Effectiveness of Platelet-Rich Plasma and Bone Marrow Aspirate Concentrate as Treatments for Chronic Hindlimb Proximal Suspensory Desmopathy.
Authors: Maleas Grigorios, Mageed Mahmoud
Journal: Frontiers in veterinary science
Summary
# Editorial Summary Chronic proximal suspensory desmopathy in the hindlimbs presents a significant rehabilitation challenge, and this retrospective analysis compared two cellular therapies against conservative management alone to determine their clinical utility. Ninety-three horses with established hindlimb proximal suspensory ligament disease (>3 months duration) were allocated to control (exercise only, n=22), leukocyte-rich PRP (n=46), or bone marrow aspirate concentrate (n=25) treatment groups, with lameness and ultrasonographic assessment at 6 months and performance records tracked to 18 months post-intervention. At the 6-month checkpoint, BMAC demonstrated superior outcomes with 84% of treated horses showing clinical soundness versus 59% in the PRP cohort and just 9% in controls; both biologic therapies also showed significantly improved ultrasound appearances compared to exercise alone. Long-term follow-up at 18 months revealed 72% of BMAC-treated and 43% of PRP-treated horses remained sound, with 64% and 33% respectively returning to previous or enhanced performance levels, compared to minimal gains in the control group (4.6% sound, single horse returning to work). For practitioners managing chronic hindlimb suspensory injuries, these findings provide robust evidence that cellular therapies—particularly BMAC—substantially improve both lameness resolution and functional recovery beyond what controlled exercise can achieve, though the lack of correlation between BMAC cytology profiles and outcomes suggests the healing mechanisms may be more complex than cell counts alone would indicate.
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Practical Takeaways
- •BMAC and LR-PRP both substantially outperform conservative management alone for chronic hindlimb PSD, with BMAC showing superior outcomes (72% vs 43% sound at 18 months)
- •Most horses treated with BMAC or LR-PRP can expect to return to work, with meaningful lameness improvement visible by 6 months and performance recovery by 12-18 months
- •BMAC cytology profiles did not predict clinical outcomes, so clinicians cannot use cell counts to prognosticate individual cases
Key Findings
- •At 6 months, 84% of BMAC-treated horses were sound versus 59% in LR-PRP and 9% in control group
- •At 18 months, 72% of BMAC-treated horses remained sound compared to 43% in LR-PRP and 4.6% in control group (p=0.02)
- •68% of BMAC-treated horses returned to previous performance level by 12 months versus 39% in LR-PRP group
- •BMAC demonstrated superior short- and long-term lameness improvement compared to LR-PRP for chronic hindlimb proximal suspensory desmopathy