The influence of exercise during growth on ultrasonographic parameters of the superficial digital flexor tendon of young Thoroughbred horses

Equine tendon mechanical behaviour: Prospects for repair and regeneration applications

Tendons are dense connective tissues that play an important role in the biomechanical function of the musculoskeletal system. The mechanical forces have been implicated in every aspect of tendon biology. Tendon injuries are frequently occurring and their response to treatments is often unsatisfactory. A better understanding of tendon biomechanics and mechanobiology can help develop treatment options to improve clinical outcomes. Recently, tendon tissue engineering has gained more attention as an alternative treatment due to its potential to overcome the limitations of current treatments. This review first provides a summary of tendon mechanical properties, focusing on recent findings of tendon mechanobiological responses. In the next step, we highlight the biomechanical parameters of equine energy-storing and positional tendons. The final section is devoted to how mechanical loading contributes to tenogenic differentiation using bioreactor systems. This study may help develop novel strategies for tendon injury prevention or accelerate and improve tendon healing.

Equine flexor tendon imaging part 1: Recent developments in ultrasonography, with focus on the superficial digital flexor tendon

Flexor tendon injuries are a major cause of lameness in performance horses and have considerable impact on equine welfare and the wider horse industry. Ageing and repetitive strain frequently cause varying degrees of tendon micro-damage prior to the recognition of clinical tendinopathy. Whilst B-mode ultrasonography is most commonly utilised for detection and monitoring of tendon lesions at the metacarpal/metatarsal level, the emphasis of recent research has focused on the identification of subclinical tendon damage in order to prevent further tendon injury and improve outcomes. The introduction of elastography, acoustoelastography and ultrasound tissue characterisation in the field of equine orthopaedics shows promising results and might find wider use in equine practice as clinical development continues. Based on the substantial number of research studies on tendon imaging published over the past decade this literature review aims to examine the currently used ultrasonographic imaging techniques and their limitations, and to introduce and critically appraise new modalities that could potentially change the clinical approach to equine flexor tendon imaging.

Training Young Horses: The Science behind the Benefits

Simple Summary

Of common debate among equine professionals and enthusiasts alike, is whether entering race training at two years of age is detrimental or beneficial to the animal’s career and growth. This literature review evaluates epidemiological studies to elucidate that two-year-old horses are not at greater risk of injury compared to older horses. Horses which enter race training at two years of age are, in fact, found to have greater earnings and longer race careers. This review also tackles the impact that exercising an animal at two years of age or younger has on bone, articular cartilage, and tendons. Numerous studies on growing animals have found confinement to be detrimental to normal musculoskeletal growth. However, exercise of dynamic nature in moderate distances, such as that attained with pasture access or prescribed sprints, is beneficial to musculoskeletal development and may prevent injuries when entering race training. Based on scientific evidence, the research cited in this review supports the training and racing of two-year-old horses and advises caution in the use of medications such as corticosteroids.

Abstract

Conflicting research and anecdotal evidence have created disagreement among equestrians as to whether two-year-old horses should be trained and raced. The objective of this literature review is to evaluate epidemiological studies, as well as physiological data on equine bone, articular cartilage, and tendons to better determine the impact of training and racing two-year-old horses. The evaluation of numerous studies on the topic provides evidence that a horse which is trained or raced as a two-year-old has a lower risk of injury and better adapted tissues for the rigors of racing. Unfortunately, the current prolific use of pain-mitigating substances in the racing industry does place horses, including young cohorts, at greater risk of injury, and should be used with caution.

Equine musculoskeletal development and performance: impact of the production system and early training

The welfare debate around horse racing appears to be focussed on musculoskeletal injury and the racing of 2-year-olds. Much of this debate appears contrary to the evolutionary history of the horse as a cursorial animal and the capability of the equine musculoskeletal system to respond to the demands of race training. Epidemiological studies have reported that 2-year-old racehorses have a longer time period from entering training to the first race and a greater number of lost training days than older horses. However, this is, in part, due to the time taken to learn to train and the impact of dorsal metacarpal disease, which is due to loading of naïve as opposed to immature tissue. Across several racing jurisdictions and codes, it has been demonstrated that horses that train and race as 2-year-olds have longer, more successful, careers than those that start racing later in life. This positive trend has also been observed with horses starting in equestrian sport at an early age. The literature on the growth and development of the horse indicates that the musculoskeletal system is primed for activity and loading from an early age. Additional exercise for the young horse has a positive rather the negative effect, with many tissues having a sensitive period for ‘priming’ when the horse is a juvenile. This implies that under many modern management systems, the challenge to horse welfare is not ‘too much exercise too soon’ but ‘too little too late’. The current limitation in our understanding is the lack of knowledge of what is the correct exercise dose to optimise the musculoskeletal system. Modern management systems invariably provide too little exercise, but is the exercise data from feral horses the ‘gold standard’, or more a reflection of what the horse is capable of if resources such as food and water are limited? Further research is required to refine our understanding of the optimal exercise levels required and development of greater precision in identifying the sensitive periods for priming the musculoskeletal system.

Temporal and spatial changes in bone accrual, density, and strain energy density in growing foals

Bone adaptation is in part driven by mechanical loading, and exercise during youth has been shown to have life-long benefits for bone health. However, the development of early exercise-based interventions that reduce the incidence of fractures in racing horses is limited by the lack of characterization of normal development in growing bone. Previous efforts to quantify bone development in the horse have relied on repeated radiographs or peripheral quantitative computed tomography scans, which are limited in their assessment of the entire bone. In this study, we acquired computed tomography scans of three Standardbred trotting colts longitudinally between 2 and 12 months of age. Finite-element models were constructed of the left forelimb proximal phalanx and used to assess strain energy density during quiet standing. Growth related changes in mineral density and bone area fraction in the distal epiphysis, mid-diaphysis, and proximal epiphysis were evaluated. Mineral density and bone area fraction uniformly increased in the diaphysis and strain energy density was constant during growth, indicating adaptation to quiet standing. Bone mineral density and bone area fraction increased in the medial quadrant of the proximal epiphysis but not in the fracture-prone lateral quadrant. The data presented provides a benchmark of normal growth trajectories that can be used to evaluate the effect of training regimens during growth.

The Effect of Training on Stride Duration in a Cohort of Two-Year-Old and Three-Year-Old Thoroughbred Racehorses

Simple Summary

Objective gait monitoring via GPS and motion sensors is becoming increasingly popular with racehorse trainers. This has the potential to assist in early detection of lameness and performance issues. This study sought to identify normal changes in gait in a population of two and three-year-old racehorses in order to inform future studies. We found that horses decrease their stride duration at a given speed over time with training. Stride duration appears to increase with increased distance galloped, but this effect is reduced over a training season and presumably increased fitness, so this may serve as a useful indicator for fatigue.

Abstract

Objective gait monitoring is increasingly accessible to trainers. A more comprehensive understanding of ‘normal’ gait adaptations is required. Forty two-year-old thoroughbred racehorses were recruited when entering training and followed for 22 months. Gait analysis was performed by equipping each horse with an inertial measurement unit with inbuilt GPS (GPS-IMU) mounted on the dorsum. Horses were exercised as per their regular training regimen. Data were analysed using a linear mixed model. For two-year-old horses, there was a non-linear pattern of stride duration (SD) over time (p < 0.001) with SD decreasing initially and then ‘flattening off’ over time (linear and quadratic coefficients −0.29 ms/week and 0.006 ms/week²). Horses showed an increase in SD of 2.21 ms (p < 0.001) per 100 m galloped, and over time, SD decreased by 0.04 ms (p < 0.001) with each 100 m galloped per week. Three-year-old horses overall showed no change in SD over time (p = 0.52), but those that had a period of time off showed a decrease in SD of −0.59 ms per week (p = 0.02). They showed an increase in SD of 1.99 ms (p < 0.001) per 100 m galloped, and horses that had a period of time off showed an increase in stride duration of 1.05 ms per 100 m galloped (p = 0.01) compared to horses which did not have time off. Horses demonstrate an adaptation to high-speed exercise over time. SD decreases with training when other factors are controlled for in naïve horses.

Achilles tendon injuries in elite athletes: lessons in pathophysiology from their equine counterparts

Superficial digital flexor tendon (SDFT) injury in equine athletes is one of the most well-accepted, scientifically supported companion animal models of human disease (i.e., exercise-induced Achilles tendon [AT] injury). The SDFT and AT are functionally and clinically equivalent (and important) energy-storing structures for which no equally appropriate rodent, rabbit, or other analogues exist. Access to equine tissues has facilitated significant advances in knowledge of tendon maturation and aging, determination of specific exercise effects (including early life), and definition of some of the earliest stages of subclinical pathology. Access to human surgical biopsies has provided complementary information on more advanced phases of disease. Importantly, equine SDFT injuries are only a model for acute ruptures in athletes, not the entire spectrum of human tendonopathy (including chronic tendon pain). In both, pathology begins with a potentially prolonged phase of accumulation of (subclinical) microdamage. Recent work has revealed remarkably similar genetic risk factors, including further evidence that tenocyte dysfunction plays an active role. Mice are convenient but not necessarily accurate models for multiple diseases, particularly at the cellular level. Mechanistic studies, including tendon cell responses to combinations of exercise-associated stresses, require a more thorough investigation of cross-species conservation of key stress pathway auditors. Molecular evidence has provided some context for the poor performance of mouse models; equines may provide better systems at this level. The use of horses may be additionally justifiable based on comparable species longevity, lifestyle factors, and selection pressure by similar infectious agents (e.g., herpesviruses) on general cell stress pathway evolution.

Reproducibility and feasibility of acoustoelastography in the superficial digital flexor tendons of clinically normal horses

OBJECTIVE

To evaluate the feasibility and repeatability of in vivo measurement of stiffness gradients by means of acoustoelastography in the superficial digital flexor tendons (SDFTs) of clinically normal horses.

ANIMALS

15 clinically normal horses.

PROCEDURES

For each horse, stiffness gradient index and dispersion values for SDFTs in both forelimbs were evaluated in longitudinal orientation by use of acoustoelastography at 3 sites (5, 10, and 15 cm distal to the accessory carpal bone) by 2 observers; for each observer, data were acquired twice per site. The left forelimb was always scanned before the right forelimb. Lifting of the contralateral forelimb with the carpus flexed during image acquisition resulted in the required SDFT deformation in the evaluated limb. Interobserver repeatability, intraobserver repeatability, and right-to-left limb symmetry for stiffness gradient index and dispersion values were evaluated.

RESULTS

Stiffness gradient index and dispersion values for SDFTs at different locations as well as effects of age or sex did not differ significantly among the 15 horses. Interclass correlation coefficients for interobserver repeatability, intraobserver repeatability, and limb symmetry revealed good to excellent agreement (intraclass correlation coefficients, > 0.74).

CONCLUSIONS AND CLINICAL RELEVANCE

Results indicated that acoustoelastography is a feasible and repeatable technique for measuring stiffness gradients in SDFTs in clinically normal horses, and could potentially be used to compare healthy and diseased tendon states.

Effect of treadmill exercise timing on repair of full-thickness defects of articular cartilage by bone-derived mesenchymal stem cells: an experimental investigation in rats

OBJECTIVE

Current medical practice for the treatment of articular cartilage lesions remains a clinical challenge due to the limited self-repair ability of articular cartilage. Both experimental and clinical researches show that moderate exercise can improve articular cartilage repair process. However, optimal timing of moderate exercise is unclear. We aimed to evaluate the effect of timing of moderate treadmill exercise on repair of full-thickness defects of articular cartilage.

DESIGN

Full-thickness cartilage defects were drilled in the patellar groove of bilateral femoral condyles in a total of 40 male SD rats before they were randomly assigned into four even groups. In sedentary control (SED) group, no exercise was given; in 2-week (2W), 4-week (4W) and 8-week groups, moderate treadmill exercise was initiated respectively two, four and eight weeks after operation. Half of the animals were sacrificed at week 10 after operation and half at week 14 after operation. Femoral condyles were harvested for gross observation and histochemical measurement by O'Driscoll scoring system. Collagen type II was detected by immunohistochemistry and mRNA expressions of aggrecan and collagen type II cartilage by RT-PCR.

RESULTS

Both 10 and 14 weeks post-operation, the best results were observed in 4W group and the worst results appeared in 2W group. The histochemistry scores and the expressions of collagen type II and aggrecan were significantly higher in 4W group than that in other three groups (P<0.05).

CONCLUSIONS

Moderate exercise at a selected timing (approximately 4 weeks) after injury can significantly promote the healing of cartilage defects but may hamper the repair process if performed too early while delayed intervention by moderate exercise may reduce its benefits in repair of the defects.

Cross sectional area of forelimb metacarpal region flexor tendons in horses of different breeds and age

There are few studies on the effects of age within breeds on cross sectional area (CSA) of flexor tendons in horses. This study was designed to evaluate the relationship between age and the CSA of the superficial flexor tendon (SDFT), the deep digital flexor tendon (DDFT) and its accessory ligament (AL-DDFT) of both forelimbs in horses utilising ultrasound. Ages of the horses ranged from 2 years to aged, and the breeds evaluated were Thoroughbred (TB), Standardbred (SB), Quarterhorse (QH) and German Warmblood Riding horse (WB). CSAs were measured with ultrasound at 4 cm intervals, starting 4 cm from the distal border of the accessory carpal bone down to the metacarpophalangeal joint. The CSA of the SDFT in 3-year-old and older TB, QH and WBs was smaller than in the 2-year-olds (all P<0.001) and did not differ between 3-year-olds and older horses (P≯0.05). In comparison, the CSA of the SDFT in 2-year-old and 3-year-old SBs was smaller than in the horses older than 3 years (P<0.05 among age groups). The 2-year-olds had larger CSA of the DDFTs than the 3-year-olds (P<0.01), and the CSA was also larger in the older horses of all breeds (P<0.01). However, the 3-year-old QH and SBs had smaller CSAs of the DDFT than the horses older than 3 years of age, (P<0.001), but interestingly the CSA was not different in the TB and WBs based on age (P≯0.05). The CSA of the AL-DDFT in the left forelimb was smaller than in the right forelimb (P<0.01) of all horses. The results of this study show that differential effects exist between age and within breeds on the CSA of the SDFT, DDFT and AL-DDFT, indicating that training and management may play a role, in addition to genetics, in the CSA of the metacarpal region flexor tendons of horses. The data on the CSAs of the SDFT, DDFT and AL-DDFT in WB, QH and SBs provides additional physiological references for these breeds to compliment the CSA data previously published for other breeds.

Do the rotator cuff tendons of young athletic subjects hypertrophy in response to increased loading demands?

BACKGROUND

The rotator cuff is composed of muscle and tendon units. Although muscle has been shown to adapt to mechanical loads, the response of human tendon is not well defined. We hypothesized that increased loading demands on the rotator cuff of young trainees would cause an adaptive muscle response but not an adaptive hypertrophic tendon response.

METHODS

The hypertrophic response of the rotator cuff tendon, shoulder strength, aerobic fitness, and the lean body weight of 70 young male recruits were studied before and after a 1-year course of elite infantry training. Shoulder strength was assessed by the maximum number of pull-ups done and the rotator cuff thickness by ultrasound measurement of the supraspinatus thickness. Aerobic physical fitness was assessed by maximum oxygen consumption (Vo(2) max). Lean body weight was measured by skin-fold thickness.

RESULTS

The mean number of pull-ups done increased from 17.5 to 21.7 (P = .01), but the supraspinatus thickness at the beginning of training (6.1 mm) was unchanged at the end of the training. Vo(2) max increased from 57 to 64 mL/kg/min (P = .0001). Lean body weight increased from 58.3 to 64.7 kg (P = .0001).

CONCLUSIONS

As a result of increased loading, the strength of the rotator cuff muscles of young trainees increased, but by the parameter of hypertrophy, no evidence was found of a parallel adaptive response of the rotator cuff tendon.

Histologic and histomorphometric evaluation of midcarpal joint defects in Thoroughbreds raised with and without early conditioning exercise

OBJECTIVE

To describe and measure histologic features of midcarpal joint cartilage defects in Thoroughbreds and evaluate the influence of early conditioning exercise on defect development.

SAMPLE

24 midcarpal joints from twelve 18-month-old Thoroughbreds.

PROCEDURES

Midcarpal joints from 12 horses (6 exercised spontaneously at pasture only and 6 given additional conditioning exercise beginning at a mean age of 3 weeks were evaluated. Gross cartilage defects were assessed histologically. Third and radial carpal bones were categorized with regard to the presence or absence of calcified cartilage (CC) abnormalities at the dorsoproximal and dorsodistal articular surfaces, respectively; histomorphometric assessment and statistical analysis were conducted for the third carpal bone.

RESULTS

Number and severity of defects did not appear different between exercise groups. Nine third or radial carpal bones had thickened CC with microcracks, matrix and osteochondral junction changes, and increased vascularity, without histologic changes in the hyaline cartilage. Third carpal bones with CC abnormalities had significantly thicker CC (452 vs 228 μm) than did those without CC abnormalities in the evaluated region. However, in the same region, there were no significant differences in hyaline cartilage thickness (681 vs 603 μm), vascular channel area in the subchondral bone (624,894 vs 490,320 μm(2)), or number of vascular channels (15.9 vs 18.0).

CONCLUSIONS AND CLINICAL RELEVANCE

Early exercise did not appear to influence the distribution or severity of cartilage defects in the midcarpal joint. Calcified cartilage abnormalities beneath the undisrupted hyaline cartilage in the dorsoproximal aspect of the third carpal bone may represent the first changes in the pathogenesis of midcarpal osteochondral disease.

The effect of previous conditioning exercise on diaphyseal and metaphyseal bone to imposition and withdrawal of training in young Thoroughbred horses

This study recorded the response to training of the diaphysis of the proximal phalangeal bone and the third metacarpal bone (Mc3) and the Mc3 proximal metaphysis. Nineteen 2- and 3-year old horses in training were exposed either to spontaneous exercise at pasture (PASTEX group) or additional imposed exercise (CONDEX group) from a very young age. Quantitative computed tomography scans were analysed for bone mineral content, size, bone mineral density, periosteal and endosteal circumference, cortical thickness and an estimate of bone strength. The bones of the CONDEX horses were bigger and stronger than those of the PASTEX horses at the start of the observation period, and these differences were maintained after adjusting for training workload. Increase in the bone strength index was through size and not density increase. Density increased during training and decreased during paddock rest between the two training campaigns, during which time bone strength continued to increase because of the slow growth that was still occurring. The greatest variance in the response to the training exercise of diaphyseal bone mineral content, bone strength index or cortical thickness was associated with the cumulative workload index at the gallop, although statistically significant unexplained variances remained. There were no differences in bone response to training, with the exception of the endosteal circumference at 55% of the Mc3 length from the carpometacarpal joint space between CONDEX and PASTEX, which indicated that young horses may be able to be exercised slightly more vigorously than currently accepted.

Cross-sectional area of the tendons of the tarsal region in Standardbred trotter horses

REASONS FOR PERFORMING STUDY

The assessment of a normal range for cross-sectional area (CSA) of tendons in the tarsal region is important in order to use them as reference values in the identification of pathological changes of dimensions.

OBJECTIVES

To provide normal reference values for the CSA of the tendons of the tarsus of Standardbred trotter horses (STH) by means of ultrasonography.

METHODS

Transverse echographic images of the tendons were obtained at different levels proximodistally; these images were digitised and CSA values (mean ± s.d.) were obtained for each structure.

RESULTS

The largest structure corresponded with the lateral digital flexor/caudal tibial tendon complex at Level 1 and the smallest was the medial digital flexor tendon at Level 4. Almost all tendons showed a slight decreasing in their CSA when crossing the tarsus.

CONCLUSIONS

The normal CSA values of tendinous structures in the tarsal region of the STH are reported. These data could be used as anatomical references.

POTENTIAL RELEVANCE

The establishment of reference values could serve as a tool to discriminate between normal and abnormal dimensions of tarsal tendons in STH. Other horse breeds should need their own reference values.

Mild exercise early in life produces changes in bone size and strength but not density in proximal phalangeal, third metacarpal and third carpal bones of foals

Exercise or lack of it in early life affects chondro-osseous development. Two groups of horses were used to investigate the effects of age and exercise regimen on bone parameters of diaphyseal, metaphyseal, epiphyseal and cuboidal bones of the distal limb of Thoroughbreds. One group had exercised only spontaneously from an early age at pasture (PASTEX group), while the other group of horses were exposed to a 30% greater workload through additional defined exercise (CONDEX). Longitudinal data from peripheral quantitative computed tomography (pQCT) were obtained from eight scan sites of the left forelimb (proximal phalangeal (P(p); 1 site), third metacarpal (Mc3; six sites) and third carpal (C(3); one site) bones) of 32 Thoroughbred foals scanned five times from ∼3 weeks to 17 months of age. The primary outcome measures were bone mineral content (BMC), bone area (BA), and periosteal circumference (Peri C) in diaphyseal bone, with cortical thickness (CortTh), volumetric bone mineral density (BMD(v)) and a bone strength index (SSI) also being analysed. At the P(p) site within the model there was a significant effect (P=0.00-0.025) of conditioning exercise increasing bone parameters, except endosteal circumference (Endo C) and BMD(v). The BMC, BA, and SSI of P(p) were significantly greater in the CONDEX than PASTEX groups at 12 and 17 months (P=0.015-0.042) and CortTh at 17 months (P=0.033). At the M55 site of Mc3 BMC, BA and SSI (P=0.02-0.04), and at the M33 site, SSI (P=0.05) were higher in the CONDEX than PASTEX group. The adaptive responses, consistent with diaphyseal strengthening, were more marked in the diaphysis of P(p) than Mc3. In the Mc3, metaphysis, trabecular BMD(v) was less in the CONDEX than PASTEX group, associated with greater bone mineral accretion in the outer cortical-sub-cortical bone in the CONDEX group. There were no significant between-group differences in any epiphyseal or cuboidal bone parameter. Although the early imposed exercise regimen was not intensive, it had significant effects on diaphyseal bone strength, through change in size but not bone density.

Ultrasonographic assessment of the superficial digital flexor tendons of National Hunt racehorses in training over two racing seasons

REASONS FOR PERFORMING STUDY

It is important to ascertain the prevalence of superficial digital flexor tendon (SDFT) injuries and to improve methods of predicting injury in National Hunt (NH) racehorses.

OBJECTIVES

To establish: 1) the prevalence of SDFT tendinopathy in NH horses; 2) whether routine ultrasonography can be used to predict SDFT injuries; 3) whether previous tendinopathy predisposes to reinjury; 4) a normal range for the SDFT cross-sectional area (CSA); and 5) the effects of gender, age, background (ex-flat or ex-store), limb, training and rest periods on SDFT CSA.

METHODS

Routine ultrasound assessment of the palmar metacarpal soft tissues of 263 NH racehorses was performed on up to 6 occasions over 2 NH racing seasons.

RESULTS

The prevalence of SDFT pathology detected using ultrasonography was 24% (n = 148), with a nonsignificant variation between yards of 10-40%. No changes in SDFT CSA or ultrasonographic appearance were detected prior to injury. Older horses had a significantly higher prevalence of SDFT pathology compared to younger horses, and horses with tendinopathy were more likely to suffer an acute injury compared to horses with no evidence of pathology. A reference range for normal CSA measurements was established as 77-139 mm2 at level 4, from 142 horses with no ultrasonographic evidence of SDFT pathology. The CSA of normal horses did not vary significantly with age, limb or over 2 racing seasons, but did with sex and background.

CONCLUSIONS

The study confirms that SDFT tendinopathy is common in NH horses, with substantial variation between training yards. Ultrasonography at 3 month intervals did not seem to predict acute SDFT injuries.

POTENTIAL RELEVANCE

Variation in the prevalence of tendinopathy between yards suggests that training methods may influence injury rate. It was not possible to predict injury using routine ultrasonography and therefore other methods must be identified. A normal reference range for SDFT CSA is provided.

Influence of early conditioning exercise on the development of gross cartilage defects and swelling behavior of cartilage extracellular matrix in the equine midcarpal joint

OBJECTIVE

To investigate the influence of early conditioning exercise on the development of gross cartilage defects and swelling behavior of cartilage extracellular matrix (ECM) in the midcarpal joint of horses.

ANIMALS

12 Thoroughbreds.

PROCEDURES

6 horses underwent early conditioning exercise from birth to 18 months of age (CONDEX group), and 6 horses were used as control animals (PASTEX group). The horses were euthanized at 18 months of age, and the midcarpal joints were harvested. Gross defects of the cartilage surface were classified and mapped. Opposing surfaces of the third and radial carpal bones were used to quantify swelling behavior of the cartilage ECM.

RESULTS

A wide range of gross defects was detected in the cartilage on the opposing surfaces of the bones of the midcarpal joint; however, there was no significant difference between the CONDEX and PASTEX groups. Similarly, no significant difference in swelling behavior of the cartilage ECM was evident between the CONDEX and PASTEX groups.

CONCLUSIONS AND CLINICAL RELEVANCE

In the study reported here, we did not detect negative influences of early conditioning exercise on the prevalence of gross defects in cartilage of the midcarpal joint or the quality of the cartilage ECM as defined by swelling behavior. These results suggested that early conditioning exercise may be used without negative consequences for the midcarpal joint and the cartilage ECM of the third and radial carpal bones.