FREE SHIPPING over $40
OVER 9000 FIVE-STAR REVIEWS
5% OFF ALL SUBSCRIPTIONS
100% HAPPINESS GUARANTEE
Analyze Diet
0
Home / Equine Research Bank / BMC Vet Res / Outcome following local injection of a liquid amnion allogra...
BMC veterinary research2022; 18(1); 391; doi: 10.1186/s12917-022-03480-5

Outcome following local injection of a liquid amnion allograft for treatment of equine tendonitis or desmitis – 100 cases.

Abstract: Tendon and ligament injuries are significant causes of loss of use and early retirement in performance horses. Amniotic fluid and tissue are excellent sources of growth factors and cytokines important in tendon and ligament healing. Thus, an equine-origin liquid amnion allograft (ELAA) may be beneficial in the treatment of equine tendonitis and desmitis. Objectives of this study were to report the outcome achieved (i.e. ability to return to work) for horses diagnosed with tendonitis or desmitis lesions treated with local injection of ELAA and to compare these outcomes to those reported for other regenerative medicine modalities. Methods: A prospective, multi-center, non-blinded clinical trial was conducted. Equine veterinarians at 14 sites were selected to participate in the data collection for the trial. Criterion for inclusion was a horse presenting with lameness which was attributed to tendonitis or desmitis by diagnostic anesthesia and/or imaging. These horses were subsequently treated by local injection of the lesion with ELAA by the attending veterinarian. Standardized questionnaires describing each horse's signalment, discipline, ability to return to work, and any adverse events were completed and submitted by the attending veterinarian following a minimum of six months of follow-up. The current literature was reviewed to identify clinical studies reporting outcomes of equine tendonitis/desmitis lesions treated with other regenerative therapies. Contingency table analyses were performed comparing outcomes. Results: Questionnaires for 100 horses with 128 tendonitis and desmitis lesions met the inclusion criteria. Of these, 72 horses with 94 lesions returned to or exceeded their original level of work, 10 horses with 13 lesions returned to work but could not perform to previous standards, and 18 horses with 20 lesions did not return to work as a result of the injury. No differences were observed when outcome of horses treated with ELAA were compared to those of similar studies using other regenerative therapies. Conclusions: Treatment of tendonitis and desmitis lesions by local injection of ELAA resulted in similar outcomes for horses returning to previous level of performance as other regenerative modalities such as mesenchymal stem cells, platelet-rich plasma, and autologous conditioned serum; however, blinded placebo-controlled studies are indicated.
© 2022. The Author(s).
Get Full Text
Publication Date: 2022-11-07 PubMed ID: 36345002PubMed Central: PMC9639279DOI: 10.1186/s12917-022-03480-5Google Scholar: Lookup
The Equine Research Bank provides access to a large database of publicly available scientific literature. Inclusion in the Research Bank does not imply endorsement of study methods or findings by Mad Barn.
LinkedInCopy
  • Journal Article

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.

This research study investigates the effectiveness of using equine-origin liquid amnion allograft (ELAA) in treating tendon and ligament injuries in performance horses, finding similar outcomes to other forms of regenerative treatment like stem cells and platelet-rich plasma.

Overview of the Study

  • The research was a prospective, multi-center, non-blinded clinical trial aimed at understanding the benefits of ELAA in the treatment of tendonitis or desmitis in horses.
  • To qualify for the study, a horse had to present with lameness attributed to tendonitis or desmitis based on diagnostic anesthesia or imaging.
  • Affected horses were treated locally with injections of ELAA by a veterinarian, and outcomes were monitored over a period of at least six months.
  • The researchers made comparisons between their results and the results of similar studies using other regenerative medicines, such as mesenchymal stem cells, platelet-rich plasma, and autologous conditioned serum.

Results of the Study

  • The study involved 100 horses manifesting 128 lesions due to tendonitis or desmitis. Out of these, 72 horses with 94 lesions were able to return to their original levels of performance or exceeded them.
  • An additional 10 horses with 13 lesions were able to return to work, but could not perform to their previous standards.
  • 18 horses with 20 lesions were unable to return to work as a result of their injury.
  • When these outcomes were compared to past studies using other types of regenerative treatment, there was no significant difference in results.

Conclusion of the Study

  • Overall, the research concluded that treating tendonitis and desmitis lesions by locally injecting ELAA yielded similar outcomes in terms of horses returning to previous performance levels as did other regenerative therapies.
  • The study, however, acknowledges the need for further research including blinded, placebo-controlled studies in order to further validate these results.

Cite This Article

APA
Duddy HR, Schoonover MJ, Hague BA. (2022). Outcome following local injection of a liquid amnion allograft for treatment of equine tendonitis or desmitis – 100 cases. BMC Vet Res, 18(1), 391. https://doi.org/10.1186/s12917-022-03480-5

Publication

BMC veterinary research
ISSN: 1746-6148
NlmUniqueID: 101249759
Country: England
Language: English
Volume: 18
Issue: 1
Pages: 391

Researcher Affiliations

Duddy, Hugh R
  • Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Oklahoma State University, Stillwater, OK, USA.
Schoonover, Mike J
  • Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Oklahoma State University, Stillwater, OK, USA. mjsdvm@gmail.com.
Hague, Brent A
  • Oakridge Equine Hospital, Edmond, OK, USA.

MeSH Terms

  • Horses
  • Animals
  • Horse Diseases / surgery
  • Horse Diseases / diagnosis
  • Amnion / pathology
  • Prospective Studies
  • Tendinopathy / surgery
  • Tendinopathy / veterinary
  • Allografts / pathology
  • Treatment Outcome

Conflict of Interest Statement

MJS and BAH have consulting agreements with Equus Innovations. Their responsibilities are to serve as medical experts on issues pertaining to products, collaborate with personnel and external parties in the selection, construction and implementation of clinical trials to evaluate performance of products, participate in product design, development, and testing and engage with stakeholders on a peer-to-peer basis regarding product use, characteristics and potential for expanded clinical indications. Additionally, BAH is a minority shareholder in Equus innovations. HRD has no conflicts of interest to declare.

References

This article includes 37 references
  1. Dahlgren LA. Pathobiology of tendon and ligament injuries.. Clin Tech Equine Pract 2007;6:168–173.
    doi: 10.1053/j.ctep.2007.08.002google scholar: lookup
  2. Denoix J-M. Functional anatomy of tendons and ligaments in the distal limbs (manus and pes). Vet Clin North Am Equine Pract 1994;10:273–322.
    doi: 10.1016/S0749-0739(17)30358-9pubmed: 7987720google scholar: lookup
  3. Dowling BA, Dart AJ, Hodgson DR, Smith RKW. Superficial digital flexor tendonitis in the horse.. Equine Vet J 2000;32:369–378.
    doi: 10.2746/042516400777591138pubmed: 11037257google scholar: lookup
  4. Ely ER, Avella CS, Price JS, Smith RKW, Wood JLN, Verheyen KLP. Descriptive epidemiology of fracture, tendon and suspensory ligament injuries in National Hunt racehorses in training.. Equine Vet J 2009;41:372–378.
    doi: 10.2746/042516409X371224pubmed: 19562899google scholar: lookup
  5. Nixon AJ, Dahlgren LA, Haupt JL, Yeager AE, Ward DL. Effect of adipose-derived nucleated cell fractions on tendon repair in horses with collagenase-induced tendinitis.. Am J Vet Res 2008;69:928–937.
    doi: 10.2460/ajvr.69.7.928pubmed: 18593247google scholar: lookup
  6. O’Sullivan CB. Injuries of the flexor tendons: focus on the superficial digital flexor tendon.. Clin Tech Equine Pract 2007;6:189–197.
    doi: 10.1053/j.ctep.2007.08.005google scholar: lookup
  7. Smith RKW, Webbon PM. Harnessing the stem cell for the treatment of tendon injuries: heralding a new dawn?. Br J Sports Med 2005;39:582–584.
    doi: 10.1136/bjsm.2005.015834pmc: PMC1725307pubmed: 16118291google scholar: lookup
  8. Thorpe CT, Clegg PD, Birch HL. A review of tendon injury: Why is the equine superficial digital flexor tendon most at risk?. Equine Vet J 2010;42:174–180.
    doi: 10.2746/042516409X480395pubmed: 20156256google scholar: lookup
  9. Durgam S, Stewart M. Cellular and molecular factors influencing tendon repair.. Tissue Eng Part B Rev 2017;23:307–317.
    doi: 10.1089/ten.teb.2016.0445pubmed: 28092213google scholar: lookup
  10. Richardson LE, Dudhia J, Clegg PD, Smith R. Stem cells in veterinary medicine – attempts at regenerating equine tendon after injury.. Trends Biotechnol 2007;25:409–416.
    doi: 10.1016/j.tibtech.2007.07.009pubmed: 17692415google scholar: lookup
  11. Watkins JP, Auer JA, Gay S, Morgan SJ. Healing of surgically created defects in the equine superficial digital flexor tendon: collagen-type transformation and tissue morphologic reorganization.. Am J Vet Res 1985;46:2091–2096.
    pubmed: 4062012
  12. Fortier LA, Smith RKW. Regenerative medicine for tendinous and ligamentous injuries of sport horses.. Vet Clin North Am Equine Pract 2008;24:191–201.
    doi: 10.1016/j.cveq.2007.11.002pubmed: 18314043google scholar: lookup
  13. Lopez MJ, Jarazo J. State of the art: Stem cells in equine regenerative medicine.. Equine Vet J 2015;47:145–154.
    doi: 10.1111/evj.12311pubmed: 24957845google scholar: lookup
  14. Ortved KF. Regenerative medicine and rehabilitation for tendinous and ligamentous injuries in sport horses.. Vet Clin North Am Equine Pract 2018;34:359–373.
    doi: 10.1016/j.cveq.2018.04.012pubmed: 29803299google scholar: lookup
  15. Schnabel LV, Boone L, Peroni JF. Regenerative medicine.. In: Auer JA, Stick JA, Kümmerle JM, Prange T, editors. Equine Surgery. 5. St Louis: W.B. Saunders; 2019. pp. 104–122.
  16. Renzi S, Riccò S, Dotti S, Carlin S, Patruno M, Cinotti S, Ferrari M. Autologous bone marrow mesenchymal stromal cells for regeneration of injured equine ligaments and tendons: A clinical report.. Res Vet Sci 2013;95:272–277.
    doi: 10.1016/j.rvsc.2013.01.017pubmed: 23419936google scholar: lookup
  17. Van Loon VJF, Scheffer CJW, Genn HJ, Hoogendoorn AC, Greve JW. Clinical follow-up of horses treated with allogeneic equine mesenchymal stem cells derived from umbilical cord blood for different tendon and ligament disorders.. Vet Q 2014;34:92–97.
    doi: 10.1080/01652176.2014.949390pubmed: 25072527google scholar: lookup
  18. Romagnoli N, Rinnovati R, Ricciardi G, Lambertini C, Spinella G, Spadari A. Clinical evaluation of intralesional injection of platelet-rich plasma for the treatment of proximal suspensory ligament desmitis in horses.. J Equine Vet Sci 2015;35:141–146.
    doi: 10.1016/j.jevs.2014.12.011google scholar: lookup
  19. Waselau M, Sutter WW, Genovese RL, Bertone AL. Intralesional injection of platelet-rich plasma followed by controlled exercise for treatment of midbody suspensory ligament desmitis in Standardbred racehorses.. J Am Vet Med Assoc 2008;232:1515–1520.
    doi: 10.2460/javma.232.10.1515pubmed: 18479242google scholar: lookup
  20. Scala M, Lenarduzzi S, Spagnolo F, Trapasso M, Ottonello C, Muraglia A, Barla A, Squillario M, Strada P. Regenerative medicine for the treatment of teno-desmic injuries of the equine. a series of 150 horses treated with platelet-derived growth factors.. In Vivo 2014;28:1119–23.
    pubmed: 25398809
  21. Castelijns G, Crawford A, Schaffer J, Ortolano GA, Beauregard T, Smith RKW. Evaluation of a filter-prepared platelet concentrate for the treatment of suspensory branch injuries in horses.. Vet Comp Orthop Traumatol 2011;24:363–369.
    doi: 10.3415/VCOT-11-01-0001pubmed: 21887455google scholar: lookup
  22. Zuffova K, Krisova S, Zert Z. Platelet rich plasma treatment of superficial digital flexor tendon lesions in racing Thoroughbreds.. Vet Med 2013;58:230–239.
    doi: 10.17221/6761-VETMEDgoogle scholar: lookup
  23. Geburek F, Gaus M, van Schie HTM, Rohn K, Stadler PM. Effect of intralesional platelet-rich plasma (PRP) treatment on clinical and ultrasonographic parameters in equine naturally occurring superficial digital flexor tendinopathies – a randomized prospective controlled clinical trial.. BMC Vet Res 2016;12:191.
    doi: 10.1186/s12917-016-0826-1pmc: PMC5015224pubmed: 27604193google scholar: lookup
  24. Geburek F, Lietzau M, Beineke A, Rohn K, Stadler PM. Effect of a single injection of autologous conditioned serum (ACS) on tendon healing in equine naturally occurring tendinopathies.. Stem Cell Res Ther 2015;6:1–14.
    doi: 10.1186/s13287-015-0115-0pmc: PMC4513386pubmed: 26113022google scholar: lookup
  25. Easter JL, Watts AE. How to select cases and use autologous conditioned serum to treat proximal suspensory desmitis.. Proc Am Assoc Equine Pract 2014;41:516–522.
  26. Litwiniuk M, Grzela T. Amniotic membrane: New concepts for an old dressing.. Wound Repair and Regen 2014;22:451–456.
    doi: 10.1111/wrr.12188pubmed: 25041617google scholar: lookup
  27. McCoy AM, Smith RL, Secor EJ, Roady PJ. Effects of 2 preparation methods and long-term storage on structural integrity and bacterial loads of equine amnion.. Vet Surg 2019;48:222–228.
    doi: 10.1111/vsu.13138pubmed: 30570165google scholar: lookup
  28. AAEP Lameness Exams: Evaluating the Lame Horse. Available at https://aaep.org/horsehealth/lameness-exams-evaluating-lame-horse.
  29. Gutierrez-Nibeyro SD, White NA, Werpy NM, Tyrrell L, Allen KA, Sullins KE, Mitchell RD. Magnetic resonance imaging findings of desmopathy of the collateral ligaments of the equine distal interphalangeal joint.. Vet Radiol Ultrasound 2009;50:21–31.
    doi: 10.1111/j.1740-8261.2008.01485.xpubmed: 19241750google scholar: lookup
  30. Witte TH, Yeager AE, Nixon AJ. Intralesional injection of insulin-like growth factor-I for treatment of superficial digital flexor tendonitis in Thoroughbred racehorses: 40 cases (2000–2004). J Am Vet Med Assoc 2011;239:992–997.
    doi: 10.2460/javma.239.7.992pubmed: 21961641google scholar: lookup
  31. Smith MRW, Wright IM, Smith RKW. Endoscopic assessment and treatment of lesions of the deep digital flexor tendon in the navicular bursae of 20 lame horses.. Equine Vet J 2007;39:18–24.
    doi: 10.2746/042516407X151095pubmed: 17228590google scholar: lookup
  32. Sampson SN, Schneider RK, Tucker RL, Gavin PR, Zubrod CJ, Ho CP. Magnetic resonance imaging features of oblique and straight distal sesamoidean desmitis in 27 horses.. Vet Radiol Ultrasound 2007;48:303–311.
    doi: 10.1111/j.1740-8261.2007.00247.xpubmed: 17691627google scholar: lookup
  33. Schneider RK, Tucker RL, Habegger SR, Brown J, Leathers CW. Desmitis of the straight sesamoidean ligament in horses: 9 cases (1995–1997). J Am Vet Med Assoc 2003;222:973–977.
    doi: 10.2460/javma.2003.222.973pubmed: 12685789google scholar: lookup
  34. Denoix JM, Guizien I, Perrot P, Bousseau B. Ultrasonographic diagnosis of the accessory ligament of the superficial digital flexor tendon (proximal check ligament) in 23 horses.. Proc Am Assoc Equine Pract 1995;41:142–143.
  35. Dyson SJ. Normal ultrasonographic anatomy and injury of the patellar ligaments in the horse.. Equine Vet J 2002;34:258–264.
    doi: 10.2746/042516402776185976pubmed: 12108743google scholar: lookup
  36. Ursini TL, Amelse LL, Elkhenany HA. Retrospective analysis of local injection site adverse reactions associated with 230 allogenic administrations of bone marrow-derived mesenchymal stem cells in 164 horses.. Equine Vet J 2019;51:198–205.
    doi: 10.1111/evj.12992pubmed: 29992618google scholar: lookup
  37. Hyvisc [package insert]. St. Joseph, MO 64506 U.S.A.: Boehringer Ingelheim Vetmedica, Inc.; 2009.

Citations

This article has been cited 1 times.
  1. Leal Reis I, Lopes B, Sousa P, Sousa AC, Branquinho MV, Caseiro AR, Rêma A, Briote I, Mendonça CM, Santos JM, Atayde LM, Alvites RD, Maurício AC. Treatment of Equine Tarsus Long Medial Collateral Ligament Desmitis with Allogenic Synovial Membrane Mesenchymal Stem/Stromal Cells Enhanced by Umbilical Cord Mesenchymal Stem/Stromal Cell-Derived Conditioned Medium: Proof of Concept. Animals (Basel) 2024 Jan 24;14(3).
    doi: 10.3390/ani14030370pubmed: 38338013google scholar: lookup
Subscribe to our newsletter
Join 99,357 horse owners like you who receive our email updates on horse health and nutrition.