Page 58 - Barrel Stallion Register 2017

Researchers did a long term, 2-year follow-up in humans who had undergone removal of the meniscus. “It was a random- ized, placebo controlled study with 3 groups. They had two different doses of stem cells, and the third was a placebo. They were able to show that there was improvement in pain parameters and the volume of meniscus present (based on MRIs). There have been some good studies in people looking at stem cells treating meniscal disease, and this is very compelling. Our data in horses certainly mirrors that,” says Frisbie.
An earlier study with horses by John Walmsley (United Kingdom) published
in 2003 reported on stifles with meniscal damage that were then treated with surgery. “He reported that 6 out of 35 of the grade 3s (the worst tears) were successes. The problem with his definition of success was that he
had 3 options in discussing outcome. One was that the horse was euthanized (failure). Two was that the horse was lame and work- ing, but not euthanized, and three was that the horse went back to work. This is a very broad category. For our study, we broke it up further into the horses that didn’t go back to work, or went back to work and with medical management could go back to the same level they were before the injury, or went back
to the same level and never needed treated again,” says Frisbie.
“Most owners would be happy with the lat- ter two. If we take the latter two categories and compare this to the number of cases that were sound, Walmsley only had one of his 35 grade 3s that went back to work; 5 of them were lame and could not go back to work,” he says.
“We were able to improve the success
rate with use of stem cells, and increase the number of horses that returned back to work by up to 6-fold over surgery alone. This was an interesting finding. So now, any horse that has stifle disease that takes more than just an
injection to make it better, we often treat with stem cells,” he says.
“We use the bone-derived culture- expanded stem cells (rather than fat-derived stem cells) and put them into the joint at least 30 days or more after the injury. In this par- ticular study, we used the lab that was a CSU spin-out (Advanced Regenerative Therapies) to culture the stem cells,” he says.
“We believe that it is very important to
use bone-marrow aspirated cells and culture- expanded. This way we can have 20 million cells. With fat-derived cells, only a few of the cells that you put back in are actually stem cells,” he explains. The studies that show significant results are treating those joints with at least 20 million stem cells, and the only way you can get this many is by culture-expanding them. The other important thing is to wait at least 30 days before putting the stem cells into the joint.
Standing arthroScopy
Frisbie and other researchers at CSU published a paper in a 2013 issue of Veterinary Surgery entitled “Diagnostic Stifle Joint Arthroscopy Using a Needle Arthroscope in Standing Horses.” Their paper discussed standing diagnostic arthroscopy of the stifle joint. “This is still the hallmark of how we are making more progress in stifle diagnosis and treatment. We are doing this with horses in which you can’t see anything on x-rays and can’t see anything you are really sure of on ultra- sound, and yet they are not responding to treatment. Most people don’t want to spend $3,000 to lay the horse down if they don’t need to, yet still want to find out what’s wrong. So now we have another option, with our ability to put an arthroscope into the joint. The scope is 1.2 mm in diameter, which is the same diameter as an 18-gauge needle—which is what we utilize to inject
For horses not responding to treatment and
in which you can’t see anything on x-rays or ultrasound, a standing diagnostic arthroscopy of the stifle joint can be done to look around the joint to see any cartilage or meniscal tears.
The diagnosis is about 1/3 the cost of surgery and allows for earlier treatment, and the horse can return to work much sooner.
the blocking anesthetic to treat the joint. We can usually stick that scope into the standing horse and look around in the joint,” says Frisbie.
“This way we can see cartilage tears or meniscal tears and make that diagnosis at about 1/3 of the cost. If there is no problem in the joint and we don’t need to do anything in there, the horse can go back to work within a week instead of the more prolonged rehab time that we usually associate with general
Stifle surgery, especially when combined with stem cell treatment, can help the horse get back to work at or near the same level they were before the injury.
56 SPEEDHORSE
equine health