Clinic for Horses, University of Veterinary Medicine Hannover, Foundation, Bünteweg 9, 30559, Hannover, Germany.
Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 112, 3584 CM, Utrecht, Netherlands.
BMC Vet Res. 2016 Sep 7;12(1):191. doi: 10.1186/s12917-016-0826-1.
Regenerative and anti-inflammatory effects on tendinopathies have been attributed to blood-derived biologicals. To date the evidence for the efficacy of autologous platelet-rich plasma (PRP) treatment of naturally occurring equine tendinopathies is limited. The purpose of this placebo-controlled clinical trial was to describe the effect of a single treatment of equine superficial digital flexor tendon (SDFT) disease with PRP on clinical and ultrasonographic parameters. Twenty horses with naturally occurring tendinopathies of forelimb SDFTs were randomly assigned to the PRP-treated group (n = 10) or control group (n = 10) after clinical and ultrasonographic examination. The SDFTs received an intralesional treatment with autologous PRP or were injected with saline, respectively (day 0). All horses participated in a standardized exercise programme and were re-examined clinically, with B-mode ultrasonography (5 times at regular intervals) and ultrasound tissue characterization (week 12 and 24 after treatment) until week 24. Long-term performance was estimated via telephone inquiry.
Compared to day 0, lameness decreased significantly by week 8 after treatment with PRP and by week 12 in the control group. Ultrasonographically there was no difference in the summarized cross sectional area between the groups at any time point. Ultrasound tissue characterization showed that echo types representing disorganized matrix decreased significantly throughout the observation period in the PRP-treated group. Echo type II, representing discontinuous fascicles, not yet aligned into lines of stress was significantly higher 24 weeks after PRP treatment. Eighty percent of the PRP treated horses reached their previous or a higher level of performance after 12 months compared to 50 % in the CG. After 24 months these proportions were 60 % and 50 %, respectively.
A single intralesional treatment with PRP up to 8 weeks after onset of clinical signs of tendinopathy contributes to an earlier reduction of lameness compared to saline treatment and to an advanced organization of repair tissue as the fibrillar matrix is getting organized into fascicles while remodelling continues. Long term, PRP treatment has the potential to increase the number of horses reaching their previous level of performance. Earlier treatment of tendinopathy with PRP should be considered to enhance these effects.
再生和抗炎作用已归因于血液来源的生物制剂在腱病。迄今为止，自体富血小板血浆（PRP）治疗自然发生的马腱病的疗效证据有限。本安慰剂对照临床试验的目的是描述单次治疗马前肢伸肌腱（SDFT）疾病的 PRP 对临床和超声参数的影响。20 匹患有前肢 SDFT 自然发生腱病的马经过临床和超声检查后，随机分为 PRP 治疗组（n=10）或对照组（n=10）。SDFT 接受自体 PRP 或生理盐水的腔内治疗（第 0 天）。所有马匹均参加标准化运动计划，并在第 5 次定期间隔接受 B 型超声（US）检查（第 0、4、8、12 和 24 周）和超声组织特征（治疗后第 12 和 24 周），直到第 24 周。通过电话询问评估长期性能。
与第 0 天相比，PRP 治疗后第 8 周跛行明显减轻，对照组第 12 周跛行明显减轻。在任何时间点，两组的总结横截面积均无差异。超声组织特征显示，PRP 治疗组整个观察期内，代表无序基质的回声类型显著降低。治疗后 24 周，代表不连续束的 II 型回声显著升高，尚未排列成应力线。与 CG 相比，PRP 治疗后 12 个月，80%的 PRP 治疗马达到以前或更高的运动水平，而 CG 为 50%。24 个月后，这些比例分别为 60%和 50%。
与生理盐水治疗相比，在腱病临床症状出现后 8 周内进行单次腔内 PRP 治疗可更早地减轻跛行，并促进修复组织的高级组织，因为纤维状基质正在组织成束，而重塑仍在继续。从长远来看，PRP 治疗有潜力增加达到以前运动水平的马匹数量。应考虑早期用 PRP 治疗腱病以增强这些效果。
