Regenerative Medicine For The Treatment Of Musculoskeletal Overuse Injuries In Competition Horses

International Orthopaedics (SICOT) (2011) 35:1569–1576
DOI 10.1007/s00264-011-1237-3

ORIGINAL PAPER

Regenerative medicine for the treatment of musculoskeletal
overuse injuries in competition horses
Paola Torricelli & Milena Fini & Giuseppe Filardo &
Matilde Tschon & Mario Pischedda &
Alessandra Pacorini & Elizaveta Kon & Roberto Giardino

Received: 30 December 2010 / Accepted: 17February 2011 / Published online: 11 March 2011
# Springer-Verlag 2011

Abstract
Purpose Tissue repair in musculoskeletal injuries is often a
slow and sometimes incomplete process. Regenerative medicine based on the use of growth factors (GFs) and cell therapy
is aimed at improving the quality and speed of tendon and
ligament healing. The aim of this study was to evaluate the
potential forthe administration of a combination of autologous platelet-rich plasma (PRP) and freshly isolated bone
marrow mononucleated cells (BMMNCs) in 13 competition
horses affected by overuse musculoskeletal injuries (suspensory ligament desmopathy and superficial flexor tendinopathy) and refractory to other therapies.
Methods After ultrasonographic localisation of the lesion,
the autologous BMMNCsuspension and PRP were injected
directly into the core lesion. BMMNC and platelet count as
well as growth factors in PRP were measured to determine
factors influencing the clinical outcome.
Results Horses showed a marked improvement in their degree
of lameness and 84.6% were able to return to competition.
Among all the factors studied, the platelet concentration
P. Torricelli : M. Fini : M.Tschon : R. Giardino
Laboratory of Preclinical and Surgical Studies,
Research Institute Codivilla-Putti, Rizzoli Orthopaedic Institute,
Via di Barbiano 1/10,
40136 Bologna, Italy
G. Filardo : E. Kon (*)
Laboratory of Biomechanics and Technology Innovation– III
Clinic, Rizzoli Orthopaedic Institute,
Via di Barbiano 1/10,
40136 Bologna, Italy
e-mail: e.kon@biomec.ior.it
M. Pischedda : A.Pacorini
Veterinary Studio,
via Marzabotto 12, Rastignano,
Bologna, Italy

predicted the healing time: significantly faster recovery (p =
0.049) was observed in cases of PRP with more than 750×
103/μl platelets.
Conclusions Competition horses are involved in highly
demanding activities, thus being a similar model for the
high mechanical overload typical of human athletes. The
promisingresults obtained suggest that this combined
biological approach may be useful even for the treatment of
recalcitrant overuse musculoskeletal injuries in highly demanding patients if the appropriate dose of cells and GFs is applied.

Introduction
Chronic painful musculoskeletal disorders are common
debilitating conditions, and the real cost of these injuries to
society is remarkable [1]. Insports patients or professional
athletes the impact on life and work is even greater, and the
fast recovery of full efficiency and return to competition is of
primary importance. Tissue repair in musculoskeletal injuries
is often a slow and sometimes incomplete process, and the
treatment options available may offer incomplete recovery
and difficulties in returning to high activity level [2, 3].Recently, regenerative medicine and tissue engineering have
focused on the use of growth factors (GFs) and cell-based
therapy to improve the quality and speed of healing in tendons
and ligaments [4]. GFs are important signalling molecules
involved in connective tissue healing, regulating many aspects
of cellular metabolism, such as cell proliferation and
differentiation, and extracellularmatrix synthesis [5]. Platelet
products, such as platelet-rich plasma (PRP), are a great
reservoir of GFs and cytokines. In fact, activated platelets
secrete GFs, such as platelet-derived growth factor
(PDGF), transforming growth factors (TGFs), insulinlike growth factor (IGF), epidermal growth factor (EGF),

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