Stem cells and platelet-rich plasma for the treatment of naturally occurring equine tendon and ligament injuries: a systematic review and meta-analysis.
Authors: W. M'Cloud, Kimberly E. Guzman, Char L Panek, Aimee C Colbath
Journal: Journal of the American Veterinary Medical Association
Summary
# Editorial Summary Despite growing enthusiasm for regenerative medicine in equine practice, a comprehensive analysis of 21 peer-reviewed studies on platelet-rich plasma (PRP) and mesenchymal stromal cells (MSCs) reveals surprisingly limited evidence that these biologics improve return-to-performance outcomes in horses with naturally occurring tendon and ligament injuries. Researchers applied rigorous systematic review methodology (PRISMA guidelines) to assess 17 studies meeting criteria for meta-analysis, evaluating return to performance and reinjury rates as primary outcomes. The findings indicate no statistically significant improvement in performance recovery across PRP monotherapy, MSC monotherapy, or combined PRP-MSC treatments; however, horses receiving MSCs alone or in combination with PRP demonstrated meaningfully reduced reinjury rates compared with control groups. These results warrant cautious interpretation given substantial heterogeneity between studies, inconsistent methodological quality, and widespread risk of bias across the evidence base—factors that should inform clinical decision-making and highlight the need for standardised, high-quality trials establishing optimal dosing protocols, application timing, and patient selection criteria before these treatments can be considered evidence-based practice rather than experimental options.
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Practical Takeaways
- •While PRP and MSC treatments may help reduce reinjury rates, current evidence does not support using them to improve chances of return to performance
- •If choosing biological treatments, combining MSCs with PRP or using MSCs alone appears more effective than PRP alone for preventing re-injury
- •Study quality and bias concerns mean these findings should be interpreted cautiously; consider waiting for higher-quality evidence before investing heavily in these treatments
Key Findings
- •Meta-analysis of 17 studies found no significant increase in return to performance with PRP or MSC treatments for equine tendon and ligament injuries
- •MSCs alone and MSCs combined with PRP demonstrated reduced reinjury risk compared to control groups
- •21 studies met inclusion criteria from 764 identified studies, indicating heterogeneous literature with variable quality and high bias risk