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

Gerard A Malanga, Paul S Chirichella, Nathan S Hogaboom, Teresa Capella, Gerard A Malanga, Paul S Chirichella, Nathan S Hogaboom, Teresa Capella

Abstract

Purpose: The management of knee pain secondary to meniscal tears with osteoarthritis is limited by the poor inherent healing potential of the meniscus. Previous studies have reported on the benefit of autologous micro-fragmented fat as a therapeutic for various knee pathologies. The goal of this prospective pilot study was to determine the safety and potential treatment effect of micro-fragmented adipose tissue injection for patients with knee pain secondary to osteoarthritis and meniscal tears who have failed conservative management.

Methods: Twenty subjects with knee pain secondary to osteoarthritis with associated meniscal tear after failed conservative management were enrolled in the study. Numeric Pain Scale (NPS) and Knee Injury and Osteoarthritis Outcome Scale (KOOS) following ultrasound-guided intra-meniscal and intra-articular micro-fragmented adipose tissue injections were examined at three, six and 12 months.

Results: The mean NPS revealed a significant decrease in patient pain at the 1-year time point compared with baseline (5.45 to 2.21, p < .001). Similarly, overall, mean KOOS symptoms significantly improved from 57.7 to 78.2 (p < .001), with all 4 KOOS subscales demonstrating significant improvement at the final one year follow-up. One subject developed uncomplicated cellulitis at the harvest site which was treated with oral antibiotics. Other complications were minor and mostly limited to adipose harvest.

Conclusion: This study demonstrated that micro-fragmented adipose tissue injected directly into a torn meniscus and knee joint using ultrasound guidance represents a safe and potentially efficacious treatment option for patients with knee pain suffering from degenerative arthritis and degenerative meniscal tears. A larger, randomized, controlled trial is warranted to determine efficacy.

Trial registration: Clinicaltrials.org Identifier: NCT03714659.

Keywords: Adipose tissue; Injections; Intra-articular; Knee injuries; Knee osteoarthritis; Meniscus; Ultrasonography.

Figures

Fig. 1
Fig. 1
Changes in Knee Injury and Osteoarthritis Outcome Score (KOOS) subscale scores in response to treatment. Increases were seen across all five subscales, which leveled off after 6 months through to 12 months post-treatment. Triangle = symptoms subscale, circle = pain subscale, square = activities of daily living subscale, diamond = sports and recreation subscale, “X” = quality of life subscale
Fig. 2
Fig. 2
Overall changes in numerical pain scale scores over the duration of the study. Decreases were observed at all time points were observed relative to pre-treatment pain levels. Improvements in pain appeared to level and remain steady after 6 months
Fig. 3
Fig. 3
Needle tip visualized in an out-of-plane view for MFAT injection into the meniscus under ultrasound guidance

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