Regenerative Strategies for the Treatment of Equine Intra Articular Lesions

there are many unanswered questions surrounding the therapeutic use of stem cells in horses. While no treatment paradigms have been described, this lecture will provide general recommendations for the current treatment of equine intra-articular lesions. in addition to stem cells, the use of platelet rich plasma (prp), bone marrow aspirate concentrate (BMaC), and autologous conditioned serum/irap for the treatment of intra-articular lesions will also be discussed.

Treatment of osteoarthritis (oA)
• Stem cells can be injected intra-articularly either alone or in conjunction with prod- ucts routinely used to treat oa.
• inject stem cells on as needed basis as would be performed if using corticosteroids.
• in the absence of surgery, horses are returned to exercise after 24 hours similar to more routine treatment with corticosteroids and/or chondroprotective agents.
• treatment of cartilage defects (surgical)
• Stem cells or BMC can be grafted into a lesion under arthroscopic guidance. this requires:
-  use of gas arthroscopy.
-  Dual syringe injection system in which the cellular component is in one syringe and bovine thrombin is in the other syringe.
-  alternatively, autologous or commercial fibrin can be used to retain the cells.
• following a grafting procedure, a rehabilitation protocol is established and is largely dependent on the size, location, and nature of the cartilage defect:
- young horses treated for osteochondritis dissecans (oCD) lesions are generally confined to a box stall for 2 weeks post-operatively, following which time gradually increasing amounts of hand walking are initiated. at 3 months post-operatively, a vet- erinary examination is performed and radiographs of the affected joint are taken and evaluated for healing prior to small paddock turnout for an additional month and then full turnout for another 2 months. Veterinary examination and radiographs at 6 months postoperatively are then used to determine if the horse can start training. [...]