Core decompression augmented with bone marrow aspirate concentrate for refractory distal sesamoid bone pathology in horses: A retrospective clinical study.

Core decompression with BMAC may enable return to function in horses with refractory navicular bone pathology.

This retrospective observational study evaluated the outcomes of arthroscopic core decompression combined with autologous bone marrow aspirate concentrate (BMAC) in 21 Warmblood horses with moderate-to-severe distal sesamoid bone (navicular bone) trabecular pathology refractory to conservative management. Diagnosis was confirmed via diagnostic analgesia and MRI prior to surgery. The procedure involved arthroscopic core decompression through the palmar recess of the distal interphalangeal joint, followed by intraosseous BMAC injection. No major intraoperative or postoperative complications were recorded across all 21 horses. Nine horses met criteria for full long-term follow-up including clinical evaluation, radiography, and MRI at 6 and 18 months postoperatively. At 6 months, 67% (6/9) of these horses were sound and had returned to training, with MRI demonstrating reduced STIR hyperintensity and improved T1-weighted signal indicative of decreased active trabecular pathology. Three horses remained persistently lame with static MRI findings. At 18 months, six horses maintained soundness and three returned to their previous or intended performance levels. Radiographic evidence of cyst-like lesion remodeling was observed in three cases. Limitations include the small sample size, retrospective design, incomplete long-term follow-up in 12 of 21 horses, and absence of a control group. Despite these limitations, this combined surgical-orthobiologic approach appears well-tolerated and may represent a promising therapeutic option for horses with advanced, refractory navicular bone pathology unresponsive to conventional treatments.

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