{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T15:06:07Z","timestamp":1779203167470,"version":"3.51.4"},"reference-count":18,"publisher":"American Veterinary Medical Association (AVMA)","issue":"S1","license":[{"start":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T00:00:00Z","timestamp":1780358400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["javma"],"published-print":{"date-parts":[[2026,6,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To describe principles of ultrasound-guided injection techniques for intralesional delivery of regenerative orthobiologics into equine tendon and ligament core lesions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Animals<\/jats:title>\n                    <jats:p>A university-owned horse and equine cadaver forelimbs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A reproducible protocol for ultrasound-guided injection is demonstrated with the superficial digital flexor tendon used as an example. Following diagnosis of the lesion, the horse should be sedated and the affected limb desensitized with perineural anesthesia. The lesion is identified ultrasonographically in transverse and longitudinal planes, marked externally, and aseptically prepared. Under sterile conditions, the needle is placed through the skin, viewed on ultrasound, advanced to the lesion\u2019s hypoechoic core or region of fiber disruption, and stabilized during attachment of the syringe and subsequent injection. Injectate volume is governed by product type and lesion size, with platelet-rich plasma (PRP), bone marrow aspirate concentration (BMAC), mesenchymal stem cells (MSCs), and autologous conditioned serum or protein solution (ACS\/APS) representing the most commonly used equine orthobiologics. Ultrasound monitoring throughout the injection confirms intralesional placement and dispersion of the injectate.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Ultrasound guidance enables precise intralesional placement and real-time observation of injectate dispersion. Current clinical opinion suggests injecting tendon\/ligament injuries during the sub-acute phase or within a few weeks of injury. The technique minimizes iatrogenic trauma and improves delivery accuracy for regenerative treatments.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Relevance<\/jats:title>\n                    <jats:p>Ultrasound-guided intralesional injection is an accessible and effective method to enhance the precision, safety, and therapeutic success of orthobiologic delivery in equine tendon and ligament injuries.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2460\/javma.25.12.0786","type":"journal-article","created":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T14:17:28Z","timestamp":1774016248000},"page":"S10-S11","source":"Crossref","is-referenced-by-count":0,"title":["Ultrasound-guided intralesional tendon and ligament injections in the horse"],"prefix":"10.2460","volume":"264","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5652-7827","authenticated-orcid":true,"given":"Charl\u00e8ne","family":"Pig\u00e9","sequence":"first","affiliation":[{"name":"Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8820-7192","authenticated-orcid":true,"given":"Betsy","family":"Vaughan","sequence":"additional","affiliation":[{"name":"Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8534-8839","authenticated-orcid":true,"given":"Heidi L.","family":"Reesink","sequence":"additional","affiliation":[{"name":"Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1272","reference":[{"issue":"20-22","key":"ref1","series-title":"Disabil Rehabil","first-page":"1752","article-title":"Mesenchymal stem cell therapy for equine tendinopathy","volume":"30","author":"Smith RKW","year":"2008","unstructured":"Smith RKW. Mesenchymal stem cell therapy for equine tendinopathy. Disabil Rehabil. 2008;30(20-22):1752-1758. doi:10.1080\/09638280701788241"},{"key":"ref2","series-title":"Proceedings of the 55th Annual Convention of the American Association of Equine Practitioners","article-title":"How to improve accuracy of ultrasound-guided procedures","author":"Vaughan B","year":"2009","unstructured":"Vaughan B, Whitcomb M, Maher O. How to improve accuracy of ultrasound-guided procedures. In: Proceedings of the 55th Annual Convention of the American Association of Equine Practitioners. American Association of Equine Practitioners; 2009. Accessed December 1, 2025. https:\/\/www.semanticscholar.org\/paper\/How-to-Improve-Accuracy-of-Ultrasound-Guided-Vaughan-Whitcomb\/7bd93062fe84b3d19f9c3009ce9492f3b01cb1cb"},{"issue":"1","key":"ref3","series-title":"Stem Cell Res Ther","first-page":"126","article-title":"Effect of a single injection of autologous conditioned serum (ACS) on tendon healing in equine naturally occurring tendinopathies","volume":"6","author":"Geburek F","year":"2015","unstructured":"Geburek F, Lietzau M, Beineke A, Rohn K, Stadler PM. Effect of a single injection of autologous conditioned serum (ACS) on tendon healing in equine naturally occurring tendinopathies. Stem Cell Res Ther. 2015;6(1):126. doi:10.1186\/s13287-015-0115-0"},{"issue":"1","key":"ref4","series-title":"BMC Vet Res","first-page":"191","article-title":"Effect of intralesional platelet-rich plasma (PRP) treatment on clinical and ultrasonographic parameters in equine naturally occurring superficial digital flexor tendinopathies\u2014a randomized prospective controlled clinical trial","volume":"12","author":"Geburek F","year":"2016","unstructured":"Geburek F, Gaus M, van Schie HTM, Rohn K, Stadler PM. Effect of intralesional platelet-rich plasma (PRP) treatment on clinical and ultrasonographic parameters in equine naturally occurring superficial digital flexor tendinopathies\u2014a randomized prospective controlled clinical trial. BMC Vet Res. 2016;12(1):191. doi:10.1186\/s12917-016-0826-1"},{"issue":"5","key":"ref5","series-title":"Vet Surg","first-page":"731","article-title":"Effect of needle diameter on the viability of equine bone marrow derived mesenchymal stem cells","volume":"46","author":"Lang HM","year":"2017","unstructured":"Lang HM, Schnabel LV, Cassano JM, Fortier LA. Effect of needle diameter on the viability of equine bone marrow derived mesenchymal stem cells. Vet Surg. 2017;46(5):731-737. doi:10.1111\/vsu.12639"},{"issue":"6","key":"ref6","series-title":"Equine Vet J","first-page":"979","article-title":"Treatment of racehorse superficial digital flexor tendonitis: a comparison of stem cell treatments to controlled exercise rehabilitation in 213 cases","volume":"55","author":"Salz RO","year":"2023","unstructured":"Salz RO, Elliott CRB, Zuffa T, Bennet ED, Ahern BJ. Treatment of racehorse superficial digital flexor tendonitis: a comparison of stem cell treatments to controlled exercise rehabilitation in 213 cases. Equine Vet J. 2023;55(6):979-987. doi:10.1111\/evj.13922"},{"issue":"4","key":"ref7","series-title":"Stem Cell Res Ther","first-page":"94","article-title":"Viability of equine mesenchymal stem cells during transport and implantation","volume":"5","author":"Garvican ER","year":"2014","unstructured":"Garvican ER, Cree S, Bull L, Smith RK, Dudhia J. Viability of equine mesenchymal stem cells during transport and implantation. Stem Cell Res Ther. 2014;5(4):94. doi:10.1186\/scrt483"},{"issue":"S1","key":"ref8","series-title":"J Am Vet Med Assoc","first-page":"S50","article-title":"Stem cells and platelet-rich plasma for the treatment of naturally occurring equine tendon and ligament injuries: a systematic review and meta-analysis","volume":"262","author":"M\u2019Cloud WRC","year":"2024","unstructured":"M\u2019Cloud WRC, Guzm\u00e1n KE, Panek CL, Colbath AC. Stem cells and platelet-rich plasma for the treatment of naturally occurring equine tendon and ligament injuries: a systematic review and meta-analysis. J Am Vet Med Assoc. 2024;262(S1):S50-S60. doi:10.2460\/javma.23.12.0723"},{"key":"ref9","series-title":"Ultrasound-Guided Procedures in Equine Orthopedics and Surgery","author":"Estrada RJ","year":"2024","unstructured":"Estrada RJ. Ultrasound-Guided Procedures in Equine Orthopedics and Surgery. SpringerCham; 2024. doi:10.1007\/978-3-031-17562-6"},{"issue":"20-22","key":"ref1","series-title":"Disabil Rehabil","first-page":"1752","article-title":"Mesenchymal stem cell therapy for equine tendinopathy","volume":"30","author":"Smith RKW","year":"2008","unstructured":"Smith RKW. Mesenchymal stem cell therapy for equine tendinopathy. Disabil Rehabil. 2008;30(20-22):1752-1758. doi:10.1080\/09638280701788241"},{"key":"ref2","series-title":"Proceedings of the 55th Annual Convention of the American Association of Equine Practitioners","article-title":"How to improve accuracy of ultrasound-guided procedures","author":"Vaughan B","year":"2009","unstructured":"Vaughan B, Whitcomb M, Maher O. How to improve accuracy of ultrasound-guided procedures. In: Proceedings of the 55th Annual Convention of the American Association of Equine Practitioners. American Association of Equine Practitioners; 2009. Accessed December 1, 2025. https:\/\/www.semanticscholar.org\/paper\/How-to-Improve-Accuracy-of-Ultrasound-Guided-Vaughan-Whitcomb\/7bd93062fe84b3d19f9c3009ce9492f3b01cb1cb"},{"issue":"1","key":"ref3","series-title":"Stem Cell Res Ther","first-page":"126","article-title":"Effect of a single injection of autologous conditioned serum (ACS) on tendon healing in equine naturally occurring tendinopathies","volume":"6","author":"Geburek F","year":"2015","unstructured":"Geburek F, Lietzau M, Beineke A, Rohn K, Stadler PM. Effect of a single injection of autologous conditioned serum (ACS) on tendon healing in equine naturally occurring tendinopathies. Stem Cell Res Ther. 2015;6(1):126. doi:10.1186\/s13287-015-0115-0"},{"issue":"1","key":"ref4","series-title":"BMC Vet Res","first-page":"191","article-title":"Effect of intralesional platelet-rich plasma (PRP) treatment on clinical and ultrasonographic parameters in equine naturally occurring superficial digital flexor tendinopathies\u2014a randomized prospective controlled clinical trial","volume":"12","author":"Geburek F","year":"2016","unstructured":"Geburek F, Gaus M, van Schie HTM, Rohn K, Stadler PM. Effect of intralesional platelet-rich plasma (PRP) treatment on clinical and ultrasonographic parameters in equine naturally occurring superficial digital flexor tendinopathies\u2014a randomized prospective controlled clinical trial. BMC Vet Res. 2016;12(1):191. doi:10.1186\/s12917-016-0826-1"},{"issue":"5","key":"ref5","series-title":"Vet Surg","first-page":"731","article-title":"Effect of needle diameter on the viability of equine bone marrow derived mesenchymal stem cells","volume":"46","author":"Lang HM","year":"2017","unstructured":"Lang HM, Schnabel LV, Cassano JM, Fortier LA. Effect of needle diameter on the viability of equine bone marrow derived mesenchymal stem cells. Vet Surg. 2017;46(5):731-737. doi:10.1111\/vsu.12639"},{"issue":"6","key":"ref6","series-title":"Equine Vet J","first-page":"979","article-title":"Treatment of racehorse superficial digital flexor tendonitis: a comparison of stem cell treatments to controlled exercise rehabilitation in 213 cases","volume":"55","author":"Salz RO","year":"2023","unstructured":"Salz RO, Elliott CRB, Zuffa T, Bennet ED, Ahern BJ. Treatment of racehorse superficial digital flexor tendonitis: a comparison of stem cell treatments to controlled exercise rehabilitation in 213 cases. Equine Vet J. 2023;55(6):979-987. doi:10.1111\/evj.13922"},{"issue":"4","key":"ref7","series-title":"Stem Cell Res Ther","first-page":"94","article-title":"Viability of equine mesenchymal stem cells during transport and implantation","volume":"5","author":"Garvican ER","year":"2014","unstructured":"Garvican ER, Cree S, Bull L, Smith RK, Dudhia J. Viability of equine mesenchymal stem cells during transport and implantation. 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