Ultrasound-guided intralesional tendon and ligament injections in the horse.

Overview

• This research article explains how ultrasound guidance can be used to accurately inject regenerative treatments directly into tendon and ligament injuries in horses.

Purpose and Context

• The study aims to describe the principles and a reproducible protocol for ultrasound-guided injection techniques targeting core lesions within equine tendons and ligaments.
• The focus is on delivering regenerative orthobiologic therapies such as platelet-rich plasma (PRP), bone marrow aspirate concentration (BMAC), mesenchymal stem cells (MSCs), and autologous conditioned serum or protein solutions (ACS/APS).
• These therapies are gaining popularity in equine sports medicine to enhance healing in tendon and ligament injuries.

Methodology

• Subjects: Both a living university-owned horse and equine cadaver forelimbs were used to develop and demonstrate the injection technique.
• Lesion Identification:
  • The affected tendon or ligament lesion is first diagnosed via ultrasound imaging.
  • Imaging is performed in two planes: transverse and longitudinal, to precisely locate the lesion.
  • The lesion site is externally marked for injection guidance.
• Preparation:
  • The horse is sedated to minimize movement and discomfort.
  • The limb is desensitized using perineural anesthesia to further reduce pain.
  • The skin is aseptically prepared to maintain sterile conditions during injection.
• Injection Procedure:
  • Using ultrasound, a needle is inserted through the skin and visualized in real-time to ensure accurate positioning.
  • The needle is advanced into the hypoechoic (dark on ultrasound) core or area of fiber disruption within the lesion.
  • The needle is stabilized during attachment of the syringe and injection to prevent displacement.
  • Injectate volume is selected based on the type of orthobiologic product and size of the lesion.
  • Injection is monitored with ultrasound to confirm proper distribution within the lesion.

Key Orthobiologic Agents Discussed

• Platelet-Rich Plasma (PRP)
• Bone Marrow Aspirate Concentrate (BMAC)
• Mesenchymal Stem Cells (MSCs)
• Autologous Conditioned Serum/Protein Solution (ACS/APS)

Clinical Implications and Benefits

• Ultrasound guidance enhances the precision of injections, minimizing the risk of damaging surrounding tissues (iatrogenic trauma).
• Real-time visualization allows confirmation that the therapeutic agent has penetrated and dispersed within the lesion, which is critical for treatment effectiveness.
• The technique supports administration during the sub-acute phase of tendon or ligament injury — typically within a few weeks post-injury, which is thought to optimize healing.
• This method is accessible and can improve the safety and therapeutic success of delivering regenerative treatments.

Conclusion

• Ultrasound-guided intralesional injections represent a reliable and effective approach for administering regenerative orthobiologic therapies into equine tendon and ligament core lesions.
• The technique enhances treatment accuracy, reduces procedure-related trauma, and provides guidance for timing post-injury therapy.
• Implementing this method can improve clinical outcomes in equine sports medicine and rehabilitation.