Evidence Related to the Effects of Intralesional/Intrasynovial Corticosteroids on Tendon/Ligament Homeostasis and Healing.
Authors: Vivian G Quam
Journal: The Veterinary clinics of North America. Equine practice
Summary
# Editorial Summary: Intralesional Corticosteroid Injections in Equine Tendon and Ligament Injuries Whilst inflammation is recognised as a necessary component of soft tissue healing in horses, clinicians frequently rely on corticosteroid injections to manage pain and inflammatory responses in acute and chronic tendon and ligament injuries. Quam's review synthesised current evidence regarding how intralesional and intrasynovial corticosteroid administration affects the biological processes underpinning tissue repair and long-term structural integrity. The evidence reveals a paradox: corticosteroids deliver rapid and measurable reductions in pain and inflammation in the short term, yet no consistent benefits to healing outcomes have been demonstrated beyond this window, with potential for adverse effects including delayed tissue remodelling and increased re-injury risk in some cases. Practitioners should recognise that whilst these agents remain cost-effective anti-inflammatory tools, emerging biologic alternatives (including regenerative therapies) warrant consideration—particularly in high-performance horses or those with risk factors for poor healing. Future case-by-case decision-making should balance the short-term anti-inflammatory advantages of corticosteroids against individual patient factors, injury chronicity, and the expanding therapeutic arsenal available within a truly multimodal treatment framework.
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Practical Takeaways
- •Intralesional corticosteroids effectively reduce pain and inflammation short-term but don't improve long-term healing outcomes—use them strategically for acute pain management, not as a complete solution
- •Consider biologic alternatives (PRP, stem cells, etc.) for horses at risk of corticosteroid complications or when long-term outcomes matter
- •Corticosteroids work best as part of a multimodal plan alongside controlled exercise, rehabilitation, and other therapies rather than as standalone treatment
Key Findings
- •Local corticosteroids provide consistent and profound short-term effects on pain and inflammation in equine tendon/ligament injuries
- •No demonstrated long-term benefit of intralesional/intrasynovial corticosteroids for tendon/ligament healing
- •Complications can occur with corticosteroid use requiring consideration of alternative biologic anti-inflammatory treatments
- •Corticosteroids remain affordable and effective as part of multimodal treatment when indicated on a case-by-case basis