Decompression and bone marrow aspirate for refractory navicular disease

Core decompression augmented with bone marrow aspirate concentrate for refractory distal sesamoid bone pathology in horses: A retrospective clinical study
Vet Surg. 2026 Aug 1. doi: 10.1111/vsu.70139. Online ahead of print.
Authors
Grigorios Maleas 1 , Mahmoud Mageed 1 2 , Kristyna Hargitaiova 3
Affiliations

1 Equuria Orthopedics, Emstek, Germany.
2 Equipixel Veterinary Teleradiology, Bakum, Germany.
3 College of Veterinary Medicine, Cornell University, Ithaca, USA.

PMID: 42541767
DOI: 10.1111/vsu.70139

Abstract

Objective: To determine short- and long-term outcomes of core decompression combined with autologous bone marrow aspirate concentrate (BMAC) in treating moderate-to-severe refractory distal sesamoid bone (DSB) trabecular pathology in horses.

Study design: Retrospective observational study.

Animals: A total of 21 client-owned Warmblood horses with DSB pathology unresponsive to conservative management.

Methods: Preoperative diagnosis included lameness localization by diagnostic analgesia and magnetic resonance imaging (MRI) confirmation of DSB trabecular pathology. Horses underwent arthroscopic core decompression via the palmar recess of the distal interphalangeal joint followed by intraosseous BMAC injection. Outcomes were assessed clinically and by follow-up radiography and MRI.

Results: No major intraoperative or postoperative complications occurred in any of the 21 operated horses. Nine horses met inclusion criteria for long-term follow-up, which included clinical, radiographic, and MRI assessments at 6 months and up to 18 months postoperatively. At 6 months, six of nine horses (67%) were sound and returned to training. MRI follow-up demonstrated reduced short tau inversion recovery (STIR) hyperintensity and increased T1-weighted signal within the DSB trabecular bone, consistent with a reduction in active trabecular bone pathology. Three horses remained lame with unchanged MRI findings. At 18 months, six horses remained sound, and three returned to their previous or intended performance levels. Radiographic remodeling of cyst-like lesions was evident in three cases.

Conclusion:
Core decompression augmented with BMAC may represent a promising treatment option for horses with moderate to severe distal sesamoid bone trabecular pathology unresponsive to conservative management. Clinical improvement observed in this study was accompanied by favorable changes in MRI signal characteristics in most horses. However, given the retrospective design and lack of controls, these findings should be interpreted as descriptive and hypothesis-generating.

Clinical impact: This combined surgical-orthobiologic approach may offer a viable therapeutic option for horses with advanced refractory navicular bone pathology.

© 2026 The Author(s). Veterinary Surgery published by Wiley Periodicals LLC on behalf of American College of Veterinary Surgeons.

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