Comparative Clinical Observation of Arthroscopic Microfracture in the Presence and Absence of a Stromal Vascular Fraction Injection for Osteoarthritis

Abstract

Osteoarthritis (OA) is a degenerative cartilage disease that is characterized by a local inflammatory reaction. Consequently, many studies have been performed to identify suitable prevention and treatment interventions. In recent years, both arthroscopic microfracture (AM) and stem cell therapy have been used clinically to treat OA. This study aimed to evaluate the clinical effects of AM in the presence and absence of a stromal vascular fraction (SVF) injection in the management of patients with OA. Thirty patients with grade 2 or 3 (Lawrence scale) OA of the knee participated in this study. Placebo group patients (n = 15) received AM alone; treatment group patients (n = 15) received AM and an adipose tissue‐derived SVF injection. The SVF was suspended in platelet‐rich plasma (PRP) before injection into the joint. Patient groups were monitored and scored with the Western Ontario and McMaster Universities Arthritis Index (WOMAC), Lysholm, Visual Analog Pain Scale (VAS), and modified Outerbridge classifications before treatment and at 6, 12, and 18 months post‐treatment. Bone marrow edema was also assessed at these time points. Patients were evaluated for knee activity (joint motion amplitude) and adverse effects relating to surgery and stem cell injection. Treatment efficacy was significantly different between placebo and treatment groups. All treatment group patients had significantly reduced pain and WOMAC scores, and increased Lysholm and VAS scores compared with the placebo group. These findings suggest that the SVF/PRP injection efficiently improved OA for 18 months after treatment. This study will be continuously monitored for additional 24 months. Stem Cells Translational Medicine 2017;6:187–195

Expanded autologous adipose derived stem cell transplantation for type 2 diabetes mellitus

“…Adipose tissues from patients were collected according to a previously published study (Nguyen et al, 2016). Briefly, patients were given local anesthesia with 2-3 mL of marcaine (5 g/L); the lower abdomen area was also anesthetized.…”

Concise Review: Using Fat to Fight Disease: A Systematic Review of Nonhomologous Adipose-Derived Stromal/Stem Cell Therapies

“…Patients have experienced improvements in pain, function, mobility, and overall quality of life on various clinical questionnaires after SVF and ASC administration into the affected joints (Fig. H) . Clinical improvement persisted in these studies for several months to more than two years.…”

“…Various studies have been conducted in which human patients with osteoarthritis of the knee received an intra‐articular injection with autologous SVF and ASC. Many of the studies specifically recruited patients with osteoarthritis which was refractory to oral medications, physical therapy, autologous cartilage transplantation, and hyaluronic acid injection . Patients have experienced improvements in pain, function, mobility, and overall quality of life on various clinical questionnaires after SVF and ASC administration into the affected joints (Fig.…”

“…Clinical improvement persisted in these studies for several months to more than two years. Additionally, MRI and arthroscopy have demonstrated improvement or maintenance of cartilage status along the same time period after SVF or ASC administration . Preclinical studies suggest that these effects of ASCs may be due to ASC‐mediated reduction of pro‐inflammatory cytokines and chemokines, apoptosis of chondrocytes, hypertrophic and fibrotic chondrocyte phenotypes, and collagenases .…”

Autologous osteochondral transplantation for treatment of cartilage defects in osteoarthritic knee: preliminary results

“…Some recent studies have shown that autologous adipose stem cell transplantation can improve osteoarthritis (Bui et al, 2014). Combination of stem cell transplantation and microfracture have also proven to be better than microfracture alone (Nguyen et al, 2016). However, similar to osteochondral allograft transplantation and autologous chondrocyte implantation, stem cell transplantation is expensive but yields promising results in clinical trials.…”