs
• Steroid (single iv dexamethasone dose)
• External support
• Cold therapy
• Confinement

Question 3

What are intralesional therapies? When are they used?

Answer 3

• At start of repair phase (2-3 weeks after injury)
• Suitable only when a hole / space is present.
• Therapy is injected into lesion under ultrasound guidance.
• Aim to improve speed and quality of healing → supra-physiological healing
• Not a substitute for long term rest and controlled exercise.

Question 4

How does stem cell therapy work? WHat are the different stages?

Answer 4

• Autologous graft of mesenchymal stem cells
• Collected from bone marrow or fat
• Cultured in laboratory (3 weeks)
• Differentiate into tenocytes to promote healing
• 2 stage procedure, expensive

Question 5

How is platelet rich plasma used in tendon injuries? How does it work?

Answer 5

• Autologous graft of platelets suspended in plasma.
• Collected from blood by filtration or centrifugation.
• Stimulate angiogenesis and proliferation & differentiation of tissues (bring in nutients and growth factors which promotes healing)

Question 6

How is bone marrow aspirate concentrate used in tendon injuries?

Answer 6

• Autologous graft of fluid & cells from within bone marrow.
• Collected from sternum or tuber coxae.
• Contains mesenchymal stem cells, platelets & growth factors.
• Fluid is centrifuged to concentrate cells.
• Injected in lesion under ultrasound guidance.
• Fewer stem cells/platelets than stem cell therapy/PRP.
• Single stage procedure.

Question 7

When are surgical therapies used on tendon injuries? What techniques are used?

Answer 7

• A few tendon and ligament injuries are amenable to surgical treatment.
• Soft tissue injuries within tendon sheaths or joints heal poorly by medical management due to exposure of tendon fibrils to synovial fluid.
• Exposed fibres are best treated by arthroscopic removal.
• Constriction / contraction of some structures following injury can be managed by transection.

Question 8

What surgical therapies are available for palmar/plantar annular ligament desmitis, SDFT tendinitis, manica flexor tear and DDFT tear?

Answer 8

• Palmar / plantar annular ligament desmitis → PAL desmotomy
• SDFT tendonitis→ Superior check ligament desmotomy
• Manica flexor tear → manica flexor removal
• DDFT tear → DDFT debridement