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9
EQUINE MATTERS
Dandy,
a nine year old
gelding, used for eventing,
had been working at canter
when he suddenly pulled
up lame.
The owner had noticed a swelling just below
the knee and came to the clinic for further
assessment.
On examination Dandy was lame on his right
fore, graded 2/5. Palpation of his tendons
identified a swelling of the flexor tendons in
the proximal metacarpal region which was hot
and painful to the touch. To further evaluate the
tendons we agreed to perform an ultrasound
examination. This revealed an injury to the
superficial digital flexor tendon (SDFT) with
a hole in the middle of the tendon called a
core lesion. After discussion with the owner,
it was agreed that we would try and speed
up the healing process by using Platelet Rich
Plasma (PRP).
PRP can be harvested from the injured horses’
own blood. It can be prepared by either
centrifugation or filtration and will contain
more than four times the number of platelets
compared to normal blood. These platelets
contain growth factors that enhance and
accelerate ligament and tendon healing. By
injecting the PRP back into the injured section
of ligament or tendon it is placed where it will
be most effective.
A sterile blood sample was taken from Dandy,
which was then processed to harvest the PRP.
Dandy’s leg in the mean time was clipped and
scrubbed and a nerve block was performed
so that the area of the injury was numb. When
the PRP was ready it was injected into the
SDFT injury. By using a special technique
called ultrasound guidance, the needle was
directed straight into the core lesion, this was
to ensure that the PRP was placed exactly
where it needed to be.
Following the injection a sterile bandage was
placed on the limb and Dandy could go home
the same day. He was given strict box rest for
two weeks, before he was able to start a
controlled exercise program, beginning with
walking in hand. After six weeks Dandy was
doing well, he was sound at walk and trot and
a further increase in exercise was allowed.
Three months following the medication a repeat
ultrasound scan was made which showed that
the core lesion had all but disappeared, and
only very mild swelling of the tendon was seen.
Dandy’s owner was very pleased that she
could start ridden exercise at this stage. It was
stressed that the tendons should be checked
before and after every ride and that any
increase in heat, swelling or lameness was a
sign that the tendon was under too much strain.
It took a further five months of carefully
increasing the exercise before Dandy returned
to full work. Dandy’s owner was really pleased
with the result and was already planning her
next eventing season!
TENDON INJURY
Veterinary Surgeon
Egbert Willems
XLEquine Practice
Cliffe Veterinary
Group
CASE REPORT...
Egbert Willems DVM CertES(Orth) MRCVS
Cliffe Veterinary Group
Case Study:
Platelet
Rich Plasma
Figure 1:
Injury of the superficial digital flexor
tendon
Figure 2:
After collection, the blood sample is
centrifuged
Figure 3:
After centrifugation the platelet rich
plasma (light yellow) is ready to be harvested
Figure 4:
The platelet rich plasma is ready to
be injected