Arthroscopic Debridement and Autologous Micronized Adipose Tissue Injection in the Treatment of Advanced-Stage Posttraumatic Osteoarthritis of the Ankle

Abstract

Objective To evaluate the effect of intra-articular injection of autologous micronized adipose tissue (MAT) with ankle arthroscopic debridement in patients with advanced-stage posttraumatic osteoarthritis (PTOA) of ankle. Design A retrospective cohort study investigating patients treated with arthroscopic debridement and autologous MAT injection for ankle PTOA was performed. Patients with Kellgren-Lawrence (KL) grade 3 to 4 were included. Visual analogue scale (VAS), Foot and Ankle Outcome Scores (FAOS), and patient satisfaction were evaluated. Results A total of 19 patients (19 ankles) were included (KL grade 3, 8 patients; grade 4, 11 patients). At a mean follow-up time of 14.3 months (range, 7-23 months), the mean FAOS subscales for pain and quality of life significantly increased from 48.8 and 20.1 preoperatively to 61.1 and 30.1 ( P = 0.029 and 0.048, respectively). The mean VAS score significantly improved from 6.1 to 3.8 (P = 0.003) at final follow-up. A total of 10.5% (2/19) of patients were very satisfied, 31.6% (6/19) satisfied, 26.3% (5/19) neutral, 21.1% (4/19) unsatisfied, and 10.5% (2/19) very unsatisfied with their outcomes. The overall FAOS score demonstrated a significant difference in pre- to postoperative change with 14.8 for KL grade 3 and 5.9 for KL grade 4 ( P = 0.048). Conclusions Autologous MAT injection is a safe and potentially beneficial procedure for advanced-stage ankle PTOA as an adjunct to arthroscopic debridement, although more than one-third of patients were unsatisfied with the procedure. This procedure may be more beneficial for KL grade 3 patients than grade 4 patients. However, future investigations are necessary to define the role of MAT for ankle PTOA.

Rethinking Cartilage Lesions of the Ankle: An Update on the Role of Biologic Adjuvants

“…The authors reported improved FAOS and VAS scores postoperatively but also reported more improvement in patients with Kellgren-Lawrence grade 3 when compared with Kellgren-Lawrence grade 4. 45 Freitag et al 46 reported on a single case treated with adipose-derived stem cells in the treatment of an unstable osteochondral lesion of the talus and demonstrated excellent clinical and radiological outcomes. Although there have been very few studies evaluating MAT in the ankle, several studies have demonstrated notable improvements with excellent patient satisfaction scores in patients treated with MAT injection associated with an arthroscopic procedure for knee osteoarthritis.…”

Contemporary Review: The Use of Adipocyte-Derived Mesenchymal Stem Cells in Pathologies of the Foot and Ankle

“…After processing, the final product is transferred into 10-mL syringes and can be injected into the target site. 53 ADSC harvesting is substantially more involved than the harvest required for other orthobiologic products, such as platelet-rich plasma, which involves a simple blood draw. Thus, considerations such as the comfort of liposuction techniques of the clinician who may be using these products are relevant to their clinical practice.…”

“…51 Within foot and ankle surgery, adipose-derived mesenchymal stem cell (ADSC) application is in its infancy. Proposed applications include osteochondral lesions (OCLs) of the talus, 16 diabetic foot wounds, 35 end-stage osteoarthritis (OA) of the ankle in conjunction with arthroscopic debridement, 53 and as an adjunct to improve cartilage restoration after lateral displacement calcaneal osteotomy for varus ankle OA. 28 The purpose of the current work is to provide the foot and ankle practitioner with an understanding of the collection, isolation, and preparation of ADSCs.…”

Effect of mesenchymal stromal cells transplantation on the outcomes of patients with knee osteoarthritis: A systematic review and meta‐analysis

“…1 In the early stage of KOA, conservative treatments such as physical therapy and medication are commonly suggested to delay disease progression and reduce clinical symptoms, while in the late stage, knee arthroplasty can be considered. 2 In recent years, advances in molecular biology, cell biology, and precision medicine have provided novel therapeutic options for osteoarthritis. Especially in the field of regenerative medicine, cell therapy has been explored as a new regenerative treatment for osteoarthritis.…”