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

Abstract

Introduction. Microfragmented adipose tissue (MFAT) has been shown to benefit osteoarthritic patients by reducing pain and supporting tissue regeneration through a mesenchymal stem cell (MSC)-related paracrine mechanism. This observational study of 110 knees assessed patient-centered outcomes of pain, functionality, and quality of life, analyzing their variation at twelve months following one ultrasound-guided intra-articular injection of autologous MFAT for the treatment of knee osteoarthritis (KOA). Method. Inclusion criteria were as follows: VAS >50, and the presence of KOA as diagnosed on X-ray and MRI. Exclusion criteria included the following: recent injury (<3 months) of the symptomatic knee, intra-articular steroid injections performed within the last three months, and hyaluronic acid injections prior to this treatment. Changes in VAS, OKS, and EQ-5D were scored at baseline and twelve months following a single intra-articular injection of autologous MFAT. Score variation was analyzed utilizing a nonparametric paired samples Wilcoxon test. The statistical analysis is reproducible with Open Access statistical software R (version 4.0.0 or higher). The study was carried out with full patient consent, in a private practice setting. Results. Median VAS (pain) improved from 70 (IQR 20) to 30 (IQR 58) (p<0.001); median OKS (function) improved from 25 (IQR 11) to 33.5 (IQR 16) (p<0.001); and median EQ-5D (quality of life) improved from 0.62 (IQR 0.41) to 0.69 (IQR 0.28) (p<0.001). No adverse events were reported during the intraoperative, recovery, or postoperative periods. Conclusions. For patients with all grades of knee osteoarthritis who were treated with intra-articular injections of MFAT, statistically significant improvements in pain, function, and quality of life were reported. Although further research is warranted, the results are encouraging and suggest a positive role for intra-articular injection of MFAT as a treatment for knee osteoarthritis.

Characterisation of Novel Angiogenic and Potent Anti-Inflammatory Effects of Micro-Fragmented Adipose Tissue

“…Several previous studies have looked at the expression profiles of cytokines released by MFAT and SVF in a culture [ 6 ] although only using available commercial arrays and showed the MFAT expression of angiogenic factors such as the placental growth factor and angiogenin as well as HGF (shown in our data here also) and PDGF growth factors and other inflammation associated molecules such as IL-13, 3, 16 and 27. Their purpose was to compare the secretion against that of SVF and whilst MFAT was clearly more active in its secretion profile the comparisons failed to include key markers that defined the capability of MFAT; for example, to reduce pain and support the repair of or regeneration in joints with osteoarthritis [ 16 ]. Here, we have constructed an array that identified the major players, demonstrating a very high expression of the critical anti-inflammatory protein IL1-Rα antagonist, the major ‘protector’ against Il-1 signalling, which is the critical inflammatory pathway activated during the development of O/A and blocking, which has been shown to nullify multiple connected inflammatory pathways in disease [ 17 ].…”

Autologous Micro-Fragmented Adipose Tissue (MFAT) to Treat Symptomatic Knee Osteoarthritis: Early Outcomes of a Consecutive Case Series

“…Considering the results of the largest published MFAT series to date ( n = 110 knees), patient reported outcome measures VAS, OKS, and EQ-5D score all improved in statistically significant ways at 12 months follow-up [ 37 ]. However, in contrast to our study, no adverse events were reported.…”

Gender-Specific Response in Pain and Function to Biologic Treatment of Knee Osteoarthritis: A Gender-Bias-Mitigated, Observational, Intention-to-Treat Study at Two Years

“…Adipose tissue was harvested and microfragmented using previously published technique [ 9 ]. The MFAT was then injected under ultrasonographic guidance into the knee joint.…”

“…Microfragmented adipose tissue (MFAT) is one such therapy and is being increasingly explored for its benefit in managing OA. Cell-based therapies have demonstrated potential in treating OA [ 8 , 9 ]. Mesenchymal stem cells (MSCs), derived from MFAT, can transform into cartilage, adipocytes, osteoblasts, and osteocytes [ 10 ]; inhibit T cell growth [ 11 ]; and encourage joint repair through cartilage regeneration and inflammatory downregulation.…”

“…They also relieve OA pain by producing cytokines that target neurogenic pain pathways [ 12 ]. The role of microfragmented adipose tissue (MFAT) to optimise the joint environment during surgery is promising; authors of studies relating to MFAT and OA consistently conclude that MFAT is safe [ 13 ] and effective, increasing glycosaminoglycan (GAG) cartilage content [ 14 ] to result in improved joint function, pain, and quality of life [ 9 , 13 , 15 – 21 ].…”