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Published on: December 9, 2015
Core decompression augmented with bone marrow aspirate concentrate for refractory distal sesamoid bone pathology in
Grigorios Maleas1, Mahmoud Mageed1,2, Kristyna Hargitaiova3
1Equuria Orthopedics, Emstek, Germany.
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 was well tolerated with no unexpected complications in this cohort. This approach allowed horses with advanced DSB trabecular pathology refractory to conservative therapy return to function.
Clinical Impact:
This combined surgical-orthobiologic approach may offer a viable therapeutic option for horses with advanced refractory navicular bone pathology.
