Comparative Efficacy of Combined Mesenchymal Stem Cell and Platelet-Rich Plasma Therapy with ESWT/Hydrotherapy in Equine Superficial Digital Flexor Tendinopathy: A Prospective Clinical Trial
DOI:
https://doi.org/10.52331/v31i2rs08Keywords:
Keywords: equine tendinopathy, mesenchymal stem cells, platelet-rich plasma, extracorporeal shockwave therapy, hydrotherapy, superficial digital flexor tendonAbstract
Equine superficial digital flexor tendon (SDFT) tendinopathy is a frequent cause of reduced athletic performance and prolonged lameness in sport horses, characterized by limited intrinsic healing capacity, fibrosis, and high recurrence rates after return to exercise. Regenerative and adjunctive therapies such as mesenchymal stem cells (MSCs), platelet-rich plasma (PRP), extracorporeal shockwave therapy (ESWT), and hydrotherapy have been increasingly used, yet comparative clinical evidence remains limited. This prospective clinical trial evaluated the efficacy of combined MSC-PRP therapy compared with PRP-ESWT and MSC-hydrotherapy in horses with naturally occurring SDFT lesions managed under a standardized rehabilitation program. Twelve horses with ultrasonographically confirmed SDFT tendinopathy and grade 2–4/5 forelimb lameness were randomly allocated to three treatment groups (n = 4/group): Group 1 received intralesional MSC followed by PRP injections, Group 2 received PRP combined with ESWT, and Group 3 received MSC combined with underwater treadmill hydrotherapy. Clinical and ultrasonographic assessments were performed at baseline, days 14 and 28, and weeks 12 and 24. All groups showed significant improvement in lameness scores by week 12 (p < 0.01 versus baseline), with mean AAEP scores decreasing from 3.0 ± 0.8 to 1.2 ± 0.4 in Group 1, 1.5 ± 0.5 in Group 2, and 1.3 ± 0.4 in Group 3. Lesion cross-sectional area decreased significantly over time (p < 0.001), reaching reductions of 85%, 72%, and 78% in Groups 1, 2, and 3, respectively, by week 24. Echogenicity and fiber alignment improved most markedly in the MSC-PRP group. Return to previous performance level at 6 months was achieved in 100% of horses in Group 1 and 75% in Groups 2 and 3. No adverse events were recorded. Combined MSC-PRP therapy within a structured rehabilitation protocol may provide superior structural and functional recovery in equine SDFT tendinopathy, while PRP-ESWT and MSC-hydrotherapy represent effective alternative treatment strategies.
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