The past 15 years have brought significant science-backed advancements in treatment options for equine musculoskeletal injuries.

In the realm of equine health, few challenges capture the attention of veterinarians and scientists quite like orthopedic disorders. These conditions are not limited to osteoarthritis (OA)—one of the top causes of lameness, poor performance, and loss of use in equine athletes—but also encompass issues affecting related soft tissues. Fortunately, a wave of innovative orthopedic therapies is reshaping how these issues are managed, offering hope for improved recovery and longevity in equine athletes.

For instance, “veterinarians worldwide are making major strides in regenerative therapeutics research,” says Catherine Thurston, VMD, Dipl. ACVS-LA, an equine surgeon at the Mid-Atlantic Equine Medical Center, in Ringoes, New Jersey.

Let’s take stock of the recent research studies on orthopedic therapies and how find­ings are enhancing the health and performance of sport horses today. We’ll focus mainly on osteoarthritis but also touch on related soft tissue.

Where Do We Stand with Equine Orthopedic Therapies Today?

Last year a group of Spanish researchers published a comprehensive review of regenerative medicine applications in equine musculoskeletal injuries¹. The authors established that tendons, ligaments, and cartilage—all of which have a restricted ability to self-heal—are the tissues horses most commonly injure.

In their review of seven different clinical studies, they determined that three distinct therapies—autologous conditioned serum (ACS), platelet-rich plasma (PRP), and mesenchymal stem cells (MSCs)—have emerged as the leading innovations in equine orthopedics. (Technically, all three approaches are autologous, which means originating from the patient, though MSCs can also be allogeneic, or obtained from a donor horse.) “Autologous protein solution, IRAP (interleukin-1 receptor antagonist protein, generated through ACS production), and stem cells are the intra-articular regenerative therapies I am most likely to reach for,” says Thurston.

Leah Walker, DVM, Dipl. ACVSMR, of Cave Creek Equine Hospital, in Phoenix, Arizona, applies many of the same orthopedic therapies. Her practice commonly uses stem cells, PRP, IRAP, and ACS. She also has experience with an allogeneic regenerative product that combines PRP and IRAP with other proteins and growth factors from equine amnion, designed to facilitate healing and tissue repair.

“The progress equine veterinarians have seen with regenerative joint therapies in recent years is extraordinary,” says Walker. Thanks to these advancements, today’s sport horse can benefit from reduced recovery time and improved healing. More specifically, researchers have suggested that regenerative therapies are disease-modifying agents because they promote better regeneration of fibrocartilaginous tissue, improved cellular organization, and improved joint functionality over symptom-modifying agents such as corticosteroid injections. “The use of these (regenerative) treatments early on in the healing process can make a real difference in the career longevity of these athletes,” says Thurston.

A Look at the Past 13 Years in Equine Orthopedics

In a 2022 survey of 407 U.S.-based equine veterinarians, triamcinolone acetonide and methylprednisolone emerged as the most commonly used corticosteroids for treating high-motion and low-motion joints, respectively. These drug choices align with the 2009 survey results. However, “continued research has guided practitioners in making more educated steroid selections based on the type of joint they are treating and the degree of pathology present,” says Walker. “And while adding hyaluronic acid (HA, to intra-articular injections) is still very common, I’m seeing a trend where more practitioners are combining corticosteroids with either an orthobiologic agent or polyacrylamide gel instead