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Journal ArticleDOI: 10.1007/S00264-021-04947-0

Two-year clinical outcomes of autologous microfragmented adipose tissue in elderly patients with knee osteoarthritis: a multi-centric, international study

02 Mar 2021-International Orthopaedics (Springer Berlin Heidelberg)-Vol. 45, Iss: 5, pp 1179-1188
Abstract: The aim of this study is to evaluate the outcomes of autologous microfragmented adipose tissue (MFAT) injection in elderly patients with knee osteoarthritis (OA). We hypothesized that MFAT knee infiltration for the treatment of knee OA would yield good clinical results out to two years follow-up. Multi-centric, international, open-label study conducted by orthopedic surgery, and/or regenerative medicine facilities utilizing patient registries. Subjects recruited for eligibility. The primary outcome measure was Knee Injury and Osteoarthritis Outcome Score (KOOS). Outcomes and patient factors were compared to baseline, at six, 12, and 24 months. Statistical models were used to assess KOOS subscores and probability of exceeding the Minimally Clinically Important Difference (MCID) or Patient Acceptable Symptom State (PASS), and to assess the effect of the treatment variables on KOOS - Pain. Seventy-five patients, 120 primary treatments, mean age 69.6 years, (95%CI 68.3–70.9), BMI 28.4 (95%CI 27.3–29.6), with KL grade 2 to 4 knee OA treated with a single MFAT injection. KL grades 2 (15.1%), 3 (56.3%), and 4 (28.6%), with 20.8% of knees having previously undergone surgery. Patients with KL grade 2 disease had the best results in KOOS - Pain (P = 0.001), at six, 12, and 24 months. Including advanced KL grade 3 and 4 osteoarthritis patients, significant functional and quality of life success was seen in 106/120 treatments (88.3%, 66 patients) at all follow-up time points. Fourteen treatments (11.7%, 9 patients) failed prior to the study endpoint. This study shows that a single-dose MFAT injection leads to clinical, functional, and quality of life improvement at two years in elderly patients, in KL grades 2 to 4 of knee osteoarthritis. These findings provide evidence that this treatment modality could be a safe and effective option to other commonly available treatments in carefully selected patients.

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Open accessJournal ArticleDOI: 10.1089/SCD.2021.0053
Abstract: The objective of this study was to compare the clinical efficacy of repeated doses of leucocyte-poor platelet-rich plasma (LP-PRP) plus hyaluronic acid (HA) to a single dose of autologous microfrag...

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Topics: Platelet-rich plasma (56%), Hyaluronic acid (54%), Adipose tissue (53%) ... show more

3 Citations


Open accessJournal ArticleDOI: 10.1016/J.JCJP.2021.100021
01 Sep 2021-
Abstract: Introduction Subchondral bone pathology includes a wide range of pathologies, such as osteoarthritis, spontaneous insufficiency fractures, osteonecrosis, transient bone marrow lesions syndromes, and trauma. They show typical magnetic resonance imaging (MRI) findings termed bone marrow lesions (BMLs). However, the etiology and evolution of BMLs in multiple conditions remains unclear. There is still no gold standard treatment protocol in treating BMLs in the knee, and a variety of treatment modalities have been tested in the hope that they might reduce pain and stop disease progression. Objectives To review the treatment options for BMLs of the knee. Methods A literature review was performed that included searches of PubMed, Cochrane, and Medline databases using the following keywords: Bone marrow lesions, sub chondroplasty, bone marrow concentrate, platelet-rich plasma (PRP), subchondral bone augmentation. Results The use of novel biologic techniques to treat BMLs in the knee, such as PRP and Bone Marrow Cells, has yielded promising clinical outcomes. Conclusions Future research of BMLs will be mandatory to address the different pathologies better and determining appropriate treatment strategies. There is still a need for high-quality RCTs studies and systematic reviews in the future to enhance further treatment strategy in preventing or treating BMLs of the knee.

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Topics: Bone marrow (51%), Chondroplasty (50%)

2 Citations


Open accessJournal ArticleDOI: 10.1016/J.JCJP.2021.100023
01 Sep 2021-
Abstract: Introduction Over the past decade, human adipose-derived mesenchymal stem/signaling/stromal cell (ADSC) therapies have become increasingly popular as a biologic treatment for a variety of orthopedic conditions. ADSCs represent a source of stromal cells with biologic properties that allow for paracrine and immunomodulatory functions and the ability to differentiate into various downstream cellular tissues. Before considering the use of adipose tissue as a cellular source, it is imperative to understand its anatomy and physiology and its roles in the human body. Objectives To review the current literature regarding the anatomy, physiology, and various roles of human adipose tissue, as well as harvesting techniques and its role in biologic therapy. Methods A comprehensive literature review that included searches of PubMed, medline, EMBASE, and Google Scholar database(s), including both preclinical and clinical studies, was performed. Results This manuscript represents an updated understanding of adipose tissue, including its anatomy, functions in the human body, and role as a perivascular cellular source for tissue renewal, in addition to its role in providing cushioning and support to various structures. Conclusion Adipose tissue is widespread throughout the body and serves multiple physiologic functions. It can be harvested through several techniques and is an abundant source of bioactive molecules and ADSCs. Research in orthopedic surgery has begun using adipose tissue as a source of homologous and non-homologous cell and tissue applications. Future study will continue to investigate optimal sources of adipose-derived cells and tissues, and its therapeutic applications in orthopedics.

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Topics: Adipose tissue (58%)

2 Citations


Open accessJournal ArticleDOI: 10.1155/2021/9921015
Abstract: Background Knee osteoarthritis (KOA) is a significant cause of disability in a globally ageing population. Knee replacement surgery has been shown to improve function and quality of life. Access to this intervention can be limited for a number of reasons including rationing of care, lack of healthcare provision in austere environments, and more recently, due to the cessation of elective orthopaedic care as a result of the COVID pandemic. Referral for knee replacement surgery is often guided by the patient's Oxford Knee Score (OKS). Recent therapies including treatment with microfragmented adipose tissue (MFAT) have emerged as alternatives to relieve pain and improve function in such patients. Method We identified all patients with KOA Kellgren-Lawrence grade 3 and 4 in our dataset of patients treated with a single injection of MFAT and applied published OKS thresholds for referral for TKR to separate them into 3 cohorts according to their functional impairment. 220 patients (95 females, 125 males) with KOA were given one MFAT injection. The function (OKS) and quality of life (EuroQol-5) prior to and 24 months after therapy were compared. Results MFAT injection provided a statistically significant improvement in the quality of life (EQ-5D) at 24 months in patients with a baseline OKS of 39 or less (p value: <0.001) as well as those with OKS of 27 or less who are deemed suitable for a knee replacement (p value: <0.001). Conclusion MFAT injection improves quality of life in patients with KOA who are deemed suitable for the knee replacement. MFAT is a low-morbidity alternative biological treatment and can delay the need for total knee replacement in suitable patients.

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Topics: Oxford knee score (63%), Knee replacement (58%)

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33 results found


Open accessJournal ArticleDOI: 10.1136/ARD.16.4.494
Abstract: In a previous study (Kellgren and Bier, 1956), three sets of x rays of the hands were used to assess interand intra-observer differences in interpreting changes of rheumatoid arthritis. Wide disagreement between observers was found, and it was concluded that, to ensure maximum uniformity in grading x rays in field surveys and therapeutic trials, all readings should be made by the same observer, preferably at a single session. The advisability of having a set of standard reference films was also considered.

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8,795 Citations


Open accessJournal ArticleDOI: 10.1186/1477-7525-1-64
Ewa M. Roos1, L. Stefan Lohmander1Institutions (1)
Abstract: The Knee injury and Osteoarthritis Outcome Score (KOOS) was developed as an extension of the WOMAC Osteoarthritis Index with the purpose of evaluating short-term and long-term symptoms and function in subjects with knee injury and osteoarthritis. The KOOS holds five separately scored subscales: Pain, other Symptoms, Function in daily living (ADL), Function in Sport and Recreation (Sport/Rec), and knee-related Quality of Life (QOL). The KOOS has been validated for several orthopaedic interventions such as anterior cruciate ligament reconstruction, meniscectomy and total knee replacement. In addition the instrument has been used to evaluate physical therapy, nutritional supplementation and glucosamine supplementation. The effect size is generally largest for the subscale QOL followed by the subscale Pain. The KOOS is a valid, reliable and responsive self-administered instrument that can be used for short-term and long-term follow-up of several types of knee injury including osteoarthritis. The measure is relatively new and further use of the instrument will add knowledge and suggest areas that need to be further explored and improved.

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Topics: WOMAC (58%), Osteoarthritis (52%)

1,362 Citations


Open accessJournal ArticleDOI: 10.1016/J.STEM.2011.06.008
Arnold I. Caplan1, Diego Correa1Institutions (1)
08 Jul 2011-Cell Stem Cell
Abstract: Now that mesenchymal stem cells (MSCs) have been shown to be perivascular in vivo, the existing traditional view that focuses on the multipotent differentiation capacity of these cells should be expanded to include their equally interesting role as cellular modulators that brings them into a broader therapeutic scenario We discuss existing evidence that leads us to propose that during local injury, MSCs are released from their perivascular location, become activated, and establish a regenerative microenvironment by secreting bioactive molecules and regulating the local immune response These trophic and immunomodulatory activities suggest that MSCs may serve as site-regulated "drugstores" in vivo

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Topics: Mesenchymal stem cell (56%)

1,223 Citations


Open accessJournal ArticleDOI: 10.1038/EMM.2013.94
Abstract: Mesenchymal stem cells (MSCs) are partially defined by their ability to differentiate into tissues including bone, cartilage and adipose in vitro, but it is their trophic, paracrine and immunomodulatory functions that may have the greatest therapeutic impact in vivo. Unlike pharmaceutical treatments that deliver a single agent at a specific dose, MSCs are site regulated and secrete bioactive factors and signals at variable concentrations in response to local microenvironmental cues. Significant progress has been made in understanding the biochemical and metabolic mechanisms and feedback associated with MSC response. The anti-inflammatory and immunomodulatory capacity of MSC may be paramount in the restoration of localized or systemic conditions for normal healing and tissue regeneration. Allogeneic MSC treatments, categorized as a drug by regulatory agencies, have been widely pursued, but new studies demonstrate the efficacy of autologous MSC therapies, even for individuals affected by a disease state. Safety and regulatory concerns surrounding allogeneic cell preparations make autologous and minimally manipulated cell therapies an attractive option for many regenerative, anti-inflammatory and autoimmune applications.

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838 Citations


Open accessJournal ArticleDOI: 10.1093/BMB/LDS038
Abstract: Background: Osteoarthritis (OA) is a degenerative joint disease involving the cartilage and many of its surrounding tissues. Disease progression is usually slow but can ultimately lead to joint failure with pain and disability. OA of the hips and knees tends to cause the greatest burden to the population as pain and stiffness in these large weight-bearing joints often leads to significant disability requiring surgical intervention. Sources of data: The article reviews the existing data on epidemiology of osteoarthritis and the burden of the disease. Areas of agreement: Symptoms and radiographic changes are poorly correlated in OA. Established risk factors include obesity, local trauma and occupation. The burden of OA is physical, psychological and socioeconomic. Areas of controversy: Available data does not allow definite conclusion regarding the roles of nutrition, smoking and sarcopenia as risk factors for developing OA. Growing points: Variable methods of diagnosing osteoarthritis have significantly influenced the comparability of the available literature. Areas timely for developing research: Further research is required to fully understand how OA affects an individual physically and psychologically, and to determine their healthcare need.

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Topics: Population (51%), Osteoarthritis (50%)

685 Citations