Platelet-Rich Plasma Versus Microfragmented Adipose Tissue for Knee Osteoarthritis: A Randomized Controlled Trial

Abstract

Background: Platelet-rich plasma (PRP) has been established as safe and effective for knee osteoarthritis (OA). Another orthobiologic therapy, microfragmented adipose tissue (MFAT), has gained attention because of its heterogeneous cell population (including mesenchymal stem cells). However, prospective comparative data on MFAT are lacking. Because of the safety, efficacy, and simplicity of PRP, new therapeutics such as MFAT should be compared directly with PRP. Purpose: To compare patient-reported outcomes of a single injection of PRP versus MFAT for knee OA. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: A total of 58 patients with symptomatic knee OA (Kellgren-Lawrence grades 1-4) were randomized to receive a single injection of either leukocyte-rich PRP or MFAT under ultrasound guidance. PRP was created by processing 156 mL of whole blood. MFAT was created by harvesting 30 mL of adipose tissue via standard lipoaspiration. Scores for the Knee injury and Osteoarthritis Outcome Score (KOOS) subscales and visual analog scale for pain with Activities of Daily Living (VAS-ADL) were recorded at baseline and at 1, 3, and 6 months after the injection. The primary outcome was the KOOS–Pain subscore at 6 months after the injection. Results: The PRP group (n = 30) had a mean volume of 5.12 ± 1.12 mL injected. This consisted of a mean platelet count of 2673.72 ± 1139.04 × 10 3 /µL and mean leukocyte count of 25.36 ± 13.27 × 10 3 /µL (67.81% lymphocytes, 18.66% monocytes, and 12.33% neutrophils). The MFAT group (n = 28) had a mean volume of 7.92 ± 3.87 mL injected. The mean total nucleated cell count was 3.56 ± 4.62 million/mL. In both groups, KOOS subscale and VAS-ADL scores improved from baseline, and there was no significant difference between the PRP and MFAT groups in the final KOOS–Pain subscore (80.38 ± 16.07 vs 81.61 ± 16.37, respectively; P = .67) or any other outcome score. Conclusion: A single injection of either PRP or MFAT resulted in a clinically meaningful improvement for patients with knee OA at 6 months, with no difference between treatment groups. Registration: NCT04351087 ( ClinicalTrials.gov identifier).

Knee Osteoarthritis: Clinical and MRI Outcomes After Multiple Intra-Articular Injections With Expanded Autologous Adipose-Derived Stromal Cells or Platelet-Rich Plasma

“…25 A randomized controlled trial comprising 58 patients with symptomatic Kellgren-Lawrence I-IV knee OA showed comparable Visual Analog Scale (VAS) and KOOS scores after leukocyte-rich PRP and micro-fragmented AT intra-articular injections (3.56 ± 4.62 million nucleated cells/ml) at 6-month follow-up. 26 Similarly, Kaszyński et al, 27 in their randomized controlled trial including 60 patients with Kellgren-Lawrence I-III symptomatic knee OA, showed comparable VAS, KOOS, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and IKDC 2000 outcomes between intra-articular LP-PRP and autologous AT injections at 12 months. Similarly, Zaffagnini et al, 28 in a randomized controlled trial, showed no significant differences in IKDC, KOOS, and EuroQol 5-dimensions questionnaire (EQ-5D) between a single intra-articular injection of microfragmented AT and PRP at 12-month follow-up.…”

Autologous Adipose Tissue vs. Platelet-Rich Plasma for Treatment of Knee Osteoarthritis

“…Recently, there has been increased interest in the use of autologous biologics, including platelet-rich plasma (PRP), adipose tissue, etc., for regenerative medicine applications, especially in musculoskeletal conditions such as knee osteoarthritis [ 9 ]. Numerous randomized controlled trials and meta-analyses have shown the safety and efficacy of PRP for the treatment of knee OA [ 10 ]; thus, PRP is considered the gold-standard biologic for the treatment of musculoskeletal injuries. On the other hand, other autologous treatment modalities such as adipose tissue (including microfragmented adipose tissue (MFAT)) have not undergone a similar degree of clinical trials [ 10 ].…”

“…Numerous randomized controlled trials and meta-analyses have shown the safety and efficacy of PRP for the treatment of knee OA [ 10 ]; thus, PRP is considered the gold-standard biologic for the treatment of musculoskeletal injuries. On the other hand, other autologous treatment modalities such as adipose tissue (including microfragmented adipose tissue (MFAT)) have not undergone a similar degree of clinical trials [ 10 ]. Initial clinical studies have reported improved patient-reported outcomes in patients suffering from knee OA post-administration of MFAT [ 11 , 12 , 13 ].…”

“…However, this was one of the first prospective studies to compare the efficacy of MFAT with PRP, and various factors, including use of inferior-quality PRP, the addition of viscosupplementation, etc., complicated the conclusions from this study [ 14 ]. In this editorial, I focused on a recently published, one of the first, randomized controlled trials, titled “Platelet-Rich Plasma Versus Microfragmented Adipose Tissue for Knee Osteoarthritis: A Randomized Controlled Trial”, where the patient-reported outcomes of a single injection of PRP were compared to MFAT for knee OA [ 10 ].…”

“…In this study by Baria et al (ClinicalTrials.gov identifier: NCT04351087) [ 10 ], a total of 58 patients with symptomatic knee OA (Kellgren–Lawrence (KL) scale grade 1–4) were randomized 1:1 to receive either a single injection of leukocyte-rich PRP or MFAT. PRP was made by processing 156 mL of the whole blood.…”