Stromal vascular fraction therapy for knee osteoarthritis: a systematic review

Abstract

Background: Regenerative cell therapies, such as adipose-derived stromal vascular fraction (SVF), have been postulated as potential treatments for knee osteoarthritis (KOA). Objectives: To assess the efficacy and safety of SVF treatment against placebo and other standard therapies for treating KOA in adult patients. Design: A systematic review. Data sources and methods: We searched the following databases: MEDLINE via PubMed, Epistemonikos, PEDro, DynaMed, TripDatabase, Elsevier via Clinicalkey and Cochrane Controlled Trials Register. We included prospective interventional studies where treatment with SVF in adults with KOA was compared against placebo or other standard therapies, and results were objectively measured with at least one widely recognised osteoarthritis scale. Results: Among 266 studies published until May 2021, nine met our inclusion criteria. A total of 239 patients (274 knees) were included in our study. The follow-up ranged from 6 to 24 months. Six studies had a control group (only one being placebo). All studies showed that SVF improved pain and functionality measured, in most cases, with the visual analogue scale and the Western Ontario and McMaster Universities Osteoarthritis Index. In addition, five studies reported an improvement in anatomical structures, as detected in MR images. However, the number of cells contained in SVF varied substantially between different studies, which could induce a comparison bias. Conclusion: Although based on a small number of dissimilar studies, SVF was considered a safe treatment for KOA and could be promising in terms of pain, functionality and anatomical structure improvement. However, SVF products need to be standardised, the number of cells homogenised and the use of concomitant treatments reduced to establish proper comparisons. Registration: PROSPERO registration number: CRD42021284187.

Autologous Adipose-Derived Tissue Stromal Vascular Fraction (AD-tSVF) for Knee Osteoarthritis

“…We are currently improving our knowledge on the transition of treatment modalities from micro-and nano-fragmented fat tissue grafts to AD-cSVF, AD-tSVF, and ADMSCs. The number of patients in the follow-up studies is increasing [ 65 ]. There is a variation for the mean age of application in knee OA patients.…”

“…Well-trained athletes with very few amounts of abdominal fat would not be good candidates for AD-tSVF applications [ 64 ]. Patients with secondary arthritis, medical conditions that precluded an anesthetic procedure, psychiatric disorders, history of cancer, pregnancy, coagulopathy, signs of infection or syphilis- or HIV-positive serological results, knee joint surgery, and intra-articular injection may not be a proper choice although there were no serious adverse effects reported in appropriately selected patients [ 65 , 66 , 67 ]. Cells and tissue fragments obtained from the adipose tissue are experimented to regenerate tissues related to coronary heart disease, peripheral vascular diseases, dermatopathy, chronic wounds, ischemia [ 68 ], diabetic foot ulcers, fistulas, liver fibrosis, lipodystrophy, Burger disease, and radiation-related ulcers [ 57 , 69 , 70 ].…”

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

“…Contrary to MF-AT treatment, and as already stated in a recent systematic review, SVF is a safe and clinically and radiologically effective treatment for KOA. 1…”

“…Contrary to MF-AT treatment, and as already stated in a recent systematic review, SVF is a safe and clinically and radiologically effective treatment for KOA. 1 For all the reasons mentioned above, we firmly believe that the statement ''compared with an enzymatically processed lipoaspirate, MF-AT secreted a higher amount of growth factors and cytokines involved in tissue repair'' can be confusing, so KOA tissue regeneration cannot be guaranteed. Authors' Response:…”

Microfragmented Adipose Tissue Versus Platelet-Rich Plasma for the Treatment of Knee Osteoarthritis: Response

“…Accordingly, we cannot support the statement of Boada-Pladellorens et al to consider this product as first line among the orthobiologic products for the treatment of knee OA. The same authors in a recent systematic review of the literature 1 found just 9 clinical studies investigating SVF injections for knee OA treatment, of which there were only 2 randomized controlled trials (SVF vs placebo and hyaluronic acid, respectively) with a very small number of patients (39 and 16 patients, respectively). 3,4 These underpowered studies do not allow us to draw any meaningful conclusion on the real potential of this type of adipose-derived product.…”