Page 114 - Barrel Stallion Register 2019

STEM CELL THERAPY FOR MENISCUS INJURIES
The most common applications for stem cells are in treating ligament and tendon inju- ries. “Meniscal injuries in the stifle joint is one area where we often tend to use stem cells,” says McClure. “There have definitely been some positive outcomes associated with stem cells in meniscal injuries. This comes back
to case selection. Some of these injuries will respond better than others,” he explains.
“You need to have a stable joint, for instance, for good results. If there is meniscal injury and additional ligamentous injuries, stem cells are not going to solve that entire problem,” he says.
There has been a lot of discussion regard- ing the best source of stem cells. “Some people use the bone marrow cultured stem cells
and others use the adipose stem cells,” says McClure. “There are other things on the mar- ket that pop up from time to time that people are calling stem cells, but there are very few
to no stem cells in some of these products. I think people need to discuss these things with a veterinarian who understands the differences before using them.
“The ways we can use many stem cells are either to utilize the harvested bone marrow and cultured cells, which is sent to a lab to culture and produce a high number of stem cells, or to use the adipose stem cells that are processed on the spot to get a large number of stem cells out of the fat,” he explains. “Those cells from fat have the advantage that you can do this on site. You can liposuction the fat from the horse, process the fat, and reinject those cells. You don’t have to wait for cultur- ing. There are 500 to 1000 times the number of stem cells in adipose than there is in the bone marrow.”
There are some other therapies, such as bone marrow concentrate, that have some stem cells and growth factors, but have relatively few stem cells. This extract contains a mix of things that might be helpful, but the actual number of stem cells is very low.
“There are also therapies, such as amnion, that have benefits, but are not actually true stem cell therapy. It is important to be working with a veterinarian who understands the differences and has experience with these,” says McClure.
“Many veterinarians are treating these joints after the arthroscopic surgery with some of the biological products and regenerative medicine to speed healing.”
debriding any of the meniscus that is dis- rupted,” says McClure. “Small meniscus tears can be debrided arthroscopically, but unfor- tunately a lot of these injuries are in locations in the joints where you may not be able to
get an arthroscope or instruments in there to thoroughly clean those up.”
Additional therapies include anti-inflam- matory medication and platelet-rich plasma, IRAP, stem cells, etc. “These are often used to different degrees. The choice of therapies gen- erally comes down to severity of the injury, the age of the horse, the activity and career of that horse, and the financial ability of the owner to pursue some of these additional treatments,” says McClure.
PROGNOSIS: CHANCES FOR RECOVERY
Prognosis will depend on the extent of injury. “We find some injuries on ultrasound where the meniscus may have a little bit of tear and edema, and those can have a better prognosis,” says McClure. The horse may heal enough to return to work.
“When we see an injury where the meniscus is extruded, this has a very poor prognosis
for returning to soundness,” he says. “There
are many factors that play a role in prognosis, such as how much injury there is to the medial
collateral ligament, how much injury there is to the meniscus, the athletic activities of the horse, etc.”
If it’s just a meniscus injury and nothing else in the stifle is injured, it may have a better prognosis, but often there are other tissues involved in the injury. “Generally, there are also some other ligaments damaged and some car- tilaginous injuries, etc.,” says McClure. “These play as much into the prognosis as anything.”
The horse may heal enough to be pasture sound, but may not heal enough to return to a high level of work in an athletic career like barrel racing, roping, cutting, etc.
“Performance horses will be more of a challenge to get them completely sound for what they have to do. There is always risk for re-injury with what we are asking them to do,” McClure explains.
Most of these injuries will take a fair amount of time for healing. “The time it takes will also depend on the severity of the injury, the age of the horse, the treatment protocol, etc.,” McClure says. It’s always a case-by-case situation and your veterinar- ian can guide you in this, but most of these horses will need six months to a year off from work. Stifle injuries involving the meniscus always entail a long-term program for recovery.
Joint problems, which can cause arthritis and inflammation, and physical injury, alone or together, can result in a tear of the meniscus with considerable lameness and a lot of swelling in the stifle.
112 SPEEDHORSE
EQUINE HEALTH