The connections of harness racing pinup pacer Carabella will have a new therapy to thank if she makes it back to the racetrack - one which is poised to revolutionise the treatment of damaged tendons and ligaments.
Christchurch's Robert Famularo, owner of the Harness Horse of the Year, had no hesitation in sending Carabella to the Canterbury Equine Clinic for platelet rich plasma therapy, given the recent explosion in its popularity overseas.
Veterinarians at the clinic expect PRP therapy to soon become the No1 choice here as evidence emerges of how it promotes better and faster healing of career-threatening injuries.
Successfully employed in human medicine for years, the therapy is now being sought by racehorse owners worldwide, its relatively affordable cost virtually relegating expensive stem-cell surgery to the bench.
Famularo, ever the trailblazer in harness racing technology, sought the advice of the Canterbury Equine Clinic after Carabella damaged the ligament in her near foreleg when beating Bettor Cover Lover in her last race at Addington in February.
And two weeks ago, clinic surgeon Guy Alexander performed the treatment on the exciting mare, winner of 17 of her 19 starts for trainer Brendon Hill.
Alexander became familiar with the procedure during a stint at the Dubai Equine Hospital, where he treated more than 100 horses, many of them endurance racers.
In essence, PRP relies on the rare healing power of the blood's platelets, which contain key growth factors.
Blood is taken from the horse's jugular vein and spun in a centrifuge for 15 minutes to separate the plasma from the red blood cells.
After a further eight minutes of spinning, the platelets are isolated at the bottom of the tube and the remaining fluid is discarded.
The platelets, between two and 10 times more concentrated than in normal blood, are then injected into the lesion, guided to the exact spot using ultrasound.
The benefit of PRP lies in the nature of the healing. Historically, horses with tendon and ligament injuries have a poor prognosis because while the scar tissue is strong, it lacks the elasticity of healthy tendons.
"And it creates a stress point between the scar and where it attaches," Alexander says.
Damaged tendons tend to repair themselves with type 3 collagen, short fibres with many cross links, which do not move as independently and so become functionally inferior.
But PRP reduces the risk of re-injury because the platelets cause the tendon to be repaired with type 1 collagen, which is made up of long fibres, with few cross links.
"It's more like tendon and less like scar tissue," he says.
"But I tell people that their horse had a normal tendon and whatever they do, it will still be inferior to what the horse had to start with.
"This is not a cure-all - everyone is searching for the perfect solution - but it's better than rehabilitation alone and better than stem cells, which nobody in UK racing stables uses any more. It's a lot more expensive because the cells have to be cultured, and the trainers perceive PRP is working better."
Alexander said on a three-point scale of mild, moderate and marked, he rated Carabella's injury as moderate to marked.
The presence of two smaller lesions, on top of one other, elevated it from moderate.
"Had she not had PRP I would say her prognosis for racing again was fair. With the treatment I'd say her prognosis is good."
While recovery times varied from one individual to another, Alexander said he hoped Carabella could resume training in no more than nine months. The mare's progress will be established at a follow-up ultrasound exam two months after treatment.
That's a scenario which pleases Famularo. "We're thinking we don't have a racehorse for a year, and possibly not ever, and anything else is a bonus.
"We're in no panic with her, we'll take our time and go quietly, she's still young [four].
"She gets a little stroppy being kept in her box, but is handling it well."
Alexander cautions that while PRP therapy not only improves the quality of healing but speeds recovery, adequate rest is still crucial.
In Dubai, his attempts to keep track of PRP's success was hindered by trainers rushing horses back into racing without proper rehab, sometimes after only a month.
It is crucial, he says, that injured horses are rehabilitated correctly, not just thrown out into a paddock - as often happens here - to reduce chances of a repeat injury.
His patients follow a strict regime, confined for a week before a carefully controlled programme of first walking, then trotting, starting with just a few minutes a day.
Everything is designed to slowly strengthen the injured leg and progress is monitored with follow-up scans.
While PRP technology is extensively used to treat humans, is very popular with orthopaedic surgeons, and is supported with copious studies, Alexander rues the dearth of research in the equine world, despite its use on very valuable horses.
He has been forced to rely on anecdotal evidence when advising how soon after injury to treat the animal, and whether repeat injections might help.
The Canterbury clinic offers PRP for about $1100, with a day stay required so it can be done under sterile conditions.
The cost of treatment is a little more in the North Island. Waikato clinics quote about $1500.
Courtesy of Barry Lichter and the Sunday Star Times