Age and synovitis affect the results of the treatment of knee osteoarthritis with Microfragmented Autologous Fat Tissue

Abstract

Purpose This study aims to assess the effectiveness of Microfragmented Autologous Fat Tissue (MFAT) treatment for knee osteoarthritis and to investigate whether patients’ pre-treatment clinical condition, such as synovitis, correlates with clinical outcomes, to identify potential predicting factors for the success or failure of the treatment. Methods In this prospective Cohort Study Level II multicentric trial, consecutive patients with a diagnosis of early/mild osteoarthritis and failure of previous conservative measures were enrolled to undergo diagnostic arthroscopy and a single MFAT injection. Patients were assessed with repeated scoring systems at baseline, 6 months, and 12 months after surgery. The demographic features, the arthroscopic findings, the immunophenotype of injected tissue and the histologic examination of synovia of failed patients were analyzed. Results Data from 91 patients showed a significant improvement in Lysholm, WOMAC scores at 1-year follow-up (p < 0.001). A significant decrease in VAS score was observed, while a significant improvement of measured flexion angle was registered at 1 year (p < 0.001). No major complications were reported. Age and synovitis were identified as significant factors influencing the clinical outcome (p < 0.05). Body mass index, previous or concomitant procedures, and specific cartilage defects had no influence. The mean number of injected adipose tissue-derived mesenchymal stem cells seem not to correlate with the clinical outcome. Conclusion MFAT is effective in reducing pain when used with a single dose injection in early/mild OA of the knee, without major complications. Age over 60 and synovitis may be predictive for persistent pain at one year and should be considered before indications.

Adipose Tissue-Derived Minimally Manipulated Products versus Platelet-Rich Plasma for the Treatment of Knee Osteoarthritis: A Systematic Review of Clinical Evidence and Meta-Analysis

“…The mean BMI went from 24.7 [ 50 ] to > 35 [ 40 ] for MM-AT and from 26.0 [ 42 ] to 31.0 [ 29 ] for the control groups (12 studies did not report BMI). Patients presented different OA grades, often measured with KL classification: nine studies on KL 1–4 [ 28 , 29 , 39 , 44 , 45 , 46 , 54 , 56 , 59 ], eight studies on KL 3–4 [ 30 , 33 , 35 , 40 , 41 , 47 , 48 , 55 ], three studies on KL 2–3 [ 34 , 42 , 50 ], three studies on KL 1–3 [ 34 , 44 , 51 ], two studies on KL 1–2 [ 32 , 37 ], and two studies on KL 2–4 [ 36 , 53 ]. In addition, patients with mild, moderate, or severe OA grade [ 43 ], ICRS grade of 2–4 [ 51 , 52 ], and American College of Rheumatology criteria 1–3 [ 57 ] were also evaluated.…”

“…In the other four studies, Lipocell (Tiss’You, RSM) [ 27 ], Hy-tissue SVF Separation System kit (Fidia, Abano Terme, Italy) [ 50 ], MyStemTM kit (MyStem, Wilmington, DE, USA) [ 53 ], and Tulip Soft Harvest GOLD System (Tulip Medical, San Diego, CA, USA) [ 49 ] were employed, respectively. Only in four studies was the adipose tissue characterized before injection: immunophenotype analysis and viability [ 29 , 34 , 40 ], total nucleated cell count [ 29 ], and histology of lipoaspirate [ 42 ] were evaluated. Some studies did not indicate the amount (ml) of injected MM-AT; when reported, the amount was very variable, from a minimum of 3 mL [ 34 ] to a maximum of 19 mL [ 46 ], with 10 mL being the most commonly injected dose [ 27 , 28 , 30 , 31 , 41 , 44 , 49 , 50 , 51 , 52 , 57 ].…”

“…Only in four studies was the adipose tissue characterized before injection: immunophenotype analysis and viability [ 29 , 34 , 40 ], total nucleated cell count [ 29 ], and histology of lipoaspirate [ 42 ] were evaluated. Some studies did not indicate the amount (ml) of injected MM-AT; when reported, the amount was very variable, from a minimum of 3 mL [ 34 ] to a maximum of 19 mL [ 46 ], with 10 mL being the most commonly injected dose [ 27 , 28 , 30 , 31 , 41 , 44 , 49 , 50 , 51 , 52 , 57 ]. MM-AT was injected through ultrasound (US) guidance in 11 studies [ 29 , 33 , 34 , 36 , 38 , 39 , 43 , 44 , 45 , 47 , 56 ].…”

“…Some studies did not indicate the amount (ml) of injected MM-AT; when reported, the amount was very variable, from a minimum of 3 mL [ 34 ] to a maximum of 19 mL [ 46 ], with 10 mL being the most commonly injected dose [ 27 , 28 , 30 , 31 , 41 , 44 , 49 , 50 , 51 , 52 , 57 ]. MM-AT was injected through ultrasound (US) guidance in 11 studies [ 29 , 33 , 34 , 36 , 38 , 39 , 43 , 44 , 45 , 47 , 56 ].…”

Osteoarthritis as an Umbrella Term for Different Subsets of Humans Undergoing Joint Degeneration: The Need to Address the Differences to Develop Effective Conservative Treatments and Prevention Strategies

“…Single-cell injections have not proven to be very effective in repairing damaged cartilage, but they have been effective in clinical trials to affect pain and disability [ 99 , 100 ]. However, effectiveness may be negatively influenced by the intra-articular environment, particularly the presence of inflammation [ 4 , 101 ], in spite of their possible immunomodulatory role [ 102 , 103 ]. Some pilot studies with tissue-engineered constructs with autologous synovium-derived mesenchymal stem/stromal cells have indicated the good potential to restore cartilage in cartilage defects prior to the development of overt knee OA [ 104 , 105 ].…”