Autologous micro-fragmented adipose tissue for the treatment of diffuse degenerative knee osteoarthritis: an update at 3 year follow-up

Abstract

BackgroundConservative therapies for the treatment of knee degenerative processes are used before resorting to surgery; nonetheless, they may offer only short-term benefits. Encouraging preliminary results have been reported using mesenchymal stem cells (MSCs), either alone or in association with surgery. Among the many sources, adipose tissue has created a huge interest, because of its anti-inflammatory and regenerative properties ascribed to the cells of its stromal vascular fraction. We previously reported the safety and feasibility of autologous micro-fragmented adipose tissue as adjuvant for the surgical treatment of diffuse degenerative chondral lesions at 1 year. Here we present the outcomes of the same cohort of patients evaluated at 3 year follow-up. Micro-fragmented adipose tissue was obtained using a minimal manipulation technique in a closed system. The safety of the procedure was evaluated by recording type and incidence of any adverse event. The clinical outcomes were determined using the KOOS, IKDC-subjective, Tegner Lysholm Knee, and VAS pain scales taken pre-operatively and at 12 and 36 months follow-up.FindingsNo adverse events, lipodystrophy cases at the harvesting site nor atypical inflammatory reactions at the joint level were reported. Of the 30 patients previously treated, one was lost, and seven received additional treatments in the period of observation. On average, the 22 patients that had no other treatments in the 3-year period showed that the results observed at 1 year were maintained. Moreover, 41, 55, 55 and 64% of the patients improved with respect to the 1-year follow-up in the Tegner Lysholm Knee, VAS, IKDC-subjective and total KOOS, respectively.ConclusionOur results point to autologous and micro-fragmented adipose tissue injection as an innovative and safe approach for the management of diffuse degenerative knee chondropathy in the mid-term. The procedure is simple, affordable, minimally invasive, and compliant with the regulatory panorama.

Patient-Centered Outcomes of Microfragmented Adipose Tissue Treatments of Knee Osteoarthritis: An Observational, Intention-to-Treat Study at Twelve Months

“…More recently a number of clinical studies have demonstrated the safety and efficacy of microfragmented fat for the treatment of KOA. Russo et al [35] reported on 30 patients who were treated with microfragmented fat as an adjuvant for the surgical treatment of diffuse degenerative chondral lesions, with a follow-up of three years. 22 required no further treatment, and no adverse events were reported.…”

Autologous Biologic Treatment with Fat, Bone Marrow Aspirate and Platelet Rich Plasma Is an Effective Alternative to Total Knee Arthroplasty for Patients with Moderate Knee Arthrosis

“…There is thus a great need for a safe, effective, non-surgical treatment for knee arthrosis. Multiple studies have demonstrated that treatment with adipose tissue and its derivatives results in improvement in osteoarthritis symptoms in both the knee [ 19 , 20 , 21 , 22 ] and in the hip [ 23 ]. Other studies have shown similar results with bone marrow aspirate [ 24 , 25 , 26 , 27 , 28 , 29 ], and with a combination of bone marrow aspirate and adipose tissue [ 30 , 31 ].…”

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“…As already underlined in our previous review, Lipogems ® is currently used within the clinic in several orthopedic contraindications, where intra-articular injections are used to for the management of knee, hip and shoulder osteoarthritic degeneration (more than 35000 patients over the world). Initiated more than three years ago, these results have now been confirmed in several case series [50,51], and prospective clinical studies with follow up [52,53], and the "regenerative" pathophysiological mechanism of Lipogems ® , when injected into the joint, have now been more carefully elucidated [54,55]. MFAT has also been demonstrated effective also in four patients with osteochondral lesions of the talus [56] who underwent to arthroscopic injection of MFAT of the osteochondral lesion after a first phase of microperforation of the cartilage.…”