Joint, ligament and tendon disease can be difficult to treat with traditional methods.

As a consequence, many new 'biological' treatments are being tried and tested.

These therapies rely upon the horses own immune system; either by improving the repair mechanism or by blocking the destructive mechanisms which have resulted in the injury in the first instance.

Cell-based therapies induce a regenerative response as opposed to fibrous scarring, which can happen if allowed to heal on their own.

As with all therapies in equine veterinary medicine there are limitations with these therapies and they are selected very much on a case by case basis.

PRP

This treatment is often selected for the treatment of joints, bursae (small fluid filled cavities that allow tendon to run smoothly over bones), and soft tissue injuries.

In the body, platelets circulate in the blood stream, along with the red and white blood cells. The platelets play an important role in blood clotting and are a good sourse of growth factors.

In instances where the body does not produce enough blood clots, bleeding and bruising can occur when you least expect them.

Similarly, too many platelets can lead to blood clots forming in the circulatory system. When platelets arrive at the site of an injury they release growth factors (including platelet derived growth factor, transforming growth factor beta, insulin-like growth factors, vascular endothelial growth factor and connective tissue growth factor).

The presence of these growth factors stimulate the production of repair tissue (extra cellular matrix). PRP takes advantage of these growth factors.

PRP is acquired by taking a blood sample from the horse. The blood is passed through a filter, increasing the platelet number. The harvested PRP can be used within 30 minutes.

From 50ml of blood approximately 8ml of PRP is produced. The PRP is placed directly into the affected synovial cavity under sterile conditions. There do not appear to be any adverse effects from this treatment.

IRAP therapy

IRAP is relatively new to the equine market, it relies upon the production of autologous serum (serum from the same animal that the treatment is intended for).

By harnessing the anti-inflammatory properties of the horse's own blood cells, damaged tissues in the limbs are encouraged to heal.

The process starts by retrieving 50ml of blood from the intended horse. The blood is incubated for 24 hours with sodium chromate beads, the beads encourage the blood to produce more of the anti-inflammatory mediators. Following 24 hours of incubation the blood is spun down in a centrifuge, this allows the red blood cells to be separated from the serum.

The serum is divided into the number of treatments required, usually three or four and is injected into the site of injury, ie the coffin joint, at weekly intervals. As the serum is harvested from the same horse, complications and adverse effects happen infrequently.

Recent scientific literature suggests that IRAP is most effective in the coffin joint. As this product does not contain any medication, there is no withdrawal times for competition.

Stem cell therapy

This therapy is popular for treatment of tendon and ligament disease. As for IRAP the cells harvested for this treatment come from the horse requiring treatment, therefore the risks of adverse effects are lower.

Stem cells are essentially immature cells, which, in the correct environment can become any type of cell. Usually, the cells are harvested from the bone marrow of the horse, usually from the sternum (the breast bone) in a sterile fashion. Other cell types can be used, such as fat, blood or skin.

The harvested stem cells can be implanted into the damaged tendons under standing sedation (as long as the patient co-operates). Ultrasonography at the time of implantation allows the vet performing the procedure to ensure the cells are placed at the correct site.

Following implantation, you will be provided with an exercise program to follow, this will vary depending on the specific case.

In summary, there are many new treatments in equine veterinary medicine. Should your horse require treatment for musculoskeletal injuries, it is important to work closely with your veterinary surgeon to select the treatment protocol that will work for you and your horse.