Showing posts with label tendon. Show all posts
Showing posts with label tendon. Show all posts

Tuesday, August 28, 2018

Gene therapy: Second stage of research documents further success for rehabilitation of tendon injuries in lame horses

Equine surgeon Milomir Kovac performs an ultrasound on a horse; ultrasound was used to monitor healing in tendon injuries in a group of race and sport horses treated with an experimental gene therapy designed to both speed healing and improve the quality of the healed injury site to prevent recurrence. (Image courtesy of University of Nottingham)

In October 2017, The Hoof Blog reported on experimental research looking into direct-injection gene therapy for soft tissue lameness injuries in horses. The authors of the 2017 paper had successfully cured lameness in two horses and published their results in the journal Frontiers in Veterinary Science.

Thursday, September 29, 2011

Laminitis In Action: Coffin Bone Rotation Time Lapse Video (International Laminitis Conference Preview)

Laminitis, caught in the act: The foot of a horse suffering from Potomac Horse Fever is recorded as it goes through two processes subsequent to the damage in the foot caused by the disease: the coffin bone appears to be rotating away from the hoof wall at the toe and down at its tip; it is also "sinking" within the foot. These two processes are called rotation and sinking, or sinker syndrome. Many laminitis terms have parallel names in other parts of the world or even within the same country. (Andrew Van Eps video)

(You might have to watch this a few times, and if you have a slow connection, you might need to click on the stop button. Once the video is buffered, it should play smoothly. Watching it in full-screen mode helps.)

What you are seeing is a time-lapse of the radiographic view of a horse going through the process commonly called "rotation". What rotation actually is and which part of the foot is the chicken and which is the egg is perpetually debated. This particular foot is also "sinking" within the hoof capsule.

Andrew Van Eps
The video was created by Andrew Van Eps, BVSc, PhD, MACVSc, DACVIM of the University of Queensland. Dr. Van Eps earned a PhD while he was researching laminitis at the Australian Equine Laminitis Research Unit under Dr Chris Pollitt. Among the insights Dr. Van Eps' PhD research has contributed to the treatment of laminitis is the efficacy of cryotherapy in the prevention of laminitis. He created the video of the Potomac Horse Fever case during a residency at the University of Pennsylvania School of Veterinary Medicine.

At the Sixth International Equine Conference on Laminitis and Diseases of the Foot in West Palm Beach, Florida next month, Dr. Van Eps returns once again to speak. Among his subjects will be suggestions for ways to apply cryotherapy, clinical techniques to prevent support-limb laminitis and his intriguing-sounding lecture, "Lamellar Bioenergetics Studied Using Tissue Microdialysis".


You might be interested in reading "Equine laminitis: cryotherapy reduces the severity of the acute lesion" and "Equine laminitis model: cryotherapy reduces the severity of lesions evaluated seven days after induction with oligofructose" by van Eps and Dr. Pollitt, originally published in 2004 and 2009, respectively, in the Equine Veterinary Journal.

He's probably forgotten all about this video. But to anyone dealing with laminitis, the question of whether or not rotation is inevitable in a given horse remains a paramount concern. How many horses technically experience laminitis and have damaged laminae, but have minor rotation or none at all, and why is there such variation between horses? How many horses have bouts of laminitis that their owners never even notice? Is it still laminitis if no one notices but the farrier, the next time the horse is due to be trimmed or shod?

And what is rotation? Is the deep digital flexor tendon, which attaches on the underside of the coffin bone, actually pulling up and back on the bone as the laminae at the toe loosen their hold on the bone, as we've been taught, and as this video would so nicely illustrate? Or is it the weight of the horse on the compromised structures, compounded by unusual posture, that encourages a combination of those forces to work in concert?

A paper from New Zealand published in this month's (September 2011) Equine Veterinary Journal proposes that the soft tissue structures in the back of a contracted, bar-humped foot make it possible for the palmar processes of the coffin bone to act like a fulcrum around which the coffin bone rotates, and that the tendon has no involvement. (See "The effect of hoof angle variations on dorsal lamellar load in the equine hoof" by Ramsey, Hunter and Nash.)

Lead author Gordon Ramsey was kind enough to send his paper and this section begs to be highlighted; using a Finite Element analysis model, Ramsey calculated forces on the proximal hoof wall at the toe when the heels are raised, as recommended in some laminitis therapy regimen. Extrapolating from that finding, he challenged the mainstream concept of coffin bone rotation in laminitis.

Please note that the author is from the University of Auckland in New Zealand and so uses "lamellae" instead of "laminae" in his text; instead of referring to raising the heels of the foot, he refers to mechanically altering the palmar angle of the coffin bone. It's food for thought whether measurements of heels and coffin bone palmar angles are interchangeable.

C0004P0141
A typical laminitis foot, with increased heel growth, which would elevate the palmar angle of the coffin bone as per Ramsey's FE model. According to his calculations, as that palmar angle is intentionally increased in some laminitis treatment protocols, the stress on the proximal (closer to the coronet) laminae inside the hoof wall at the toe would be increased. (University of Nottingham vet school photo)


Ramsey writes:

"The first stage of structural failure in a laminitic hoof involves a stretching of the laminar junction (Pollitt 2007), with rotational displacement occurring subsequently. This seems consistent with a mode of failure that begins at the most loaded proximal part of the lamellae, as predicted by this model, with rotation only occurring after the lamellae have been weakened. 

"It has been proposed that rotational displacement of the distal phalanx, as a sequel to weakening or failure of the laminar junction, is a result of the forces imposed by the deep digital flexor tendon (DDFT) and leverage of the dorsal wall on the ground during breakover (Hood 1999). Experimental results have shown that in laminitic ponies the DDFT force is zero for the first 40% of stance and only approaches a normal value near the end of stance, but that the peak vertical ground reaction force (GRF) is only reduced by 13 percent compared to normal ponies (McGuigan et al 2005). 

"Since the peak lamellar load, predicted by this model to occur at the proximal (not the distal) region of the laminar junction, is more strongly influenced by the GRF than the DDFT force and does not occur during breakover, then this mechanism seems unlikely. 

"An alternative proposed mechanism is that the digital cushion and the region of the attachment of the DDFT are a fulcrum about which the distal phalanx rotates (Coffman et al 1970). As both the DDFT and the digital cushion are soft tissues, it seems unlikely that these could provide sufficient support. 

"However, if the hoof has contracted heels or ingrown bars (Strasser 1997), then these could provide support for the palmar processes to act as the fulcrum for rotation. This could explain why in some hooves the distal phalanx rotates but in other cases, where this fulcrum perhaps does not exist, it only displaces vertically."

Join in the discussion at the Laminitis Conference, October 29-31. The early registration discount ends soon!


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© Fran Jurga and Hoofcare Publishing; Fran Jurga's Hoof Blog is a between-issues news service for subscribers to Hoofcare and Lameness Journal. Please, no use without permission. You only need to ask. This blog may be read online at the blog page, checked via RSS feed, or received via a digest-type email (requires signup in box at top right of blog page). To subscribe to Hoofcare and Lameness (the journal), please visit the main site, www.hoofcare.com, where many educational products and media related to equine lameness and hoof science can be found. Questions or problems with this blog? Send email to blog@hoofcare.com.  
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Wednesday, October 06, 2010

Racehorse Performance "Not Significantly Affected by Tendon Injury", According to Horse Trust Research

This horse has "bowed" it superficial digital flexor tendon; the tendon protrudes, or bows out, at the back of the leg. This is the most common debilitating tendon injury suffered by racehorses and requires a long layoff for recovery, although new treatments are shortening the time lost from training. (Photo: Dr. Barak Amram/VetMoves)
Data compiled and analyzed in a research project in Great Britain funded by The Horse Trust found that racehorses who recovered from tendon injuries did not have inferior racing performance records compared to horses that had not had tendon injuries.

The research was led by Bryan O'Meara, who is in the final year of a three year clinical training scholarship funded by The Horse Trust. O'Meara carried out the research at Donnington Grove Veterinary Surgery in Newbury, under the supervision of epidemiologist Dr Tim Parkin from University of Glasgow.

Tendonitis is one of the most common musculoskeletal injuries in racehorses, with a prevalence of 11-30%, according to earlier research.

O'Meara examined the clinical records and racing histories of 400 racehorses who had been treated for superficial digital flexor (SDF) tendonitis injuries over a five year period from 2003 to 2008.

The race records of horses affected by tendon injury were compared with 400 matched control horses that had never suffered SDF tendon injuries. The controls were horses training in the same establishment at the time of injury and of the same age and sex as the case horse.

The Horse Trust-funded research looked at the performance of the racehorses in races before and after treatment for the injury, and at the performance of the control horses before and after the treatment date. The Racing Post Rating (RPR), which is published by the Racing Post (a British racing newspaper with charts) after every race, was used as a measure of performance.

O'Meara found that there was no significant difference in RPR before and after the treatment date in case and control horses.

This result is unexpected as in vitro studies have found that healed tendon tissue has reduced elasticity properties due to the presence of scar tissue. This suggests that a horse with a healed SDF tendon would need to work its muscles harder to compensate and would therefore be expected to have lower performance.

O'Meara said more research is needed to back-up his finding that performance isn't significantly affected by tendon injury.

"It could be that using Racing Post Rating to measure performance isn't sensitive enough to pick up a change in the horse's performance," said O'Meara. "However, it's encouraging that there's no marked change in performance after a horse has recovered from a tendon injury. These findings show that there's no need to give up on a horse that has a tendon injury--they can still come back and perform well, or can be used for other, less demanding riding activities."

The Horse Trust-funded research also found that there was no significant difference between case and control horses when returning to racing and completing three races. Only after completing five races, or three years post treatment, was a significant difference found between case and control horses. This finding is a step towards developing a more accurate assessment of tendon-treatment outcome after five races or three years post-treatment is a better indicator of the outcome of treatment.

"At the moment, some tendon treatments state their success as the percentage of horses that return to racing after treatment. However, we've shown that there's no significant difference between case and control horses at this time," said O'Meara. "At the moment, there are a myriad of treatments available to treat tendonitis. Hopefully this finding will be used in further research to learn which treatments are most effective."

O'Meara's research also found a link between SDF tendon injury and the racehorse competing at its maximum performance level: the case horses were significantly nearer to their pre-injury maximum performance level in the race immediately before injury (compared to matched controls), suggesting that they were competing nearer their individual maximum performance level when the SDF tendon injury occurred. (Note: this statement is not explained but would seem to suggest that either the level/class of the race or the distance perhaps was the best the horse had done in its career when the injury occurred.)

Editor's note: Information in this article was provided by The Horse Trust, a British charity that funds equine research and promotes education about horse health and welfare. Hoofcare Publishing likes to support The Horse Trust whenever possible. The research described in this article was published in the May 2010 edition of the Equine Veterinary Journal and is available online as a downloadable PDF file: "An investigation of the relationship between race performance and superficial digital flexor tendonitis in the Thoroughbred racehorse".

Readers should keep in mind that the study included only British racehorses and that the majority of British racing is done on grass. Race distances, conditioning schedules and training methods also vary in Great Britain from methods used in North America and some other countries. But the results are interesting, no matter where you live!

© Fran Jurga and Hoofcare Publishing Fran Jurga's Hoof Blog is a between-issues news service for subscribers to Hoofcare and Lameness Journal. Please, no use without permission. You only need to ask. This blog may be read online at the blog page, checked via RSS feed, or received via a digest-type email (requires signup in box at top right of blog page). To subscribe to Hoofcare and Lameness (the journal), please visit the main site, www.hoofcare.com, where many educational products and media related to equine lameness and hoof science can be found. Questions or problems with this blog? Send email to blog@hoofcare.com.
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Tuesday, July 14, 2009

Stem Cell Tendon Repair for a Dressage Horse: Not Your Typical Public Radio Reporter's Assignment

by Fran Jurga | 14 July 2009 | Fran Jurga's Hoof Blog

Today, we'll go along with KQED, the National Public Radio station in San Francisco, as they cross the bridge and leave the city behind. Their destination is the vet school hospital at the University of California at Davis. Amy Standen, the intrepid reporter, doesn't usually set up her sound equipment in a horse barn, but she gamely accepts a warmblood with the assumed name of Disney (to protect his real identity) as her subject for the day.

The goal is to portray advances in equine stem cell treatments for tendon injuries, using bone marrow or fat tissue stem cells, as promising experiments for future human treatments.

Have a listen! Thanks to KQED for setting up this shared audio file. Click here to go to the home page of Quest, KQED's science program, which produced the equine stem cell segment, where you will find photos and the reporter's notes.



© Fran Jurga and Hoofcare Publishing. No use without permission. You only need to ask.

Fran Jurga's Hoof Blog is a between-issues news service for subscribers to Hoofcare and Lameness Journal. This blog may be read online at the blog page, checked via RSS feed, or received via a digest-type email (requires signup in box at top right of blog page).

To subscribe to Hoofcare and Lameness (the journal), please visit the main site, www.hoofcare.com, where many educational products and media related to equine lameness and hoof science can be found.

Questions or problems with this blog? Send email to blog@hoofcare.com.

Saturday, November 22, 2008

Keep Going, Knowhere: Jump Champion Still Winning on Bionic Tendon

by Fran Jurga | 21 November 2008 | www.hoofcare.blogspot.com

Image by &ndie/courtesy of Flickr

News comes and go. Horses come and go. Every once in a while a story or a horse comes back into the headlines and you say, "I'll be darned..."

Last winter we reported on the jubilation of the veterinary community over the success of the jump racer Knowhere, who came back from tendon surgery to excel again at this most grueling of tests for a front tendon. Knowhere kept running, kept jumping and often, kept winning. I lost track of him after he fell at a fence in the Cheltenham Gold Cup last March, and thought he'd been retired.

But another racing season has just begun in England and a few weeks ago, Knowhere launched into his 2008 campaign...as a ten-year-old. He came home first in the Old Roan Chase at Aintree, near Liverpool, five years after bowing and having stem cells from his sternum inserted into the bulging superficial flexor tendon of his right front leg.

The technique used for Knowhere, called VetCell, is different from the normal fat-derived stem cell treatment.

Click here
to go back and read about Knowhere's treatment and all the people who will be cheering for him next Saturday in the Hennessy Gold Cup. His tendon will have to hold up over a distance of 3 miles, 2 and a half furlongs and carry him over 21 fences. The race is the oldest commercially sponsored sporting event in Europe, and Knowhere, who is trained by Nigel Twiston-Davies and ridden by Paddy Brennan, will face 53 others if they all are fit to run.

There may be plenty of horses racing with bionic parts!


© Fran Jurga and Hoofcare Publishing.

Fran Jurga's Hoof Blog is a between-issues news service for subscribers to Hoofcare and Lameness Journal. This blog may be read online at the blog page, checked via RSS feed, or received via a digest-type email (requires signup in box at top right of blog page).

To subscribe to Hoofcare and Lameness (the journal), please visit the main site, www.hoofcare.com, where many educational products and media related to equine lameness and hoof science can be found.

Questions or problems with this blog? Send email to blog@hoofcare.com.