Autologous and micro-fragmented adipose tissue for the treatment of diffuse degenerative knee osteoarthritis

A Russo, V Condello, V Madonna, M Guerriero, C Zorzi, A Russo, V Condello, V Madonna, M Guerriero, C Zorzi

Abstract

Background: Chondral lesions of the knee represent a challenge for the orthopaedic surgeon. Several treatments have been proposed with variable success rate. Recently, new therapeutic approaches, such as the use of mesenchymal stem cells, have shown promising results. The adipose tissue is a good source of these naturally occurring regenerative cells, due to its abundance and easy access. In addition, it can be used to provide cushioning and filling of structural defects. The 1-year safety and outcome of a single intra-articular injection of autologous and micro-fragmented adipose tissue in 30 patients affected by diffuse degenerative chondral lesions was evaluated.

Methods: Micro-fragmented adipose tissue was obtained using a minimal manipulation technique in a closed system. The safety of the procedure was evaluated by recording type and incidence of any adverse event. The clinical outcomes were determined using the KOOS, IKDC-subjective, Tegner Lysholm Knee, and VAS pain scales taken pre-operatively and at 12 months follow-up. A level of at least 10 points of improvement in the scores has been selected as cut-off representing a clinically significant difference.

Results: No relevant complications nor clinical worsening were recorded. A total median improvement of 20 points has been observed in IKDC-subjective and total KOOS, and a higher percentage of success was found in VAS pain and Tegner Lysholm Knee, where the total median improvement was 24 and 31 points, respectively.

Conclusion: The results of this study show the safety and feasibility of using autologous and micro-fragmented adipose tissue in patients affected by diffuse degenerative chondral lesions. The technique is safe, minimally invasive, simple, one-step, with low percentage of complications, and compliant with the regulatory panorama.

Keywords: Adipose tissue; Knee Chondropathy; MSCs; Osteoarthritis.

Conflict of interest statement

Ethics approval and consent to participate

The study was approved by the Ethics Committee of Verona and Rovigo - Italy (protocol n° 10,227, March 1st, 2016). All procedures mentioned in this study were carried on in accordance with the ethical standards and with the Helsinki Declaration of 1975, as revised in 2000.

Consent for publication

Written informed consents were obtained from all patients for publication of this paper.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Lipogems® system. Top) surgical setting. Bottom left) device. Bottom right) final product
Fig. 2
Fig. 2
Box plot of VAS pain, Tegner Lysholm knee, IKDC subjective and total KOOS pre-operatively (t0) and at 12 months (t12) after micro-fragmented adipose tissue injection. Results are expressed as median and interquartile range
Fig. 3
Fig. 3
Box plot of the five KOOS subscale scores pre-operatively (t0) and at 12 months (t12) after micro-fragmented adipose tissue injection. Results are expressed as median and interquartile range. KOOS S = symptoms; KOOS P = pain; KOOS ADL = activity daily living; KOOS Spt = sport; KOOS QoL = quality of life

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