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Microfragmented Adipose Tissue Has No Advantage Over Platelet-Rich Plasma and Bone Marrow Aspirate Injections for
Erik Hohmann1,2, Natalie Keough3,4, Rachel M Frank5
1Medical School, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
Background:
Microfragmented adipose tissue has been proposed for intra-articular treatment of knee osteoarthritis. There are little data comparing the outcomes of treatment between microfragmented adipose tissue and other biological treatments.
Purpose:
To perform a systematic review and meta-analysis comparing microfragmented aspirated fat injections to other orthobiologics, hyaluronic acid, and corticosteroid injections for symptomatic knee osteoarthritis.
Study Design:
Systematic review and meta-analysis; Level of evidence, 2.
Methods:
A systematic review of the literature was performed to identify pertinent publications in the MEDLINE, Embase, Scopus, and Google Scholar databases, including all level 1 to 3 studies from 2000 to 2023. Validated knee scores (visual analog scale [VAS] for pain, Knee injury and Osteoarthritis Outcome Score [KOOS], Lysholm, International Knee Documentation Committee) were included as outcome measures. Risk of bias was assessed using Cochrane tools. The Grading of Recommendations Assessment, Development and Evaluation system was used to assess the quality of the body of evidence and the modified Coleman Methodology Score was used to assess study quality. Heterogeneity was assessed using χ2 and I2 statistics.
Results:
Five studies were included in the analysis. One study had a high risk of bias; 4 studies had some risk of bias. The overall study quality was fair, and the certainty of evidence was low. The pooled estimate for VAS scores did not demonstrate significant differences at 3, 6, and 12 months. The pooled estimate for the KOOS Pain, Symptoms, Activities of Daily Living, Sport and Recreation, and Quality of Life subscales did not demonstrate significant differences at 3, 6, and 12 months.
Conclusion:
The results of this systematic review and meta-analysis demonstrated that there were no statistically significant differences for both the clinical outcomes and pain scores between microfragmented adipose tissue and other orthobiologics for the treatment of knee osteoarthritis. However, modest study quality, some risk of bias, and low certainty of evidence reduce external validity, and these results must be viewed with some caution.
Insights
Microfragmented adipose tissue injections show no significant difference in pain or outcomes compared to other treatments for knee osteoarthritis. However, low evidence certainty warrants cautious interpretation of these findings for knee osteoarthritis management.
Area of Science:
- Orthopedics
- Regenerative Medicine
- Biologics
Background:
- Microfragmented adipose tissue is explored for intra-articular knee osteoarthritis treatment.
- Limited comparative data exists between microfragmented adipose tissue and other biological therapies.
Purpose of the Study:
- To systematically review and meta-analyze microfragmented aspirated fat injections against other orthobiologics, hyaluronic acid, and corticosteroid injections for knee osteoarthritis.
Main Methods:
- Systematic review and meta-analysis of Level 1-3 evidence (2000-2023).
- Inclusion of studies assessing validated knee scores (VAS, KOOS, Lysholm, IKDC).
- Assessment of risk of bias, study quality, and certainty of evidence using established tools (Cochrane, GRADE, Coleman).
Main Results:
- Five studies were analyzed, with 4 showing some risk of bias and 1 high risk.
- Overall study quality was fair, and the certainty of evidence was low.
- No statistically significant differences were found in VAS or KOOS scores at 3, 6, or 12 months between treatments.
Conclusions:
- Microfragmented adipose tissue demonstrated no statistically significant difference in clinical outcomes or pain scores compared to other orthobiologics for knee osteoarthritis.
- Modest study quality, risk of bias, and low evidence certainty necessitate cautious interpretation of results.
- Further high-quality research is needed to definitively establish the efficacy of microfragmented adipose tissue in knee osteoarthritis.
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