Microfragmented adipose tissue in orthopedic regeneration: mechanisms, clinical evidence, and regulatory perspectives

Microfragmented adipose tissue (MFAT) has emerged as a minimally manipulated, autologous orthobiologic for musculoskeletal disorders, with the Lipogems system representing one of the most widely studied platforms. By preserving the stromal vascular niche and pericyte-rich microenvironment, MFAT provides a ready-to-use biologic without enzymatic digestion or ex vivo expansion. This narrative review synthesizes the biological rationale, clinical applications, and comparative effectiveness of MFAT across major orthopedic indications. We review action mechanisms, patient selection factors, procedural considerations, and regulatory context, with emphasis on outcomes, durability, and imaging correlations. Across joints, MFAT has demonstrated consistent improvements in pain and function, particularly in early to moderate osteoarthritis. However, radiographic findings are heterogeneous and often discordant with clinical outcomes. Studies suggest MFAT offers outcomes comparable to platelet-rich plasma and bone marrow aspirate concentrate rather than clear superiority. Overall, the evidence base is dominated by low- to moderate-level studies with small sample sizes, protocol variability, and limited follow-up. This review provides a cross-joint clinical synthesis to contextualize MFAT's current role in orthopedic practice, highlighting its procedural simplicity and favorable safety profile. Despite encouraging clinical signals, we strongly underscore the need for future high-quality trials, standardized methodologies, and cost-effectiveness analyses to define its long-term clinical utility.