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International orthopaedics2011; 35(10); 1569-1576; doi: 10.1007/s00264-011-1237-3

Regenerative medicine for the treatment of musculoskeletal overuse injuries in competition horses.

Abstract: Tissue repair in musculoskeletal injuries is often a slow and sometimes incomplete process. Regenerative medicine based on the use of growth factors (GFs) and cell therapy is aimed at improving the quality and speed of tendon and ligament healing. The aim of this study was to evaluate the potential for the administration of a combination of autologous platelet-rich plasma (PRP) and freshly isolated bone marrow mononucleated cells (BMMNCs) in 13 competition horses affected by overuse musculoskeletal injuries (suspensory ligament desmopathy and superficial flexor tendinopathy) and refractory to other therapies. Methods: After ultrasonographic localisation of the lesion, the autologous BMMNC suspension and PRP were injected directly into the core lesion. BMMNC and platelet count as well as growth factors in PRP were measured to determine factors influencing the clinical outcome. Results: Horses showed a marked improvement in their degree of lameness and 84.6% were able to return to competition. Among all the factors studied, the platelet concentration predicted the healing time: significantly faster recovery (p = 0.049) was observed in cases of PRP with more than 750 × 10(3)/μl platelets. Conclusions: Competition horses are involved in highly demanding activities, thus being a similar model for the high mechanical overload typical of human athletes. The promising results obtained suggest that this combined biological approach may be useful even for the treatment of recalcitrant overuse musculoskeletal injuries in highly demanding patients if the appropriate dose of cells and GFs is applied.
Publication Date: 2011-03-11 PubMed ID: 21394594PubMed Central: PMC3174295DOI: 10.1007/s00264-011-1237-3Google Scholar: Lookup
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  • Journal Article
  • Research Support
  • Non-U.S. Gov't

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 article explores using regenerative medicine to hasten and improve healing of overuse injuries in competition horses. It particularly focuses on the use of platelet-rich plasma and bone marrow mononucleated cells in treating tendon and ligament injuries.

Methods

  • The study involved 13 competition horses that were experiencing musculoskeletal injuries and were unsuccessful in responding to other forms of treatment.
  • Ultrasound was used to locate the physical anomaly, before a combination of both autologous platelet-rich plasma (PRP) and freshly isolated bone marrow mononucleated cells (BMMNCs) was injected directly into the injured area.
  • The researchers measured the concentration of BMMNC and platelets, including the quantity of growth factors in the PRP, in order to assess their impact on the clinical outcome.

Results

  • The horses exhibited a significant reduction in lameness following treatment and an impressive 84.6% were even able to return to competition.
  • The study found that the platelet concentration was a major determinant of the healing time. More specifically, a significantly faster recovery was noticed when the PRP contained more than 750 × 10^3/μl platelets.

Conclusions

  • The researchers deemed the results encouraging, suggesting that this combined biological approach could also be applied in the treatment of human athletes with similar kinds of musculoskeletal overuse injuries.
  • However, the research suggests that the prospect of the treatment’s success may be reliant on the correct dosage of cells and growth factors.

Cite This Article

APA
Torricelli P, Fini M, Filardo G, Tschon M, Pischedda M, Pacorini A, Kon E, Giardino R. (2011). Regenerative medicine for the treatment of musculoskeletal overuse injuries in competition horses. Int Orthop, 35(10), 1569-1576. https://doi.org/10.1007/s00264-011-1237-3

Publication

ISSN: 1432-5195
NlmUniqueID: 7705431
Country: Germany
Language: English
Volume: 35
Issue: 10
Pages: 1569-1576

Researcher Affiliations

Torricelli, Paola
  • Laboratory of Preclinical and Surgical Studies, Research Institute Codivilla-Putti, Rizzoli Orthopaedic Institute, Via di Barbiano 1/10, 40136, Bologna, Italy.
Fini, Milena
    Filardo, Giuseppe
      Tschon, Matilde
        Pischedda, Mario
          Pacorini, Alessandra
            Kon, Elizaveta
              Giardino, Roberto

                MeSH Terms

                • Animals
                • Athletic Injuries / therapy
                • Athletic Injuries / veterinary
                • Cell- and Tissue-Based Therapy / methods
                • Cell- and Tissue-Based Therapy / veterinary
                • Cumulative Trauma Disorders / diagnostic imaging
                • Cumulative Trauma Disorders / therapy
                • Cumulative Trauma Disorders / veterinary
                • Female
                • Horse Diseases / diagnostic imaging
                • Horse Diseases / therapy
                • Horses / physiology
                • Leukocytes, Mononuclear / cytology
                • Leukocytes, Mononuclear / transplantation
                • Male
                • Platelet Transfusion / veterinary
                • Platelet-Rich Plasma / cytology
                • Regenerative Medicine / methods
                • Sports
                • Tissue Engineering / veterinary
                • Ultrasonography

                References

                This article includes 28 references
                1. Lind M, Jakobsen BW, Lund B, Hansen MS, Abdallah O, Christiansen SE. Anatomical reconstruction of the medial collateral ligament and posteromedial corner of the knee in patients with chronic medial collateral ligament instability.. Am J Sports Med 2009;37(6):1116–1122.
                  doi: 10.1177/0363546509332498pubmed: 19336612google scholar: lookup
                2. Kettunen JA, Kvist M, Alanen E. Long term prognosis for jumper’s knee in male athletes. A prospective follow-up study.. Am J Sport Med 2002;30(5):689–692.
                  pubmed: 12239003
                3. Cook JL, Kiss ZS, Khan KM. Anthropometry, physical performance, and ultrasound patellar tendon abnormality in elite junior basketball players: a cross sectional study.. Br J Sports Med 2004;38:206–209.
                  doi: 10.1136/bjsm.2003.004747pmc: PMC1724788pubmed: 15039260google scholar: lookup
                4. Koch TG, Berg LC, Betts DH. Current and future regenerative medicine—principles, concepts, and therapeutic use of stem cell therapy and tissue engineering in equine medicine.. Can Vet J 2009;50:155–165.
                  pmc: PMC2629419pubmed: 19412395
                5. Anitua E, Andia I, Ardanza B. Autologous platelets as a source of proteins for healing and tissue regeneration.. Thromb Haemost 2004;91:4–15.
                  pubmed: 14691563
                6. Borzini P, Mazzucco L. Platelet-rich plasma (PRP) and platelet derivatives for topical therapy. What is true from the biologic view point?. ISBT Sci Ser 2007;2:272–281.
                7. Huang Q, Wang YD, Wu T. Preliminary separation of the growth factors in platelet-rich plasma: effects on the proliferation of human marrow-derived mesenchymal stem cells.. Chin Med J (Engl) 2009;122(1):83–87.
                  pubmed: 19187622
                8. Dallari D, Fini M, Stagni C. In vivo study on the healing of bone defects treated with bone marrow stromal cells, platelet-rich plasma, and freeze-dried bone allografts, alone and in combination.. J Orthop Res 2006;24(5):877–888.
                  doi: 10.1002/jor.20112pubmed: 16609976google scholar: lookup
                9. Chong AK, Chang J, Go JC. Mesenchymal stem cells and tendon healing.. Front Biosci 2009;14:4598–4605.
                  doi: 10.2741/3552pubmed: 19273374google scholar: lookup
                10. Crovace A, Lacitignola L, Rossi G, Francioso E. Histological and immunohistochemical evaluation of autologous cultured bone marrow mesenchymal stem cells and bone marrow mononucleated cells in collagenase-induced tendinitis of equine superficial digital flexor tendon.. Vet Med Int 2010;2010:250978.
                  pmc: PMC2859019pubmed: 20445779
                11. Smith RKW, Korda M, Blunn GW. Isolation and implantation of autologous equine mesenchymal stem cells from bone marrow into the superficial digital flexor tendon as a potential novel treatment.. Equine Vet 2003;35:99–102.
                  doi: 10.2746/042516403775467388pubmed: 12553472google scholar: lookup
                12. Sánchez M, Anitua E, Azofra J, Andía I, Padilla S, Mujika I. Comparison of surgically repaired Achilles tendon tears using platelet-rich fibrin matrices.. Am J Sports Med 2007;35(2):245–251.
                  doi: 10.1177/0363546506294078pubmed: 17099241google scholar: lookup
                13. Filardo G, Kon E, Della Villa S, Vincentelli F, Fornasari PM, Marcacci M. Use of platelet-rich plasma for the treatment of refractory jumper’s knee.. Int Orthop 2010;34(6):909–915.
                  doi: 10.1007/s00264-009-0845-7pmc: PMC2989009pubmed: 19641918google scholar: lookup
                14. Kon E, Filardo G, Delcogliano M. Platelet-rich plasma: new clinical application: a pilot study for treatment of jumper’s knee.. Injury 2009;40(6):598–603.
                  doi: 10.1016/j.injury.2008.11.026pubmed: 19380129google scholar: lookup
                15. Bue M, Riccò S, Ramoni R. Equine adipose-tissue derived mesenchymal stem cells and platelet concentrates: their association in vitro and in vivo.. Vet Res Commun 2008;32(S1):S51–S55.
                  doi: 10.1007/s11259-008-9093-3pubmed: 18683070google scholar: lookup
                16. Schnabel LV, Lynch ME, Meulen MCH. Mesenchymal stem cells and insulin-like growth factor-I gene-enhanced mesenchymal stem cells improve structural aspects of healing in equine flexor digitorum superficialis tendons.. J Orthop Res 2009;27(10):1392–1398.
                  doi: 10.1002/jor.20887pubmed: 19350658google scholar: lookup
                17. McCarrel T, Fortier L. Temporal growth factor release from platelet-rich plasma, trehalose lyophilized platelets, and bone marrow aspirate and their effect on tendon and ligament gene expression.. J Orthop Res 2009;27(8):1033–1042.
                  doi: 10.1002/jor.20853pubmed: 19170097google scholar: lookup
                18. Dowling BA, Dart AJ, Hodgson DR. Superficial digital flexor tendonitis in the horse.. Equine Vet J 2000;25:913–925.
                  pubmed: 11037257
                19. Fortier LA, Smith RKW. Regenerative medicine for tendinous and ligamentous injuries of sport horses.. Vet Clin Equine 2008;24:191–201.
                  doi: 10.1016/j.cveq.2007.11.002pubmed: 18314043google scholar: lookup
                20. Guest DJ, Smith MR, Allen WR. Monitoring the fate of autologous and allogenic mesenchymal progenitor cells injected into the superficial digital flexor tendon of horses. Preliminary study.. Equine Vet J 2008;40:178–181.
                  doi: 10.2746/042516408X276942pubmed: 18267891google scholar: lookup
                21. Arthur A, Zannettino A, Gronthos S. The therapeutic applications of multipotential mesenchymal/stromal stem cells in skeletal tissue repair.. J Cell Physiol 2009;218:237–245.
                  doi: 10.1002/jcp.21592pubmed: 18792913google scholar: lookup
                22. Lacitignola L, Crovace A, Rossi G, Francioso E. Cell therapy for tendinitis, experimental and clinical report.. Vet Res Commun 2008;32(Suppl 1):S33–S38.
                  doi: 10.1007/s11259-008-9085-3pubmed: 18686004google scholar: lookup
                23. Giannini S, Buda R, Vannini F. One-step bone marrow-derived cell transplantation in talar osteochondral lesions.. Clin Orthop Relat Res 2009;467(12):3307–3320.
                  doi: 10.1007/s11999-009-0885-8pmc: PMC2772930pubmed: 19449082google scholar: lookup
                24. Anitua E, Sanchez M, Nurden AT. New insights into and novel applications for platelet-rich fibrin therapies.. Trends Biotechnol 2006;24:227–234.
                  doi: 10.1016/j.tibtech.2006.02.010pubmed: 16540193google scholar: lookup
                25. Marx RE. Quantification of growth factor levels using a simplified method of platelet-rich plasma gel preparation.. J Oral Maxillofac Surg 2000;58:300–301.
                  doi: 10.1016/S0278-2391(00)90059-4pubmed: 10716112google scholar: lookup
                26. Borzini P, Mazzucco L. Tissue regeneration and in-loco administration of platelet derivatives. Clinical outcome, heterogeneous products, eterogeneity of the effector mechanisms.. Transfusion 2005;35:1759–1767.
                27. Weibrich G, Kleis WKG, Hitzler WE, Hafner G. Comparison of the platelet concentrate collection system with the plasma-rich-in-growth-factors kit to produce platelet-rich plasma: a technical report.. Int J Oral Maxillofac Implants 2005;20:118–123.
                  pubmed: 15747683
                28. Lindemann S, Tolley ND, Dixon DA. Activated platelets mediate inflammatory signaling by regulated interleukin 1β synthesis.. J Cell Biol 2001;154(3):485–490.
                  doi: 10.1083/jcb.200105058pmc: PMC2196422pubmed: 11489912google scholar: lookup

                Citations

                This article has been cited 46 times.
                1. Carmona JU, López C. Efficacy of Platelet-Rich Plasma in the Treatment of Equine Tendon and Ligament Injuries: A Systematic Review of Clinical and Experimental Studies. Vet Sci 2025 Apr 18;12(4).
                  doi: 10.3390/vetsci12040382pubmed: 40284884google scholar: lookup
                2. Bensa A, Previtali D, Sangiorgio A, Boffa A, Salerno M, Filardo G. PRP Injections for the Treatment of Knee Osteoarthritis: The Improvement Is Clinically Significant and Influenced by Platelet Concentration: A Meta-analysis of Randomized Controlled Trials. Am J Sports Med 2025 Mar;53(3):745-754.
                  doi: 10.1177/03635465241246524pubmed: 39751394google scholar: lookup
                3. Guest DJ, Birch HL, Thorpe CT. A review of the equine suspensory ligament: Injury prone yet understudied. Equine Vet J 2025 Sep;57(5):1167-1182.
                  doi: 10.1111/evj.14447pubmed: 39604165google scholar: lookup
                4. Zhang B, Dong B, Wang L, Wang Y, Gao Z, Li Y, Wang H, Lu X. Comparison of the efficacy of autologous Lp-PRP and Lr-PRP for treating intervertebral disc degeneration: in vitro and in vivo study. J Orthop Surg Res 2024 Nov 6;19(1):731.
                  doi: 10.1186/s13018-024-05196-8pubmed: 39506797google scholar: lookup
                5. Mercader-Ruiz J, Beitia M, Delgado D, Sánchez P, Porras B, Gimeno I, González S, Benito-Lopez F, Basabe-Desmonts L, Sánchez M. Current Challenges in the Development of Platelet-Rich Plasma-Based Therapies. Biomed Res Int 2024;2024:6444120.
                  doi: 10.1155/2024/6444120pubmed: 39157212google scholar: lookup
                6. Ortved KF, Alward L, Cowles B, Linardi R, Barot D, Usimaki A, Fedie JR, Amodie D, Goodrich LR. Use of quantitative mass spectrometry-based proteomics and ELISA to compare the alpha 2 macroglobulin concentration in equine blood-based products processed by three different orthobiologic devices. Front Vet Sci 2024;11:1335972.
                  doi: 10.3389/fvets.2024.1335972pubmed: 38406632google scholar: lookup
                7. Pérez Fraile A, González-Cubero E, Martínez-Flórez S, Olivera ER, Villar-Suárez V. Regenerative Medicine Applied to Musculoskeletal Diseases in Equines: A Systematic Review. Vet Sci 2023 Nov 23;10(12).
                  doi: 10.3390/vetsci10120666pubmed: 38133217google scholar: lookup
                8. Miguel-Pastor L, Satué K, Chicharro D, Torres-Torrillas M, Del Romero A, Peláez P, Carrillo JM, Cuervo B, Sopena JJ, Cerón JJ, Rubio M. Evaluation of a Standardized Protocol for Plasma Rich in Growth Factors Obtention in Cats: A Prospective Study. Front Vet Sci 2022;9:866547.
                  doi: 10.3389/fvets.2022.866547pubmed: 35498746google scholar: lookup
                9. Viganò M, Ragni E, Marmotti A, de Girolamo L. The effects of orthobiologics in the treatment of tendon pathologies: a systematic review of preclinical evidence. J Exp Orthop 2022 Apr 8;9(1):31.
                  doi: 10.1186/s40634-022-00468-wpubmed: 35394237google scholar: lookup
                10. Melotti L, Carolo A, Elshazly N, Boesso F, Da Dalt L, Gabai G, Perazzi A, Iacopetti I, Patruno M. Case Report: Repeated Intralesional Injections of Autologous Mesenchymal Stem Cells Combined With Platelet-Rich Plasma for Superficial Digital Flexor Tendon Healing in a Show Jumping Horse. Front Vet Sci 2022;9:843131.
                  doi: 10.3389/fvets.2022.843131pubmed: 35252428google scholar: lookup
                11. De Angelis E, Saleri R, Martelli P, Elviri L, Bianchera A, Bergonzi C, Pirola M, Romeo R, Andrani M, Cavalli V, Conti V, Bettini R, Passeri B, Ravanetti F, Borghetti P. Cultured Horse Articular Chondrocytes in 3D-Printed Chitosan Scaffold With Hyaluronic Acid and Platelet Lysate. Front Vet Sci 2021;8:671776.
                  doi: 10.3389/fvets.2021.671776pubmed: 34322533google scholar: lookup
                12. Collins T, Alexander D, Barkatali B. Platelet-rich plasma: a narrative review. EFORT Open Rev 2021 Apr;6(4):225-235.
                  doi: 10.1302/2058-5241.6.200017pubmed: 34040800google scholar: lookup
                13. Montano C, Auletta L, Greco A, Costanza D, Coluccia P, Del Prete C, Meomartino L, Pasolini MP. The Use of Platelet-Rich Plasma for Treatment of Tenodesmic Lesions in Horses: A Systematic Review and Meta-Analysis of Clinical and Experimental Data. Animals (Basel) 2021 Mar 12;11(3).
                  doi: 10.3390/ani11030793pubmed: 33809227google scholar: lookup
                14. Depuydt E, Broeckx SY, Van Hecke L, Chiers K, Van Brantegem L, van Schie H, Beerts C, Spaas JH, Pille F, Martens A. The Evaluation of Equine Allogeneic Tenogenic Primed Mesenchymal Stem Cells in a Surgically Induced Superficial Digital Flexor Tendon Lesion Model. Front Vet Sci 2021;8:641441.
                  doi: 10.3389/fvets.2021.641441pubmed: 33748217google scholar: lookup
                15. Yausep OE, Madhi I, Trigkilidas D. Platelet rich plasma for treatment of osteochondral lesions of the talus: A systematic review of clinical trials. J Orthop 2020 Mar-Apr;18:218-225.
                  doi: 10.1016/j.jor.2020.01.046pubmed: 32071508google scholar: lookup
                16. Shojaee A, Parham A. Strategies of tenogenic differentiation of equine stem cells for tendon repair: current status and challenges. Stem Cell Res Ther 2019 Jun 18;10(1):181.
                  doi: 10.1186/s13287-019-1291-0pubmed: 31215490google scholar: lookup
                17. Wang Y, Han C, Hao J, Ren Y, Wang J. Efficacy of platelet-rich plasma injections for treating Achilles tendonitis : Systematic review of high-quality randomized controlled trials. Orthopade 2019 Sep;48(9):784-791.
                  doi: 10.1007/s00132-019-03711-ypubmed: 30937491google scholar: lookup
                18. Sultana T, Lee S, Yoon HY, Lee JI. Current Status of Canine Umbilical Cord Blood-Derived Mesenchymal Stem Cells in Veterinary Medicine. Stem Cells Int 2018;2018:8329174.
                  doi: 10.1155/2018/8329174pubmed: 30123294google scholar: lookup
                19. Bogers SH. Cell-Based Therapies for Joint Disease in Veterinary Medicine: What We Have Learned and What We Need to Know. Front Vet Sci 2018;5:70.
                  doi: 10.3389/fvets.2018.00070pubmed: 29713634google scholar: lookup
                20. Grassi A, Napoli F, Romandini I, Samuelsson K, Zaffagnini S, Candrian C, Filardo G. Is Platelet-Rich Plasma (PRP) Effective in the Treatment of Acute Muscle Injuries? A Systematic Review and Meta-Analysis. Sports Med 2018 Apr;48(4):971-989.
                  doi: 10.1007/s40279-018-0860-1pubmed: 29363053google scholar: lookup
                21. Beerts C, Suls M, Broeckx SY, Seys B, Vandenberghe A, Declercq J, Duchateau L, Vidal MA, Spaas JH. Tenogenically Induced Allogeneic Peripheral Blood Mesenchymal Stem Cells in Allogeneic Platelet-Rich Plasma: 2-Year Follow-up after Tendon or Ligament Treatment in Horses. Front Vet Sci 2017;4:158.
                  doi: 10.3389/fvets.2017.00158pubmed: 29018808google scholar: lookup
                22. Imam MA, Holton J, Horriat S, Negida AS, Grubhofer F, Gupta R, Narvani A, Snow M. A systematic review of the concept and clinical applications of bone marrow aspirate concentrate in tendon pathology. SICOT J 2017;3:58.
                  doi: 10.1051/sicotj/2017039pubmed: 28990575google scholar: lookup
                23. Shen B, Zhang Z, Zhou NF, Huang YF, Bao YJ, Wu DS, Zhang YD. Preparing Platelet-Rich Plasma with Whole Blood Harvested Intraoperatively During Spinal Fusion. Med Sci Monit 2017 Jul 22;23:3578-3584.
                  doi: 10.12659/msm.902025pubmed: 28734116google scholar: lookup
                24. Cavallo C, Roffi A, Grigolo B, Mariani E, Pratelli L, Merli G, Kon E, Marcacci M, Filardo G. Platelet-Rich Plasma: The Choice of Activation Method Affects the Release of Bioactive Molecules. Biomed Res Int 2016;2016:6591717.
                  doi: 10.1155/2016/6591717pubmed: 27672658google scholar: lookup
                25. Filardo G, Di Matteo B, Kon E, Merli G, Marcacci M. Platelet-rich plasma in tendon-related disorders: results and indications. Knee Surg Sports Traumatol Arthrosc 2018 Jul;26(7):1984-1999.
                  doi: 10.1007/s00167-016-4261-4pubmed: 27665095google scholar: lookup
                26. Markoski MM. Advances in the Use of Stem Cells in Veterinary Medicine: From Basic Research to Clinical Practice. Scientifica (Cairo) 2016;2016:4516920.
                  doi: 10.1155/2016/4516920pubmed: 27379197google scholar: lookup
                27. Yin WJ, Xu HT, Sheng JG, An ZQ, Guo SC, Xie XT, Zhang CQ. Advantages of Pure Platelet-Rich Plasma Compared with Leukocyte- and Platelet-Rich Plasma in Treating Rabbit Knee Osteoarthritis. Med Sci Monit 2016 Apr 17;22:1280-90.
                  doi: 10.12659/msm.898218pubmed: 27086145google scholar: lookup
                28. Vannini F, Di Matteo B, Filardo G. Platelet-rich plasma to treat ankle cartilage pathology - from translational potential to clinical evidence: a systematic review. J Exp Orthop 2015 Dec;2(1):2.
                  doi: 10.1186/s40634-015-0019-zpubmed: 26914870google scholar: lookup
                29. Carr BJ, Canapp SO Jr, Mason DR, Cox C, Hess T. Canine Platelet-Rich Plasma Systems: A Prospective Analysis. Front Vet Sci 2015;2:73.
                  doi: 10.3389/fvets.2015.00073pubmed: 26779493google scholar: lookup
                30. Ilhanli I, Guder N, Gul M. Platelet-Rich Plasma Treatment With Physical Therapy in Chronic Partial Supraspinatus Tears. Iran Red Crescent Med J 2015 Sep;17(9):e23732.
                  doi: 10.5812/ircmj.23732pubmed: 26473076google scholar: lookup
                31. Salamanna F, Veronesi F, Maglio M, Della Bella E, Sartori M, Fini M. New and emerging strategies in platelet-rich plasma application in musculoskeletal regenerative procedures: general overview on still open questions and outlook. Biomed Res Int 2015;2015:846045.
                  doi: 10.1155/2015/846045pubmed: 26075269google scholar: lookup
                32. Metcalf KB, Mandelbaum BR, McIlwraith CW. Application of Platelet-Rich Plasma to Disorders of the Knee Joint. Cartilage 2013 Oct;4(4):295-312.
                  doi: 10.1177/1947603513487553pubmed: 26069674google scholar: lookup
                33. Brossi PM, Moreira JJ, Machado TS, Baccarin RY. Platelet-rich plasma in orthopedic therapy: a comparative systematic review of clinical and experimental data in equine and human musculoskeletal lesions. BMC Vet Res 2015 Apr 22;11:98.
                  doi: 10.1186/s12917-015-0403-zpubmed: 25896610google scholar: lookup
                34. Moradi M, Hood B, Moradi M, Atala A. The potential role of regenerative medicine in the man-agement of traumatic patients. J Inj Violence Res 2015 Jan;7(1):27-35.
                  doi: 10.5249/jivr.v7i1.704pubmed: 25618439google scholar: lookup
                35. Filardo G, Kon E, DI Matteo B, DI Marino A, Sessa A, Merli ML, Marcacci M. Leukocyte-poor PRP application for the treatment of knee osteoarthritis. Joints 2013 Jul-Sep;1(3):112-20.
                  pubmed: 25606520
                36. Di Matteo B, Filardo G, Kon E, Marcacci M. Platelet-rich plasma: evidence for the treatment of patellar and Achilles tendinopathy--a systematic review. Musculoskelet Surg 2015 Apr;99(1):1-9.
                  doi: 10.1007/s12306-014-0340-1pubmed: 25323041google scholar: lookup
                37. Roffi A, Filardo G, Assirelli E, Cavallo C, Cenacchi A, Facchini A, Grigolo B, Kon E, Mariani E, Pratelli L, Pulsatelli L, Marcacci M. Does platelet-rich plasma freeze-thawing influence growth factor release and their effects on chondrocytes and synoviocytes?. Biomed Res Int 2014;2014:692913.
                  doi: 10.1155/2014/692913pubmed: 25136613google scholar: lookup
                38. Jeong DU, Lee CR, Lee JH, Pak J, Kang LW, Jeong BC, Lee SH. Clinical applications of platelet-rich plasma in patellar tendinopathy. Biomed Res Int 2014;2014:249498.
                  doi: 10.1155/2014/249498pubmed: 25136568google scholar: lookup
                39. Filardo G, Kon E, Di Matteo B, Di Martino A, Tesei G, Pelotti P, Cenacchi A, Marcacci M. Platelet-rich plasma injections for the treatment of refractory Achilles tendinopathy: results at 4 years. Blood Transfus 2014 Oct;12(4):533-40.
                  doi: 10.2450/2014.0289-13pubmed: 24960641google scholar: lookup
                40. Filardo G, Kon E, Roffi A, Di Matteo B, Merli ML, Marcacci M. Platelet-rich plasma: why intra-articular? A systematic review of preclinical studies and clinical evidence on PRP for joint degeneration. Knee Surg Sports Traumatol Arthrosc 2015 Sep;23(9):2459-74.
                  doi: 10.1007/s00167-013-2743-1pubmed: 24275957google scholar: lookup
                41. Filardo G, Kon E, Tampieri A, Cabezas-Rodríguez R, Di Martino A, Fini M, Giavaresi G, Lelli M, Martínez-Fernández J, Martini L, Ramírez-Rico J, Salamanna F, Sandri M, Sprio S, Marcacci M. New bio-ceramization processes applied to vegetable hierarchical structures for bone regeneration: an experimental model in sheep. Tissue Eng Part A 2014 Feb;20(3-4):763-73.
                  doi: 10.1089/ten.TEA.2013.0108pubmed: 24099033google scholar: lookup
                42. Filardo G, Kon E, Di Matteo B, Pelotti P, Di Martino A, Marcacci M. Platelet-rich plasma for the treatment of patellar tendinopathy: clinical and imaging findings at medium-term follow-up. Int Orthop 2013 Aug;37(8):1583-9.
                  doi: 10.1007/s00264-013-1972-8pubmed: 23793514google scholar: lookup
                43. Kon E, Filardo G, Di Matteo B, Marcacci M. PRP for the treatment of cartilage pathology. Open Orthop J 2013;7:120-8.
                  doi: 10.2174/1874325001307010120pubmed: 23730375google scholar: lookup
                44. Filardo G, Kon E, Di Martino A, Di Matteo B, Merli ML, Cenacchi A, Fornasari PM, Marcacci M. Platelet-rich plasma vs hyaluronic acid to treat knee degenerative pathology: study design and preliminary results of a randomized controlled trial. BMC Musculoskelet Disord 2012 Nov 23;13:229.
                  doi: 10.1186/1471-2474-13-229pubmed: 23176112google scholar: lookup
                45. Spaas JH, Guest DJ, Van de Walle GR. Tendon regeneration in human and equine athletes: Ubi Sumus-Quo Vadimus (where are we and where are we going to)?. Sports Med 2012 Oct 1;42(10):871-90.
                  doi: 10.1007/BF03262300pubmed: 22963225google scholar: lookup
                46. Carmona JU, López C. Comments on Torricelli et al.: regenerative medicine for the treatment of musculoskeletal overuse injuries in competition horses. Int Orthop 2011 Nov;35(11):1745; author reply 1747-1748.
                  doi: 10.1007/s00264-011-1311-xpubmed: 21912946google scholar: lookup