The Stromal Vascular Fraction From Fat Tissue in the Treatment of Osteochondral Knee Defect: Case Report

Abstract

In this study we applied autologous fat tissue stromal vascular fraction (SVF) cells in combination with microfracturing technique in a 36-year-old man with an osteochondral lesion of the medial femoral condyle 8 months after the injury. Cell material was generated by fat tissue liposuction from the anterior abdominal wall with subsequent extraction of the SVF and injected through a mini-arthrotomy portal with subsequent fibrin sealant fixation. The follow-up period was 2 years. Clinical score improved from 23 to 96 according to IKDC and from 10 to 90 according to EQ-VAS at 24 months follow-up. Magnetic resonance imaging (MRI) before the surgery revealed an osteochondral lesion with development of significant trabecular edema that remained unchanged for 6 months despite conservative treatment. MRI 1 and 2 years after the surgery showed the recovery of the damaged cartilage thickness with somewhat uneven structure and a decrease in the trabecular edema of the femoral condyle. The use of SVF cells with fibrin sealant fixation might be a promising approach in the treatment of osteochondral joint lesions. Further studies are required.

Stromal Vascular Fraction and Amniotic Epithelial Cells: Preclinical and Clinical Relevance in Musculoskeletal Regenerative Medicine

“…The 35 studies on SVF were conducted to treat bone (no of studies: 16) [ 17 , 28 – 42 ], cartilage (no of studies: 13) [ 7 , 43 – 54 ], and tendon (no of studies: 6) [ 55 – 60 ] defects ( Figure 2 ). They were conducted in vitro [ 17 , 28 – 30 , 43 ] and in vivo [ 7 , 29 , 31 – 39 , 42 – 45 , 55 – 58 ], and some of them were clinical studies [ 40 – 43 , 46 – 54 , 59 , 60 ].…”

“…Eight clinical studies were performed in patients with OA, full-thickness chondral defect of the talar dome [ 50 ], and traumatic osteochondral defect of the right femoral condyle [ 54 ].…”

“…In a traumatic osteochondral lesion, microfracture associated with SVF and fibrin sealant increased the International Knee Documentation Committee (IKDC) score, the EuroQol-visual analog scale (EQ-VAS) score, and the recovery of the cartilage thickness and reduced bone edema after 1 and 2 years [ 54 ].…”

“…In general, in the studies of these cell sources, researchers prevalently performed in vivo studies [ 7 , 29 , 31 – 39 , 42 – 45 , 56 – 58 , 65 – 67 , 71 – 76 ], followed by clinical ones [ 40 – 42 , 46 – 54 , 59 , 60 ] and in vitro studies [ 17 , 28 – 30 , 43 , 61 – 64 , 68 – 70 ]. As for AECs, no clinical studies have yet been conducted, and the only two studies that analysed AEC behavior in cartilage were in vitro [ 68 , 69 ].…”

“…As for AECs, no clinical studies have yet been conducted, and the only two studies that analysed AEC behavior in cartilage were in vitro [ 68 , 69 ]. For both cell types, most of the studies regarded bone regeneration [ 17 , 28 – 42 , 61 – 67 ], followed by cartilage [ 7 , 43 – 54 , 68 , 69 ] and tendon [ 55 – 60 , 70 – 76 ]. SVF was prevalently implanted with scaffolds for bone regeneration: HA [ 31 , 32 ], β TCP [ 32 , 40 , 41 ], devitalized hypertrophic cartilage pellet [ 33 ], deproteinized sterilized bovine bone [ 34 ], PCL-DCB [ 35 ], DBM [ 36 ], PLA [ 36 ], PLGA [ 37 ], or fibrin hydrogel added with porous silicate HA microgranules [ 42 ].…”