Non-Responding Knee Pain with Osteoarthritis, Meniscus and Ligament Tears Treated with Ultrasound Guided Autologous, Micro-Fragmented and Minimally Manipulated Adipose Tissue

Abstract

Background: Chronic knee pain from advanced osteoarthritis is often associated with tears in the fibro-cartilaginous meniscus and cruciate ligaments. The result is substantial pain and impairments and loss of daily function, thus limiting activity and quality of life. These often include pain, loss of range of 116 motion, inability to elevate the leg, pain increased with activity and gradual worsening over time. This represents a challenging clinical picture for which few non-surgical options are available. Most patients failing to respond to current methods of care are offered arthroplasty. Current therapies are focused on the relief of the symptoms but cannot repair the damage nor stop the degenerative process. Objective: This is a case study of the first subject in a continuing IRB to reach a 2.5 year end-point. Our intention was to investigate the potential benefits of using autologous, minimally manipulated fat graft in subjects with advanced osteoarthritis and meniscus pathology who had failed to obtain benefit from previous, standards of care. Study description: 73 YO male, end stage bone-on-bone right knee pain. First subject to reach the 2 1/2 year follow up after Lipogems® precision ultrasound guided injections. Material and Methods: Micro-fragmented fat was obtained using a minimal manipulation technology in a closed system, Lipogems®, without the addition of enzymes or other additives. Fat graft was injected under continuous ultrasound guidance. Results: VAS pain, KOOS function, range of motion and quadriceps strength improved after treatment. Conclusion: Autologous, micronized, and minimally manipulated adipose tissue resulted in significant improvement in pain, function and quality of life. No adverse events were reported.

Clinical evaluation of micro-fragmented adipose tissue as a treatment option for patients with meniscus tears with osteoarthritis: a prospective pilot study

“…As a group, the study sample showed clinically meaningful improvement in pain, function, and QOL measures despite having previously failed other treatments for their knee pain. These results were similar to two published case reports where individuals with history of knee pain following meniscus tear in the setting of degenerative osteoarthritis were treated with ultrasound-guided intra-meniscal MFAT injections [ 12 , 35 ]. All subjects avoided the need for APM for their knee pain during the study period.…”

“…This may be compared with the cross-over rates from conservative management to APM in the Katz study as high as 21–30% at six to 14 months in various randomized controlled trials [ 36 ]. Furthermore, no participants reported serious adverse events after the procedure, which is consistent with other studies evaluating the effects of intra-articular MFAT [ 12 , 35 ].…”

“…After injury or damage to the capillary wall, pericytes can detach and gradually convert into activated MSCs [ 11 ]. Although the exact mechanism of action is not fully understood, improvement in pain and function scores following intra-articular injection of MFAT has been reported in the setting of knee osteoarthritis and meniscal tear [ 12 ]. The rationale for considering MFAT injection over PRP and bone marrow aspirate is that the adipose tissue serves as a tissue filler in defects such as torn meniscus and cartilage lesions in addition to the noted potential anti-inflammatory and healing effects.…”

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

“…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 . Furthermore, a case report has been presented on this use of this device in the successful treatment of a degenerative meniscal tear in a triathlete .…”

Adipose Tissue-Derived Mesenchymal Stem Cells: A Novel Therapy in Orthopedics

“…When compared to enzymatically derived MSCs, mechanically derived MSCs have superior differentiation potential with larger secretome content and more diverse exosome content without disruption of vascular stroma [66,67]. This method is purely mechanical with no chemical additives used; thus, showing promising results that power the method of nonenzymatic harvesting of stem cells derived adipose tissue [19,[68][69][70][71][72].…”