Micro-fragmented adipose tissue injection associated with arthroscopic procedures in patients with symptomatic knee osteoarthritis

Abstract

BackgroundThe social impact of degenerative diseases is steadily increasing, because of the continued rise in the mean age of the active population. Articular cartilage lesions are generally associated with disability and symptoms such as joint pain and reduced function, and remain a challenge for the orthopaedic surgeon. Several non-invasive solution have been proposed, but the results achieved to date are far from being completely satisfactory. Recently, new therapeutic approaches, such as the use of mesenchymal stem cells, have been developed. Among the many sources, the adipose tissue is nowadays considered one of the smartest, due to its abundance and easy access. The aim of this retrospective study is to explore whether patients affected by symptomatic knee osteoarthritis treated with micro-fragmented adipose tissue associated with a chondral shaving procedure experience an improvement in symptoms and function.MethodsThirty-eight patients affected by symptomatic knee osteoarthritis were treated in 2015 with an arthroscopic procedure associated with an injection of autologous and micro-fragmented adipose tissue. Micro-fragmented adipose tissue was obtained using a minimal manipulation technique in a closed system. Clinical outcomes were determined at 1, 3, 6, and 12 months follow-up using Knee Injury and Osteoarthritis Outcome Score questionnaire and direct physical examination. Safety of the procedure, recording type and incidence of any adverse event, was also assessed.ResultsA steady and statistically significant improvement of all the clinical scores from pre-operative evaluation to 1, 3, 6, and 12 months follow-up was observed, with KOOS sport and quality of life being the most improved scores. On average, 92% of the patients clinically improved and 100% of them were satisfied with the treatment. No adverse events nor relevant complications were recorded.ConclusionThe result of the study pointed to micro-fragmented adipose tissue as a safe and beneficial adjuvant in the surgical treatment of degenerative knee chondropathy. The procedure is simple, sustainable, quick, minimally invasive, one-step, and safe. After one year, the results are very satisfactory and promising. A longer follow-up is needed to draw definitive conclusions and enlarge the indications.Trial registrationRegistered at clinicaltrials.gov as NCT03527693 on 27 April 2018 (retrospectively registered).

Evaluation of a Single Intra-Articular Injection of Autologous Adipose Tissue for the Treatment of Osteoarthritis: A Prospective Clinical Study in Dogs

“…The development of new therapeutic strategies for the treatment of osteoarthritis is an active area of research. Recent human studies have demonstrated satisfactory results with the intra-articular administration of purified and micro-fragmented adipose tissue for the treatment of knee, 18,19 subtalar, 20 carpometacarpal 21,22 and thumb osteoarthritis. [23][24][25] In veterinary literature, a recent study 26 suggested clinical evidence of pain control over a period of up to 180 days with intra-articular administration of autologous purified and micro-fragmented adipose tissue for the treatment of osteoarthritis in dogs.…”

Treatment of Knee Meniscus Pathology: Rehabilitation, Surgery, and Orthobiologics

“…There are different methods to process autologous adipose into MFAT with minimal manipulation and avoiding the use of enzymes . Processed MFAT has been used as regenerative treatment for the management of musculoskeletal conditions such as knee osteoarthritis , shoulder pain secondary to osteoarthritis and rotator cuff tear , and osteochondral defects of the talus . In addition, case reports have reported improvement in pain and function scores after intra‐articular injection of MFAT in the setting of knee osteoarthritis and meniscal tear .…”

Adipose-Based Therapies for Knee Pain—Fat or Fiction

“…Cattaneo et al reported on 38 patients with knee OA who were treated with an arthroscopic procedure and an injection of autologous MAT. 53 They found a significant improvement in KOOS at 1, 3, 6, and 12 months follow-up, and reported that 92% of patients clinically improved, and 100% were satisfied with the treatment. However, as previously stated, there is still a paucity of evidence on MAT for the treatment of knee OA and other pathologies.…”