Veterinary surgery : VS2026; doi: 10.1111/vsu.70139

Core decompression augmented with bone marrow aspirate concentrate for refractory distal sesamoid bone pathology in horses: A retrospective clinical study.

Maleas, G
·
Mageed, M
·
Hargitaiova, K

Abstract: To determine short- and long-term outcomes of core decompression combined with autologous bone marrow aspirate concentrate (BMAC) in treating moderate-to-severe refractory distal sesamoid bone (DSB) trabecular pathology in horses. Methods: Retrospective observational study. Methods: A total of 21 client-owned Warmblood horses with DSB pathology unresponsive to conservative management. Methods: Preoperative diagnosis included lameness localization by diagnostic analgesia and magnetic resonance imaging (MRI) confirmation of DSB trabecular pathology. Horses underwent arthroscopic core decompression via the palmar recess of the distal interphalangeal joint followed by intraosseous BMAC injection. Outcomes were assessed clinically and by follow-up radiography and MRI. Results: No major intraoperative or postoperative complications occurred in any of the 21 operated horses. Nine horses met inclusion criteria for long-term follow-up, which included clinical, radiographic, and MRI assessments at 6 months and up to 18 months postoperatively. At 6 months, six of nine horses (67%) were sound and returned to training. MRI follow-up demonstrated reduced short tau inversion recovery (STIR) hyperintensity and increased T1-weighted signal within the DSB trabecular bone, consistent with a reduction in active trabecular bone pathology. Three horses remained lame with unchanged MRI findings. At 18 months, six horses remained sound, and three returned to their previous or intended performance levels. Radiographic remodeling of cyst-like lesions was evident in three cases. Conclusions: Core decompression augmented with BMAC was well tolerated with no unexpected complications in this cohort. This approach allowed horses with advanced DSB trabecular pathology refractory to conservative therapy return to function. Conclusions: This combined surgical-orthobiologic approach may offer a viable therapeutic option for horses with advanced refractory navicular bone pathology.

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Publication Date: 2026-08-01 PubMed ID: 42541767DOI: 10.1111/vsu.70139Google Scholar: Lookup

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Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

Overview

This study evaluated the effectiveness of combining core decompression surgery with the injection of bone marrow aspirate concentrate (BMAC) to treat horses suffering from severe, persistent distal sesamoid bone (navicular bone) conditions unresponsive to standard treatments.
Results indicated that this combined treatment helped most horses return to soundness and improved bone pathology as confirmed by imaging over both short- and long-term follow-up periods.

Background and Purpose

The distal sesamoid bone (DSB), also known as the navicular bone, is a critical structure in a horse’s hoof that often suffers from degenerative or traumatic trabecular (spongy bone) pathology.
Conservative management (such as rest, medication, and shoeing adjustments) sometimes fails to alleviate the lameness caused by these bone lesions.
Core decompression is a surgical technique that relieves pressure within the bone and promotes healing by creating channels to improve blood flow.
Bone marrow aspirate concentrate (BMAC) is rich in stem cells and growth factors that can enhance bone healing and regeneration.
The study aimed to assess the outcomes of combining these two approaches (core decompression plus BMAC injection) in Warmblood horses with refractory distal sesamoid bone pathology.

Methods

The study was retrospective and observational, reviewing records of 21 client-owned Warmblood horses with moderate-to-severe distal sesamoid bone trabecular pathology that did not improve with conservative treatment.
Diagnosis of the problem involved:
- Localization of lameness via diagnostic analgesia (nerve blocks)
- Confirmation of trabecular bone pathology using magnetic resonance imaging (MRI)
Treatment involved:
- Arthroscopic core decompression surgery performed via the palmar recess of the distal interphalangeal joint
- Injection of autologous (from the same horse) BMAC directly into the created bone channels
Outcomes were assessed through clinical examination and follow-up imaging (radiography and MRI) at multiple points post-surgery, including at 6 months and up to 18 months.

Results

No major surgical or postoperative complications occurred within the entire group of 21 horses indicating the procedure was well tolerated.
Long-term follow-up data was available for 9 horses who underwent clinical exams and imaging at 6 months and beyond.
At 6 months:
- 6 out of 9 horses (67%) were sound and resumed training.
- MRI showed a reduction in bone edema signals (specifically decreased STIR hyperintensity) and an increase in normal bone signals (T1-weighted), suggesting healing or reduction of active bone pathology.
- 3 horses remained lame with unchanged MRI findings, indicating a lack of response in these cases.
At 18 months:
- Those 6 horses who regained soundness continued to be sound.
- 3 horses returned to their previous or intended levels of athletic performance.
- Radiographs showed remodeling of cyst-like bone lesions in three horses, a positive sign of bone healing.

Conclusions

Combining core decompression surgery with autologous BMAC injection was safe and well tolerated in horses with advanced refractory distal sesamoid bone pathology.
This combined surgical and regenerative medicine approach enabled many horses with severe navicular bone disease to regain soundness and return to training or competition.
The study supports the use of this combined technique as a viable therapeutic option for managing refractory navicular bone conditions that do not respond adequately to conservative treatments.

Significance

This study adds evidence to the growing field of orthobiologics—using biologically active substances like stem cells and growth factors to promote tissue healing—in equine orthopedic diseases.
It demonstrates that targeted surgical decompression combined with injection of bone marrow-derived regenerative cells can improve outcomes in a challenging bone disorder with limited treatment options.
Future prospective controlled studies could further clarify the effectiveness and optimize protocols for this promising therapeutic strategy.

Cite This Article

APA

Maleas G, Mageed M, Hargitaiova K. (2026). Core decompression augmented with bone marrow aspirate concentrate for refractory distal sesamoid bone pathology in horses: A retrospective clinical study. Vet Surg. https://doi.org/10.1111/vsu.70139

Publication

Veterinary surgery : VS

ISSN: 1532-950X

NlmUniqueID: 8113214

Country: United States

Language: English

Researcher Affiliations

Maleas, Grigorios

Equuria Orthopedics, Emstek, Germany.

Mageed, Mahmoud

Equuria Orthopedics, Emstek, Germany.
Equipixel Veterinary Teleradiology, Bakum, Germany.

Hargitaiova, Kristyna

College of Veterinary Medicine, Cornell University, Ithaca, USA.

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