Navicular bone surgery with BMAC shows promise in refractory cases
Bottom line
Navicular bone surgery with BMAC shows promise in refractory cases
A retrospective clinical study in Veterinary Surgery reports that core decompression augmented with autologous bone marrow aspirate concentrate, or BMAC, helped horses with moderate-to-severe distal sesamoid bone pathology that hadn't improved with conservative care. The report describes 67% long-term soundness after treatment, with MRI follow-up at 6 months showing reduced STIR hyperintensity and increased T1 signal interpreted as revascularization, and some horses showing partial to complete trabecular remodeling on later radiographs. The authors frame the approach as a way to combine pressure relief from core decompression with a biologic repair strategy for advanced navicular bone disease. (researchgate.net)
Why it matters: For equine veterinarians, this adds to a small but growing body of evidence that bone-directed intervention may help a subset of horses whose lameness is driven by MRI-confirmed distal sesamoid bone pathology rather than primarily soft-tissue disease. The study's inclusion criteria required chronic foot lameness localized by diagnostic analgesia, MRI-confirmed trabecular pathology, failed conservative treatment, and at least 6 months of clinical, radiographic, and MRI follow-up. That makes the findings most relevant for carefully selected referral cases, not as a first-line option. Earlier equine work showed core decompression can reduce intraosseous pressure and stimulate remodeling, while a prior five-horse case series from the same line of work suggested BMAC-augmented decompression might be feasible for navicular cyst-like lesions. (researchgate.net)
What to watch: The next step is whether a larger controlled study can show that adding BMAC improves outcomes beyond core decompression alone, and define which imaging patterns predict the best response. (researchgate.net)
Key facts
- Study type
- Retrospective clinical study
- Journal
- Veterinary Surgery
- Species
- Horses
- Condition
- Moderate-to-severe distal sesamoid bone pathology
- Treatment
- Core decompression augmented with autologous bone marrow aspirate concentrate, or BMAC
- Population
- Horses with chronic foot lameness that failed conservative treatment
- Outcome
- 67% achieved long-term soundness
- Imaging follow-up
- MRI at 6 months showed reduced STIR hyperintensity and increased T1 signal, interpreted as revascularization
- Study period
- Treated between 2021 and 2024
A new retrospective equine surgery study suggests core decompression paired with autologous bone marrow aspirate concentrate may offer another option for horses with refractory distal sesamoid bone pathology, a difficult subset of navicular disease cases that often perform poorly with standard medical management. In the reported cohort, 67% of horses achieved long-term soundness, and follow-up imaging suggested biologic activity within the treated bone, including MRI changes consistent with revascularization and later radiographic remodeling in some cases. (researchgate.net)
The work builds on a long-running effort to better target the osseous component of podotrochlear disease. Earlier experimental research in healthy horses found that navicular bone core decompression reduced peak intraosseous pressure and produced remodeling and neovascularization near the drill sites, with only mild, short-lived postoperative lameness. More recently, a randomized self-controlled case series in Quarter Horses with navicular cyst-like lesions found greater lameness improvement in limbs treated with core decompression than in limbs treated with bursoscopy alone. (pubmed.ncbi.nlm.nih.gov)
In this newer report, the authors studied horses treated between 2021 and 2024 that had chronic foot lameness localized by diagnostic analgesia, MRI-confirmed distal sesamoid bone trabecular pathology, failed conservative treatment, and postoperative follow-up including MRI at 6 months. The procedure was performed endoscopically, with BMAC prepared while the horse was under general anesthesia. Postoperative management included a hoof cast, 2 weeks of box rest, 10 weeks of hand and ridden walking, and 6 weeks of trotting before reassessment. Clinical and radiographic follow-up extended from 6 to 48 months. (researchgate.net)
The rationale is familiar from human orthopedics. In the study materials, the authors note that core decompression is used in human osteonecrosis to reduce intraosseous pressure, support perfusion, and promote bone remodeling, while BMAC is intended to add osteogenic and trophic support. Their translational conference presentation goes further, reporting that 67% of horses returned to soundness and training by 6 months, with those outcomes sustained at 12 to 18 months in the horses that responded. A prior five-horse case series on navicular cyst-like lesions from the same group reported three horses becoming sound after drilling and BMAC instillation, with no major complications observed. (researchgate.net)
There doesn't appear to be much independent expert commentary on this specific paper yet, but the broader field is moving in the same direction: toward better phenotyping of heel pain and more targeted treatment of bone pathology when imaging supports it. That said, the evidence base remains early. The conference and case-series materials themselves emphasize that larger controlled studies are needed, and the prior literature on navicular disease also reflects ongoing debate about pathogenesis, with vascular, pressure-related, and biomechanical remodeling theories all still relevant. (researchgate.net)
Why it matters: For veterinary professionals, the practical takeaway is that this is a referral-level, imaging-driven option for selected horses with advanced navicular bone disease that haven't improved with shoeing, medications, biologics, or joint and bursal therapies. It may be especially relevant when MRI points to trabecular bone edema, osteonecrosis, or cyst-like lesions as the dominant pain source, and when soft-tissue pathology isn't the main finding. But it's not ready to be viewed as standard of care. The current evidence comes from retrospective and small case-series data, and the study materials acknowledge limitations including small numbers, lack of objective gait analysis, and no control for hoof conformation. (researchgate.net)
What to watch: The key questions now are whether peer-reviewed publication of the full dataset confirms the conference findings, whether comparative studies can separate the contribution of BMAC from decompression alone, and whether MRI features can help clinicians identify likely responders before surgery. (researchgate.net)