Micro-fragmented adipose tissue injection associated with arthroscopic procedures in patients with symptomatic knee osteoarthritis

G Cattaneo, A De Caro, F Napoli, D Chiapale, P Trada, A Camera, G Cattaneo, A De Caro, F Napoli, D Chiapale, P Trada, A Camera

Abstract

Background: The social impact of degenerative diseases is steadily increasing, because of the continued rise in the mean age of the active population. Articular cartilage lesions are generally associated with disability and symptoms such as joint pain and reduced function, and remain a challenge for the orthopaedic surgeon. Several non-invasive solution have been proposed, but the results achieved to date are far from being completely satisfactory. Recently, new therapeutic approaches, such as the use of mesenchymal stem cells, have been developed. Among the many sources, the adipose tissue is nowadays considered one of the smartest, due to its abundance and easy access. The aim of this retrospective study is to explore whether patients affected by symptomatic knee osteoarthritis treated with micro-fragmented adipose tissue associated with a chondral shaving procedure experience an improvement in symptoms and function.

Methods: Thirty-eight patients affected by symptomatic knee osteoarthritis were treated in 2015 with an arthroscopic procedure associated with an injection of autologous and micro-fragmented adipose tissue. Micro-fragmented adipose tissue was obtained using a minimal manipulation technique in a closed system. Clinical outcomes were determined at 1, 3, 6, and 12 months follow-up using Knee Injury and Osteoarthritis Outcome Score questionnaire and direct physical examination. Safety of the procedure, recording type and incidence of any adverse event, was also assessed.

Results: A steady and statistically significant improvement of all the clinical scores from pre-operative evaluation to 1, 3, 6, and 12 months follow-up was observed, with KOOS sport and quality of life being the most improved scores. On average, 92% of the patients clinically improved and 100% of them were satisfied with the treatment. No adverse events nor relevant complications were recorded.

Conclusion: The result of the study pointed to micro-fragmented adipose tissue as a safe and beneficial adjuvant in the surgical treatment of degenerative knee chondropathy. The procedure is simple, sustainable, quick, minimally invasive, one-step, and safe. After one year, the results are very satisfactory and promising. A longer follow-up is needed to draw definitive conclusions and enlarge the indications.

Trial registration: Registered at clinicaltrials.gov as NCT03527693 on 27 April 2018 (retrospectively registered).

Keywords: ASCs; Knee chondropathy; MSCs; Micro-fragmented adipose tissue; Osteoarthritis.

Conflict of interest statement

Ethics approval and consent to participate

The retrospective analysis of the patient data was approved by the Regional Ethics Committee of Liguria - Italy (protocol n° 164REG2016, September 22, 2016). No approval for the initial treatment of the patients was required being the procedure standard clinical practice in our Hospital. All the 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. Patients were informed about risks, benefits, and alternative options to the proposed treatment and signed the informed consent form.

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
Trend of functional improvements of the SH group from baseline to 12 months’ follow-up. Results are expressed as mean and standard error. A p < 0.05 (T12 vs. T0) was considered statistically significant (# #). a KOOS score. KOOS S = symptoms; KOOS P = pain; KOOS ADL = activity daily living; KOOS Spt = sport; KOOS QoL = quality of life. b WOMAC Index
Fig. 2
Fig. 2
Trend of functional improvements of the SM group from baseline to 12 months’ follow-up. Results are expressed as mean and standard error. A p < 0.05 (T12 vs. T0) was considered statistically significant (# #). a KOOS score. KOOS S = symptoms; KOOS P = pain; KOOS ADL = activity daily living; KOOS Spt = sport; KOOS QoL = quality of life. b WOMAC Index

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