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

Author: Malanga et al
Year: 2020

The Regenerative Clinic's view on this research

Professor Mark Slevin: The work describes a pilot clinical trial investigating the utility of autologous liposucted, Lipogems-derived MFAT for treatment of knee pain caused by mild to moderate osteoarthritis from original mostly complex meniscal tears in 20 patients (mean age 59 years) who had failed in initial alternative conservative management. The individuals were treated with ultrasound-guided intra-meniscal articular MFAT injections. Follow up was provided by measurement of the NPS (pain) and KOOS (outcome scale) after 3, 6 and 12 months. Results showed a significant reduction in pain (NPS mean 5.4 to 2.2) and increase in KOOS (mean 58 to 78) by 3 months and this remained constant up to the 12-month test period. The authors suggest MFAT treatment could be an effective and safe treatment for degenerative osteoarthritis and meniscal tears and that a large randomized controlled clinical trial is warranted.

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.

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