Orthopedics

A lameness examination starts by looking at the horse’s previous medical history and a more detailed look is taken at the nature and duration of the existing problem. It is important that we have all the information from previous examinations and treatments. After studying the medical history, a static clinical examination is carried out consisting of a visual inspection and palpation of the joints and soft tissue. A dynamic clinical examination is then carried out and the animal’s gait inspected. This is done both in a straight line and in a circle on a hard and soft surface. Flexion tests are then generally carried out. In the case of a subtle lameness, examination while the horse is being ridden has considerable added value. Finally, in most cases nerve blocks and/or intrasynovial anaesthesia are carried out to anaesthetise certain structures. This takes away the pain in a specific region, enabling more specific localisation of the pathology. A lameness examination takes on average 1 to 2 hours. After the region of pain has been identified, further medical imaging can be carried out to arrive at a diagnosis. Once the diagnosis has been made, a treatment pathway can be proposed and this should always be combined with a movement and/or rehabilitation plan.

X-ray imaging is used to create pictures of a number of bone pathologies such as arthritis, bone cysts, OCD (osteochondritis dissecans) and fractures/fissures. We have the most advanced equipment at our disposal; this includes a mobile wireless system and also an extremely powerful, fixed machine that is used specifically for the back and neck.

An ultrasonographic examination is mainly used to obtain images of the soft tissue such as ligaments, tendons and muscles using ultrasonic sound waves. It can also be useful to assess cartilage or bone surface. Another important application of echography is the delivery of ultrasound-guided injections; using this method we can inject medication very precisely at the required location.

UTC is the latest application within the field of ultrasonography. With this technique a specialised program makes an analysis of the scanned tendon to evaluate its quality. Currently this technology is only used in the cannon bone region. It provides added value when following up tendon injuries so that during rehabilitation we can determine when the load on the tendon can be increased. UTC also plays a role in preventive medicine as weaker zones in the tendon can be identified at an early stage and injuries can then be prevented. It can also provide additional insight into the horse’s health in a pre-purchase examination.

Stem cells are undifferentiated cells that have the capacity to transform themselves into different kinds of cell types. Mesenchymal stem cells offer the most advantages within orthopaedics as they can form cartilage, bone, muscle and tendon tissue. This does, however, involve a risk as the required tissue may not be created at a certain place. To avoid this we only work with predifferentiated stem cells that are tissue specific. Therefore, we use chondrogenic induced stem cells, with a view to formation of cartilage in joints, while tenogenic induced stem cells are used to transform themselves into tendon tissue. We only use the latest generation of allogeneic mesenchymal stem cells. These are isolated from the blood of strictly selected donor horses and stored in liquid nitrogen at a temperature of -196°C so that they are available at any time.

Because of the poor circulation in the tendons, if the tendon fibres are damaged, insufficient healing substances reach the injury. This means that a tendon will heal more slowly in comparison with other tissue such as muscle. Moreover, the quality of the newly formed tendon tissue will be poorer as a part of the injury is filled with lower-quality scar tissue. This reduces elasticity and therefore the strength of the tendon in the long term.

The recovery time from a tendon injury, and in particular the quality of the newly formed tendon tissue, can be improved in many cases by injecting certain products such as PRP and stem cells. An ultrasound-guided injection can be used to deliver this medication with the utmost precision.

To achieve an optimum result, in many cases this is supplemented (at a later stage during rehabilitation?) with shock wave therapy and laser therapy.

The neck, back and sacroiliac region play a very important role in the movement mechanism of the horse and have a complex anatomy in which the sacroiliac joint forms the connection between the back, pelvis and thus the hind limbs. Pain in these areas often only leads to vague complaints of general reduction in performance, making it difficult to make an exact diagnosis. In addition, pain in these regions can be both a cause and a result of a lameness. In addition, the horse's large muscle mass makes the neck, back and sacroiliac region difficult to image. Fortunately, we have a powerful X-ray machine that can be used specifically for this purpose. In addition, both an external and a transrectal ultrasound examination can be performed. The latter serves in particular to visualize the sacroiliac joint. Finally, the neck can be imaged in great detail using a CT scan.

Treatment options include mesotherapy, intramuscular injection, ultrasound-guided injection of the facet joints and sacroiliac joint, shock wave therapy, laser therapy and physiotherapy.

Inflammation in a joint causes pain in the first instance and results in lameness. If this inflammation continues, it can cause further damage to the joint. It is therefore important to act as soon as possible. A number of products are available, each with their specific properties that have both an anti-inflammatory and a healing function.

Hyaluronic acid

In joints the cartilage acts as a shock damper, while synovial fluid has a lubricating and hydrating function. Hyaluronic acid is an important component for both cartilage and synovial fluid. The injection of hyaluronic acid into a joint can contribute to repair as it promotes production of the body’s own hyaluronic acid and has an anti-inflammatory effect. It also has analgesic properties.

Steroid anti-inflammatories

This is a group of very strong anti-inflammatories. However, these should be used with the necessary caution. With repeated use or in the incorrect dose, they can damage the cartilage in the joint or cause laminitis.

IRAP

IRAP (Interleukin 1 Receptor Antagonist Protein) is used to fight inflammation within joints. It is a natural inhibitor of Interleukin 1, a cytokine that plays an important role in the inflammatory process that can lead to cartilage damage.

We take blood from the horse in a sterile way. This is incubated for a day in a special kit, causing a high concentration of the Interleukin 1 Receptor Antagonist protein to be released by the white blood cells. After centrifugation, the IRAP-rich serum is collected and injected into the joint to be treated by intra-articular injection. The rest of the serum can be stored in the freezer and used again later in any follow-up treatments.

PRP

PRP (Platelet-Rich Plasma) contains a high concentration of blood platelets. When these platelets are activated, they release large amounts of growth factors that promote the natural healing of tendons, ligaments and joints

Pro-Stride

Pro-Stride combines the anti-inflammatory properties of IRAP with the repairing effect of PRP. By means of a short procedure that only takes 20-25 minutes, Pro-Stride can be created on site. After drawing blood, the blood is collected in a special kit and centrifuged twice. In this way a high concentration is collected of the body’s own substances such as blood platelets, growth factors and anti-inflammatory proteins that contribute to tissue repair.