Racehorse repair you can bet on to f ix an Achilles tear
STEM-CELL surgery first used to help a champion racehorse get back to winning ways is now being offered to NHS patients with a damaged Achilles tendon. The groundbreaking medical innovation was pioneered by specialists at the Royal Veterinary College in Liverpool and involves stem cells being taken from the bone marrow and reinjected into the damaged tendon, helping it to heal.
The most famous recipient of the treatment is Dream Alliance – a thoroughbred who suffered a dramatic and potentially careerending injury while competing in a hurdle race at Aintree in 2008.
After the stem-cell treatment, he defied all odds to make a full recovery and went on to win the 2009 Welsh Grand National.
Researchers at the Royal National Orthopaedic Hospital in London have studied evidence from 1,500 horses treated in the same way – noting that their reinjury rate fell by 50 per cent.
Andy Goldberg, consultant orthopaedic surgeon and senior lecturer at University College London, said: ‘Tendon injuries in horses are identical to those in humans, and using this evidence we were able to persuade the regulators to allow us to launch a small safety study in humans.’
The Achilles tendon is a tough band of tissue that connects the calf muscles to the heel bone. About 85,000 Britons each year suffer damage to the area. Many are top sportsmen – David Beckham famously completely tore his Achilles during a match in 2010 – but far more common than a total rupture is a milder injury called tendinopathy, in which the ligament starts to become frayed, with strands peeling away, and often becoming inflamed too.
Patients can rest and apply ice: they may also do special stretching and strengthening exercises, but often patients have years of pain.
Now, stem-cell surgery is being offered to a select number of NHS patients in the Autologous Stem Cells in Achilles Tendinopathy (ASCAT) trial.
Doctors take 6ml of bone marrow from the back of the patient’s hip. They culture those stem cells in a laboratory for four or five weeks until they reach several million.
In a second procedure, the cells are reinjected into the Achilles. The patient then begins six months of physiotherapy.
Doctors do not yet fully understand how the stem cells prompt growth: either they grow into new tendon cells in the body, or they act as a conductor and create the right environment for the tendon to regenerate. But for the first few patients, results have been good.
Jill James, 46, from South-East London, was the trial’s first patient. She had always been a keen walker and loved skiing. Two years ago, her right ankle started to hurt unbearably. ‘If there had been a fire, I couldn’t have got out of the house in a hurry,’ she says.
She had ultrasound scans and physiotherapy, and her physiotherapist then told her about the trial. ‘I worried, because no one had ever had it before, except a horse,’ she says. ‘But I was more worried I’d end up in a wheelchair.’
In 2015, Mr Goldberg carried out the procedure on Jill. ‘The difference now is amazing,’ she says. ‘I can do five miles on the treadmill without pain, and take my dog Honey on long walks again.’
Mr Goldberg said: ‘It won’t work for everyone, for reasons that may be governed by their genes or the effectiveness of their stem cells. But for the first time, we now have a non-surgical treatment for tendinopathy which could one day help many more.’
The ASCAT trial is funded by the UK Stem Cell Foundation and is still recruiting.