Case Report: Repeated Intralesional Injections for SDF Tendonitis

Single case reports should be taken with a grain of caution but the results here, sequential injections with a mixed biological product, are very encouraging and should be followed up with further research.
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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 Feb 18;9:843131. doi: 10.3389/fvets.2022.843131. eCollection 2022.
Authors
Luca Melotti 1 , Anna Carolo 1 , Noha Elshazly 1 2 , Filippo Boesso 3 , Laura Da Dalt 1 , Gianfranco Gabai 1 , Anna Perazzi 4 , Ilaria Iacopetti 4 , Marco Patruno 1
Affiliations

1 Department of Comparative Biomedicine and Food Science, University of Padua-Agripolis Campus, Legnaro, Italy.
2 Tissue Engineering Laboratories, Faculty of Dentistry, Alexandria University, Alexandria, Egypt.
3 Veterinary Practicioner, Padua, Italy.
4 Department of Animal Medicine, Production and Health, University of Padua-Agripolis Campus, Legnaro, Italy.

PMID: 35252428
PMCID: PMC8894652
DOI: 10.3389/fvets.2022.843131

Abstract

In the present case report a show jumping 10-year-old Sella Italiano gelding, presented with severe lameness, swelling and pain at palpation of the mid-metacarpal region of the left forelimb. Clinical and ultrasound examination diagnosed a chronic tendonitis of the central region of the superficial digital flexor tendon (SDFT). The lesion was a reoccurrence since it developed from a previously healed injury. The horse had to stop competing and was unresponsive to gold-standard treatments as Non-steroidal anti-inflammatory drugs (NSAIDs) and conservative management after 6 months of therapy. The animal was subjected to repeated intralesional injections of autologous adipose-derived mesenchymal stem cells (AD-MSCs) combined with autologous platelet-rich plasma (PRP). The combined treatment was administered twice in a 1-month interval. The healing process was assessed through clinical examination, ultrasound imaging and quantification of oxidative stress products and inflammatory mediators in blood plasma. After 2 weeks from first injection, a reduction of concentration of oxidative-derived products was observed, together with an increase of anti-inflammatory cytokines and pro-mitotic growth factors. These results were reflected clinically as the horse showed a reduction of lameness along with swelling and pain after 4 weeks. At the 1-year follow-up, the horse showed no signs of lameness and swelling. The ultrasonographic examination highlighted a compact fiber alignment with a normal echogenic tendon as observed in the sound contralateral limb. Moreover, the horse went back to the previous level of competition. Our results suggest the positive effects of a repeated intralesional injection of AD-MSCs and PRP for the treatment of a chronic tendonitis with long-term effects and an improvement for both equine quality of life and athletic performance.

Keywords: SDFT; equine orthopedics; horse; mesenchymal stem cells; platelet-rich plasma; regenerative medicine; tissue regeneration.