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

Michael Baria, Angela Pedroza, Christopher Kaeding, Sushmitha Durgam, Robert Duerr, David Flanigan, James Borchers, Robert Magnussen, Michael Baria, Angela Pedroza, Christopher Kaeding, Sushmitha Durgam, Robert Duerr, David Flanigan, James Borchers, Robert Magnussen

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 × 103/µL and mean leukocyte count of 25.36 ± 13.27 × 103/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).

Keywords: knee osteoarthritis; mesenchymal stem cell; microfragmented adipose tissue; platelet-rich plasma.

Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: Funding for this study was provided through a research grant from the Lisa Dean Moseley Foundation. M.B. has received research funding from Arthrex and the Moseley Foundation and consulting and nonconsulting fees from Arthrex. C.K. has received grant support from DJO, education payments from CDC Medical, consulting fees from Arthrex and Zimmer Biomet, and nonconsulting fees from Arthrex and Smith & Nephew. S.D. has received grant support from Arthrex, education payments from Arthrex, and hospitality payments from Smith & Nephew and Stryker. D.F. has received education payments from CDC Medical; consulting fees from Bioventus, Ceterix, DePuy/Medical Device Business Services, Linvatec, Smith & Nephew, Vericel, and Zimmer Biomet; nonconsulting fees from Karl Storz Endoscopy and Smith & Nephew; and honoraria from Vericel. R.M. has received grant support from DJO and education payments from CDC Medical. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

© The Author(s) 2022.

Figures

Figure 1.
Figure 1.
CONSORT (Consolidated Standards of Reporting Trials) flow diagram. MFAT, microfragmented adipose tissue; PRP, platelet-rich plasma.
Figure 2.
Figure 2.
Outcomes at baseline and follow-up times for the Knee injury and Osteoarthritis Outcomes Score (KOOS) subscales and visual analog scale (VAS) for pain with Activities of Daily Living (ADL). lb/ub, lower bound/upper bound; MFAT, microfragmented adipose tissue; PRP, platelet-rich plasma; QoL, Quality of Life; Sport/Rec, Sport and Recreation.

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Source: PubMed

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