Microfragmented Adipose Tissue versus Platelet-Rich Plasma for the Treatment of Knee Osteoarthritis: Letter to the Editor

Abstract

Biologic therapies have a huge potential in orthopaedic conditions such as knee osteoarthritis (KOA). Recently, numerous reviews and meta-analyses have been published in the field of regenerative medicine. Unfortunately, the lack of biologic product standardization and the concomitant use of different therapies do not allow consistent conclusions on their efficacy. Among others, platelet-rich plasma (PRP), stromal vascular fraction (SVF), cultured bone marrow, and adipose tissue-derived mesenchymal stem cells are the ones extensively tested. Microfragmented adipose tissue (MF-AT) has risen as an alternative therapy that needs a minimal manipulation approach. The article by Zaffagnini and coworkers 10 has provided an interesting insight into the role of autologous MF-AT on KOA treatment. However, we would like to raise some concerns on the methods and conclusions of the study.MF-AT efficacy in KOA is not evidence based yet. MF-AT has not been found superior in terms of efficacy compared with similar treatments that need less manipulation. Randomized placebo-controlled trials are missing. To the best of our knowledge, Zaffagnini et al 10 have published 1 of the 3 existing randomized clinical trials that use MF-AT to treat KOA. 2,6,10 Dallo et al 2 found an improvement on functional scales in both groups (the one treated with MF-AT and the one treated with PRP and hyaluronic acid), without clear benefits in the experimental group. In their study, Peretti et al 6 did not find significant differences in their preliminary results comparing arthroscopy versus arthroscopy and MF-AT injection.Concerning objective outcomes, magnetic resonance imaging (MRI) performed by Zaffagnini et al 10 to evaluate KOA improvement or progression showed no differences after MF-AT injection. In contrast, as already stated in a recent systematic review, SVF has proven significant improvement not only in subjective outcomes but also in radiological findings in MRI between baseline and a 12-or 24-month control. 4,5,[7][8][9] Thus, MF-AT should not be considered the first-line biologic treatment for KOA. Among adipose-derived biological products, SVF should be considered first. A great cell population with a great amount of adipose stem cells that can rapidly differentiate into all mesodermal lines is only