# Platelet Rich Plasma



## Starcharger (10 April 2010)

Please has anyone any experience, good or bad, of a new treatment - platelet rich plasma? My horse injured his off fore check ligament some years back, and was treated with adequan and rested for months. He went sound again but within a year went lame again with it. After another adequan course and more rest he was still not sound. My vet decided to use a new treatment at that time - A-cell, which is derived from pigs bladder! Anyway, this worked wonders and Cougar has been sound ever since. However, he has now injured his check ligament in the other foreleg. Yet another course of adequan and restricted turnout (legs bandaged) he is still lame 9 weeks later. My vet has suggested we try PRP which is blood taken from my horse, treated to remove everything but the rich plasma parts, then injected direct into the lesion in the check ligament. It is supposed to help the healing process. Apparently PRP now supersedes the A-cell treatment. Due to the previous ligament injury, we are not covered by my insurance and this treatment will cost around £600 Plus. Can anyone tell me if they have used this treatment and what the outcome was, or do I just wait it out and let nature take its course. Both Cougar and myself are really fed up!! Thanks for listening!


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## glenruby (11 April 2010)

It has been in use in the US and in certain parts of Europe (esp Germany i believe) for a few years now. I have seen horses treated with it (when in New york last summer) but unfortunately I have not seen the follow-up and therfore do not know the limitations to the tx. However the surgeon there had great faith in the procedure and said in the dozen or so he had treated up to that point, there had been a lot of success. I believe that for a lesion of >25% of the ligament, success decreases hugely. VetCell are one of the main companies involved in training vets for the procedure and providing equipment. They may have some stats that might help you with your decision-maiking if you contact them - or may be able to put you in contact with someone who has used the treatment or a vet experieinced in its use. Resulting info may be a bit biased but may be useful.


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## paulineh (11 April 2010)

Last September one of my endurance horses damaged very badly the lower part of his right hind suspensory ligament (Large hole)

He is not a horse to be stabled but as long as the door is open or he can get into the field shelter he is fine(He is blind in one eye) so we made him a small corral around one of the stables, increasing the size as the weeks went on.

He had the normal treatment of Shock Wave and Adequan plus he also had the PRP treatment.I also gave him a combination of Homeopathic pills.At the moment he is bandaged all the time and he wears equaflex boots on exercise. Three months down the line and he was able to start walk exercise and now seven months down the line he is back in full work and I have entered him for a 65k (40 mile) endurance ride the first week end in May. I will watch which rides I enter him in for this season,but I do intend to do a race ride with him. 

PRP has worked well for us and I have no problem in recommending this treatment.I would go for it.

Just to add that he is not the easiest of horses to ride.


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## cavalo branco (11 April 2010)

This treatment sounds interesting and I'd also be keen to hear more about it. My boy has a RH proximal suspensory strain, I'm 2 months down the line but he's finding box rest hard - as am I  Also, sorry to highjack the post but could you tell me more about homeopathic suggestions? PM me if you prefer.


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## jumping.jack_flash (7 June 2017)

Hello, did this post get updated..... I'm now treating my horse for both hind Proximal Suspensory strains... and horse has had first round of shock wave.. been told to rest for 6 to 12 months and then possibly operate - de nerving, which I'm not keen on.

So, after lengthy emails and calls with my vet, explaining another vet practice was offering another treatment option, my Vet practice has agreed to do the following: Keep going with Shock Wave, will also do Laser therapy (although did not think there was any point), wait until all shock wave treatment is done, and then medicate hocks and PRP. If PRP works to speed up the healing process, then Im happy to pay for it. As not being able to ride, with a 7 year old horse on Part livery, who is basically a pet / happy hacker anyhow... its a very expensive hobby!

Anything I should be aware of, would appreciate all advise.


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## milliepops (7 June 2017)

There will be numerous threads on here about horses that have had PRP. Mine had it for a very badly damaged check ligament. I was told it was about the same in terms of effectiveness as stem cell, and a fraction of the cost. I had it done under insurance so it left plenty in the budget for other things.

I couldn't tell you whether it helped the healing etc, as I don't have a control to compare it to.  But we did have it fairly early, not sure where you are in terms of timescales but mine was booked in for about 10 days post injury? 

My mare made a good recovery *touch wood* from what was a pretty significant injury to the ligament (vet's original word was it was "mush"  ) she was late teens at the time of injury so healing was slower than would be in a young horse.

Is it front or hind legs? I'm assuming hinds.  I think the de-nerving is a very personal decision. Is he a candidate for the fasciotomy alone as that seems to help some quite a lot with fewer ethical issues for the owner.


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## hopscotch bandit (7 June 2017)

Friend used it for her gelding very sucessfully and horse in and out of vets on day of treatment in less than two hours. They inject blood out of neck and put in special bag thats hung up and the plasma then separates. Was inj back into leg for suspensoey branch treatment. Fascinating to watch as went with friend to support her.Horse went back to jumping for couplecof years and then had traumatic accident which resulted in calcification in branch and huge scar tissue which put an end to jumping after few yrs. Horse still in ridden exercise with varied hacking and fun rides but when schooled shows intermittent severe lameness which is eradicated on tarmac seconds later both when ridden and in hand. Very weird.


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## ihatework (7 June 2017)

PRP is probably best used on lesions.
Not sure I'd spend the money using it for a hind limb PSD which is what I presume you refer to. Echo Millie pops in that if doing more than shockwave I'd channel money into a fasciotomy and pay close attention to foot balance and training


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## jumping.jack_flash (9 June 2017)

Anyone had experience with Shock Wave and controlled exercise - did it work... or is an operation a fore gone conclusion - as if I'm honest... de nerving is not where I want to go.

FYI - Insurance covering it as a new Claim - hence I was wondering, is it not best to throw everything at it ?


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## jumping.jack_flash (13 June 2017)

Oops - just seen that I added again to the thread. Can you tell Im 'googling' everything ! ; )

Thanks all for your response. I feel a lot more happier having heard that you all went back to competing and having use of the horse after this treatment. Well second Wave Therapy is tomorrow. Horse is becoming a pain to handle.

I liked the comment about PRP - being given for lesions and at the start of treatment. In this case - I'm lucky as no lesions and term used is 'strain' - although I have no idea how the horse has strained it, as I was under the impression with all the road work and some schooling, the horse should of been ok. 

One last question - did any of you change the shoes for 'heart bar' ? Im of two minds of what I have read... and also have not helped myself from speaking with two separate practices (one saying shock wave and 6/12 months off work with heart bar shoes - then operate - and the other saying medicate, PRP etc and keep in gentle work and not changing the shoes). 

Thought process is... if I placed heart bar shoes on hinds, as 1st vet said.. for support... would the tendons not shorten as they heal... and then when changing back over to normal shoes.. will the tendons not stretch?

2nd vet commented on the horse is well shod. Had no bone changes, and the importance of keeping good balanced hoofs and to ride out on flat surfaces and take it easy. (I assume to also keep the horse sane).

Well.. sorry - data dumping as its driving me mad googling... and now the grooms are saying the horse is becoming difficult to handle... I want a speedy recovery - as moving yards is just an invitation for the horse to go bananas !


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## milliepops (13 June 2017)

Hmmm see I think I would prefer to have an obvious lesion which represents an acute injury rather than a non-existent specific "strain" which equates more to RSI than a one-off trauma  

It sounds like you need a bit more info from your vet to be able to make judgements re treatment options and prognosis. It sounds like your horse has PSD  from the surgical options offered?   Some horses do come back to a decent workload but others don't really improve :/

I don't think putting heartbars on is going to have a dramatic effect either way if that's the diagnosis,   good shoeing with appropriate length would be the important detail imo,  doesn't sound like wedges have been suggested.

With most soft tissue injuries time is the main factor in recovery,   time and careful controlled exercise. 

I'd have a chat with whoever the lameness specialist is at your practice and try to get it straight in your head with the expert on hand.


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## jumping.jack_flash (15 June 2017)

Thanks for reply, and sanity check.

So... 2nd shock wave yesterday. The vet (the one I've always had, who even did the vetting)  performed the shock wave said he didn't want to comment on treatment as was under another vet at the same practice. 

Spoke to vet at the same practice. I asked for clarity what the treatment plan now was as horse is becoming a little bit of a handful. So, horse will have a further 4 shock waves and also laser treatment. Then will medicate the hocks, and in the mean time, if I cant handle walking him in hand, I can under saddle for 30 , 40 mins. So I assume this means I can hack in walk?

The thing is, originally I was told, 6 - 12 months off work, shock wave... then operate, 3 weeks box rest and then re hab back to work.. and now, because I told my vet practice I had spoken to another practice on how they would treat this, as I felt I didn't want the horse operated on due to my own lack of knowledge what was involved, my practice said we can go down this route. Same route but has again changed, as no PRP mentioned now, which makes sense due to the previous comment in this thread - I get that... but... now I'm questioning how bad is this 'proximal suspensory'... because at the initial diagnosis, the way I was told, the horse had no chance basically would be PTS. 

So - exercise under saddle safest option:I will get back on this weekend, and ride down the road , round and back. My only concern is, in my head the horse is broken ? is it? or do I need to just get on with it .


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## Auslander (15 June 2017)

jumping.jack_flash said:



			My only concern is, in my head the horse is broken ? is it? or do I need to just get on with it .
		
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I've got a horse with PSD, and while he's vastly improved after lots of treatment/rest/rehab, I look upon him as fragile, and take great care with how I work him. Deep surfaces are out, and I rarely ride him in the school, although he's at a point now where he can cope with a bit of a play in there. I do hours and hours of walking on the road, as it's a stable surface, and only trot/canter when the ground is firm, but with a bit of give in it.
I look on it as similar to a person who has gone over badly on their ankle. It will get better, given time, but there will always be a higher risk of reinjury, so although horse has a relatively normal workload (bearing in mind his age/other issues), I take great care not to risk his legs by working him on dodgy ground.
Mine is getting on a bit, and his PSD was pretty severe, so I take each day that he is sound enough to ride as a blessing, and never expect anything from him


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## Pinkvboots (15 June 2017)

my horse had prp in 2015 for a hole in his hind nearside suspensory ligament they scanned both legs and the other one was fine, he had 5 months box rest then re scanned and it had healed and he looked sound, so we started walking under saddle and over about 4 months gradually got back to full work.

similar to auslander I am very careful with whatever he does I don't school to much no galloping no jumping and he has been fine his 13 now, they did offer me the De nerving if the prp didn't work but I would not have gone ahead it just doesn't sit right with me, I too take every day I have him to ride as being very lucky and never take him granted we are now hoping to do a few ridden shows this year.


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## milliepops (15 June 2017)

jumping.jack_flash said:



			So - exercise under saddle safest option:I will get back on this weekend, and ride down the road , round and back. My only concern is, in my head the horse is broken ? is it? or do I need to just get on with it .
		
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as with Aus, the ones I've known have been, essentially, rather fragile horses. If you want to keep them in work then caution is the best approach, but if you've been told to exercise him then quietly clip clopping round the road is the best option.

My oldie hasn't had PSD but she has had 2 ligament injuries and one tendon injury-all done in the field  She is in full work and competing again but I am extremely careful with her, because even though hers were acute injuries, the risk of reinjury is still there her regime is pretty similar to Aus's horse with loads of road hacking and I rarely find off-road ground that I'm happy with to take her for a canter.  She does 2 days a week in the school now and is fully sound, but these days we have left are precious and I know there will come a time when she can't do it any longer.

Vets can't really give you a definite prognosis with this kind of condition because it depends on so many factors, and luck is one of them. But don't be afraid to quiz them on the treatment options, you're paying for it so you should be clear on what you're choosing.


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## jumping.jack_flash (15 June 2017)

Thank you all... never thought I would be writing on the H&H with an issue... these forum's are very helpful and informative. and really pleased to hear that people are back out competing ! gives me that much needed boost of hope!.


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## jumping.jack_flash (19 June 2017)

Just been chasing up Vets - re treatment plan. This week Tuesday and Thursday - Laser Therapy / Next Week Wednesday 3rd Shock Wave / Following Monday and Thursday Laser Therapy / and then the following Wednesday 4th  Shock Wave.

So, yes I have been googling again, and reading over the H&H threads, and MP your point of RSI to me makes total sense, as when looking at the scans there are no black holes, or black gaps indicating 'lesions'. And where I work there are medics - who also have confirmed that there does not seem to be anything wrong... so the scans do look a little fuzzy in places.. no defined white lines.. but is this the scan or is the strain?

I would of liked to upload on here, but it has personal details of the horse and Vet practice, so best not to upload.

I have not ridden the horse since Friday 26th May - so it will be 4 weeks off work by the 23rd June = [ 

Anyone had laser therapy?

I guess my 5K insurance for this NEW Claim will be used up soon, as I googled how much just the shock wave treatment was and it over £209 pounds per session and that without the vets call out, and sedation. Lets hope the horse comes sound.


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## supsup (19 June 2017)

My horse was recently diagnosed with PSD in one hind leg. The vet was very thorough scanning both hinds, and the way I understood his explanation was that if the ligament is healthy, you should be able to see lines along the ligament. If all you see is grey dots all over ("disordered fibre pattern") it's a hint that there is some degeneration, likely something along the lines of an RSI or chronic injury, rather than something acute. He was also looking for a gap/black area between ligament and cannon bone. If that is gone or ill-defined, it can be a sign of thickening/swelling of the ligament. My gelding had a disordered fibre pattern and less well-defined space to the bone on the injured side.
However, he also has back issues and it's well possible the leg is actually secondary to the back problem. It's an ongoing story.

On the shoeing front: there seem to be two completely opposite approaches: My vet recommended shoes with a wide-web toe and narrow branches, and working on soft surfaces so that the heels sink in more. Apparently, this puts more load on the flexor tendon, but less on the suspensory ligament. Others seem to recommend the exact opposite - support the heel (with e.g. egg bar shoes) and avoid soft surfaces. My vet's explanation makes sense to me - there is a trade-off between the ligament and the tendon. You cannot unload/reduce the strain on the leg as a whole, unless the horse isn't using it. See here, for example:
http://brandonequine.com/publications/shoeing-the-horse-with-tendon-or-ligament-injury.pdf

The vet was quite clear that the special shoes were not likely to have any particular effect (different from normal shoes) unless I worked in my horse on a school surface. On firmer ground, the narrower branches obviously don't sink in, and the shoe acts just like a normal shoe. I figured I didn't have much to lose on that front, other than an extra £10 to the farrier to make the shoes.


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## ihatework (19 June 2017)

jumping.jack_flash said:



			Just been chasing up Vets - re treatment plan. This week Tuesday and Thursday - Laser Therapy / Next Week Wednesday 3rd Shock Wave / Following Monday and Thursday Laser Therapy / and then the following Wednesday 4th  Shock Wave.

So, yes I have been googling again, and reading over the H&H threads, and MP your point of RSI to me makes total sense, as when looking at the scans there are no black holes, or black gaps indicating 'lesions'. And where I work there are medics - who also have confirmed that there does not seem to be anything wrong... so the scans do look a little fuzzy in places.. no defined white lines.. but is this the scan or is the strain?

I would of liked to upload on here, but it has personal details of the horse and Vet practice, so best not to upload.

I have not ridden the horse since Friday 26th May - so it will be 4 weeks off work by the 23rd June = [ 

Anyone had laser therapy?

I guess my 5K insurance for this NEW Claim will be used up soon, as I googled how much just the shock wave treatment was and it over £209 pounds per session and that without the vets call out, and sedation. Lets hope the horse comes sound.
		
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The damaged bit of ligament in high PSD is in an area where the ligament runs through a groove in the lower part of the hock. Although the damage to the ligament isn't huge, there isn't room for the ligament to swell and then heal, so it presses on the local nerves and just niggles away. That is very non technical but hope it helps.
The fasciotomy procedure just gives the ligament a little more room and relieves some pressure. It is usually the next step after shockwave if you want to treat further (not everyone does). PSD can go hand in hand with other issues like sacro dysfunction or kissing spine.


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## jumping.jack_flash (19 June 2017)

Hummm thanks SupSup/ Ihatework,I'm going to go back to the scans and look. I know I should stop reading up, as I'm not getting the answer I'm looking for, as no matter what Im doing, the horse still has an issue needing to be addressed. I just don't understand how this has happened. Just got home and first invoice is in . .i was right, nearly 1.5k gone already. I'm disheartened. This is so unfair, I wish I could just wave a wand and make everything right. &#65533;&#65533;


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## milliepops (19 June 2017)

sadly horses do just get these kinds of injuries.  It seems unfair but it comes with the territory sadly. The stuff we do with them is totally unnatural and combined with the effects of bad luck/less than optimal conformation/some kind of underlying weakness that they were born with/working on surfaces etc etc... sometimes they just don't stand up to the work.

Don't drive yourself nuts reading stuff, just follow your nose with the treatment you've opted for, and keep your fingers crossed.  And be prepared to give it a lot of time.  

FWIW I think it can be hard to tell what you're looking at on scans until you've seen quite a few. (I have unfortunately!   ) so again, if your vets have pointed out the areas of interest then be prepared to take their word for it.


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## jumping.jack_flash (21 June 2017)

Thanks all!

First experience of laser therapy... was not that impressed.. but I will try anything.. even trying to book the 'Pope' to come and do a blessing over the horse!

Have saved the article on corrective shoeing (thanks ) going to show it to others at the yard, as it made good reading.

Horse had physio yesterday - turned more into a therapy session for me ; )  You know, us guys can be more oversensitive than you ladies give credit for ; ) 

Well have a good day all... 2nd laser this tomorrow and 3rd shock wave next Wednesday....!


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## jumping.jack_flash (5 July 2017)

Just giving an update....

Have been told to ride the horse for 30 min's a day in walk, as apparently this will stimulate the blood  / cells to go to the area required for healing. So to night will be my 4th time back on since the 26th May. I'm trying to do this 30 min exercise in between the laser treatments (4th Shock Wave next week). So far so good.

It is typical though, each time going out, there has always been a skip lorry / scaffolding lorry, funny thing is.. its the killer pigeons my lad does not like ; )


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