• 1.

    Cohen ND, Dresser BT, Peloso JG, et al. Frequency of musculoskeletal injuries and risk factors associated with injuries incurred in Quarter Horses during races. J Am Vet Med Assoc 1999; 215:662669.

    • Search Google Scholar
    • Export Citation
  • 2.

    Kasashima Y, Takahashi T, Smith RK, et al. Prevalence of superficial digital flexor tendonitis and suspensory desmitis in Japanese Thoroughbred flat racehorses in 1999. Equine Vet J 2004; 36:346350.

    • Search Google Scholar
    • Export Citation
  • 3.

    Gillis C. Tendon and ligament rehabilitation, in Proceedings. Dubai Int Equine Symp 1996;417421.

  • 4.

    Ferraro GL. Lameness diagnosis and treatment in the Thoroughbred racehorse. Vet Clin North Am Equine Pract 1990; 6:6384.

  • 5.

    Lam KH, Parkin TD, Riggs CM, et al. Descriptive analysis of retirement of Thoroughbred racehorses due to tendon injuries at the Hong Kong Jockey Club (1992–2004). Equine Vet J 2007; 39:143148.

    • Search Google Scholar
    • Export Citation
  • 6.

    Reef VB, Genovese RL, Davis WM. Initial long-term results of horses with superficial digital flexor tendinitis treated with intralesional β-aminopropionitrile fumarate, in Proceedings. 43rd Annu Meet Am Assoc Equine Pract 1997; 43:301305.

    • Search Google Scholar
    • Export Citation
  • 7.

    Dahlgren LA, van der Meulen MC, Bertram JE, et al. Insulin-like growth factor-I improves cellular and molecular aspects of healing in a collagenase-induced model of flexor tendinitis. J Orthop Res 2002; 20:910919.

    • Search Google Scholar
    • Export Citation
  • 8.

    Dowling BA, Dart AJ, Hodgson DR, et al. The effect of recombinant equine growth hormone on the biomechanical properties of healing superficial digital flexor tendons in horses. Vet Surg 2002; 31:320324.

    • Search Google Scholar
    • Export Citation
  • 9.

    Dyson SJ. Medical management of superficial digital flexor tendonitis: a comparative study in 219 horses (1992–2000). Equine Vet J 2004; 36:415419.

    • Search Google Scholar
    • Export Citation
  • 10.

    Smith RK. Tendon and ligament injury, in Proceedings. 54th Annu Conv Am Assoc Equine Pract 2008; 54:475501.

  • 11.

    Zapf J, Schmid C, Froesch ER. Biological and immunological properties of insulin-like growth factors (IGF) I and II. Clin Endocrinol Metab 1984; 13:330.

    • Search Google Scholar
    • Export Citation
  • 12.

    Murphy DJ, Nixon AJ. Biochemical and site-specific effects of insulin-like growth factor I on intrinsic tenocyte activity in equine flexor tendons. Am J Vet Res 1997; 58:103109.

    • Search Google Scholar
    • Export Citation
  • 13.

    Bathe AP. Tendon and ligament engineering—experiences with TGF-B. Vet Comp Orthop Traumatol 2003; 15:A16A17.

  • 14.

    Donnelly BP, Nixon AJ, Haupt JL, et al. Nucleotide structure of equine platelet-derived growth factor-A and -B and expression in horses with induced acute tendinitis. Am J Vet Res 2006; 67:12181225.

    • Search Google Scholar
    • Export Citation
  • 15.

    Abrahamsson S-O, Lundborg G, Lohmander LS. Recombinant human insulin-like growth factor-I stimulates in vitro matrix synthesis and cell proliferation in rabbit flexor tendon. J Orthop Res 1991; 9:495502.

    • Search Google Scholar
    • Export Citation
  • 16.

    Banes AJ, Tsuzaki M, Hu P, et al. PDGF-BB, IGF-I and mechanical load stimulate DNA synthesis in avian tendon fibroblasts in vitro. J Biomech 1995; 28:15051513.

    • Search Google Scholar
    • Export Citation
  • 17.

    Spindler KP, Nanney LB, Davidson JM. Proliferative responses to platelet-derived growth factor in young and old rat patellar tendon. Connect Tissue Res 1995; 31:171177.

    • Search Google Scholar
    • Export Citation
  • 18.

    Hogan PM, Bramlage LR. Transection of the accessory ligament of the superficial digital flexor tendon for treatment of tendinitis: long term results in 61 Standardbred racehorses (1985–1992). Equine Vet J 1995; 27:221226.

    • Search Google Scholar
    • Export Citation
  • 19.

    Gibson KT, Burbidge HM, Pfeiffer DU. Superficial digital flexor tendonitis in Thoroughbred race horses: outcome following non-surgical treatment and superior check desmotomy. Aust Vet J 1997; 75:631635.

    • Search Google Scholar
    • Export Citation
  • 20.

    Southwood LL, Stashak TS, Kainer RA, et al. Desmotomy of the accessory ligament of the superficial digital flexor tendon in the horse with use of a tenoscopic approach to the carpal sheath. Vet Surg 1999; 28:99105.

    • Search Google Scholar
    • Export Citation
  • 21.

    Bramlage LR, Hogan PM. Career results of 137 Thoroughbred racehorses that have undergone superior check ligament desmotomy for treatment of tendinitis, in Proceedings. 42nd Annu Conv Am Assoc Equine Pract 1996; 42:161163.

    • Search Google Scholar
    • Export Citation
  • 22.

    Fulton IC, Maclean AA, O'Reilly JL, et al. Superior check ligament desmotomy for treatment of superficial digital flexor tendonitis in Thoroughbred and Standardbred horses. Aust Vet J 1994; 71:232235.

    • Search Google Scholar
    • Export Citation
  • 23.

    Alexander GR, Gibson KT, Day RE, et al. Effects of superior check desmotomy on flexor tendon and suspensory ligament strain in equine cadaver limbs. Vet Surg 2001; 30:522527.

    • Search Google Scholar
    • Export Citation
  • 24.

    Genovese RL, Rantanen NW, Hauser ML, et al. Diagnostic ultrasonography of equine limbs. Vet Clin North Am Equine Pract 1986; 2:145226.

  • 25.

    McIlwraith CW, Nixon AJ, Wright IM, et al. Diagnostic and surgical arthroscopy in the horse. 3rd ed. Oxford: Mosby-Elsevier, 2005.

  • 26.

    Reef VB. Equine diagnostic ultrasound. Philadelphia: WB Saunders Co, 1998:39186.

  • 27.

    Wheat JD. Tendon injuries in horses, in Proceedings. 25th Brit Equine Vet Assoc Cong 1986;12.

  • 28.

    Abrahamsson S-O, Lundborg G, Lohmander LS. Long-term explant culture of rabbit flexor tendon: effects of recombinant human insulin-like growth factor-I and serum on matrix metabolism. J Orthop Res 1991; 9:503515.

    • Search Google Scholar
    • Export Citation
  • 29.

    Strömberg B. The normal and diseased superficial digital flexor tendon in racehorses. A morphologic and physiologic study. Acta Radiol Suppl 1971;(305):194.

    • Search Google Scholar
    • Export Citation
  • 30.

    Nixon AJ, Saxer RA, Brower-Toland BD. Exogenous insulin-like growth factor-I stimulates an autoinductive IGF-I autocrine/paracrine response in chondrocytes. J Orthop Res 2001; 19:2632.

    • Search Google Scholar
    • Export Citation
  • 31.

    Dahlgren LA, Mohammed HO, Nixon AJ. Expression of insulin-like growth factor binding proteins in healing tendon lesions. J Orthop Res 2004; 24:183192.

    • Search Google Scholar
    • Export Citation
  • 32.

    Kelley KM, Oh Y, Gargosky SE, et al. Insulin-like growth factor-binding proteins (IGFBPs) and their regulatory dynamics. Int J Biochem Cell Biol 1996; 28:619637.

    • Search Google Scholar
    • Export Citation
  • 33.

    Schnabel LV, Lynch ME, van der Meulen MC, et al. Mesenchymal stem cells and insulin-like growth factor-I gene-enhanced mesenchymal stem cells improve structural aspects of healing in equine flexor digitorum superficialis tendons. J Orthop Res 2009; 27:13921398.

    • Search Google Scholar
    • Export Citation
  • 34.

    Genovese RL. Prognosis of superficial flexor tendon and suspensory ligament injuries, in Proceedings. Annu Conv Am Assoc Equine Pract 1993; 39:1719.

    • Search Google Scholar
    • Export Citation
  • 35.

    Jorgensen JS, Genovese RL. Superficial digital flexor tendonitis. In: Ross MW, Dyson SJ. eds. Diagnosis and management of lameness in horses. St Louis: Saunders, 2008;628635.

    • Search Google Scholar
    • Export Citation

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Intralesional injection of insulin-like growth factor-I for treatment of superficial digital flexor tendonitis in Thoroughbred racehorses: 40 cases (2000–2004)

Thomas H. Witte BVetMed, PhD, DACVS1, Amy E. Yeager DVM, DACVR2, and Alan J. Nixon BVSc, MS, DACVS3
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  • 1 Comparative Orthopaedics Laboratory, Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853.
  • | 2 Cornell University Hospital for Animals, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853.
  • | 3 Comparative Orthopaedics Laboratory, Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853.

Abstract

Objective—To evaluate outcome after intralesional injection of insulin-like growth factor-I (IGF-I) for treatment of superficial digital flexor (SDF) tendonitis in Thoroughbred racehorses.

Design—Retrospective case series.

Animals—40 Thoroughbred racehorses.

Procedures—Medical records of racehorses with SDF tendonitis treated within 13 weeks after injury by intralesional injection of IGF-I (25 or 50 μg every other day for 4 or 5 treatments) were reviewed. Outcome was determined via analysis of race records, owner follow-up, and examination.

Results—Mean age of the horses was 3.1 years (range, 2 to 7 years), and time from injury to treatment ranged from 8 to 90 days. Mean ± SD approximate lesion length on admission was 15.6 ± 6.0 cm, and mean percentage cross-sectional area of the tendon affected was 26 ± 18%. Twenty-six of the 40 horses underwent desmotomy of the accessory ligament of the SDF tendon. Echolucency was reduced in 23 of 26 horses by the end of the treatment period. Twenty-one of 34 (62%) horses for which race data were available raced at least once after treatment, including 10 (30%) horses that raced between 1 and 4 times and 11 horses (32%) that raced ≥ 5 times. Thirteen of 28 (46%) horses had a recurrence of tendonitis or developed tendonitis elsewhere.

Conclusions and Clinical Relevance—Results suggested that in Thoroughbred racehorses with SDF tendonitis, intralesional injection of IGF-I led to a decrease in ultrasonographic lesion severity, but treated horses had only a moderate prognosis for return to racing.

Abstract

Objective—To evaluate outcome after intralesional injection of insulin-like growth factor-I (IGF-I) for treatment of superficial digital flexor (SDF) tendonitis in Thoroughbred racehorses.

Design—Retrospective case series.

Animals—40 Thoroughbred racehorses.

Procedures—Medical records of racehorses with SDF tendonitis treated within 13 weeks after injury by intralesional injection of IGF-I (25 or 50 μg every other day for 4 or 5 treatments) were reviewed. Outcome was determined via analysis of race records, owner follow-up, and examination.

Results—Mean age of the horses was 3.1 years (range, 2 to 7 years), and time from injury to treatment ranged from 8 to 90 days. Mean ± SD approximate lesion length on admission was 15.6 ± 6.0 cm, and mean percentage cross-sectional area of the tendon affected was 26 ± 18%. Twenty-six of the 40 horses underwent desmotomy of the accessory ligament of the SDF tendon. Echolucency was reduced in 23 of 26 horses by the end of the treatment period. Twenty-one of 34 (62%) horses for which race data were available raced at least once after treatment, including 10 (30%) horses that raced between 1 and 4 times and 11 horses (32%) that raced ≥ 5 times. Thirteen of 28 (46%) horses had a recurrence of tendonitis or developed tendonitis elsewhere.

Conclusions and Clinical Relevance—Results suggested that in Thoroughbred racehorses with SDF tendonitis, intralesional injection of IGF-I led to a decrease in ultrasonographic lesion severity, but treated horses had only a moderate prognosis for return to racing.

Contributor Notes

Dr. Witte's present address is Department of Veterinary Clinical Sciences, Royal Veterinary College, North Mymms, Hatfield, Hertfordshire, AL9 7TA, England.

Address correspondence to Dr. Nixon (ajn1@cornell.edu).