Adinizer-Processed Microfragmented Adipose Tissue With Ligament-Targeted Prolotherapy for Acute-on-Chronic...

Knee osteoarthritis is increasingly understood as a whole-joint disorder involving not only articular cartilage but also subchondral bone, synovium, menisci, capsule, ligaments, periarticular entheses, and neuromuscular control. In patients with pre-existing degenerative osteoarthritis whose symptoms worsen after an injury-related episode, treatment strategies focused only on the intra-articular cartilage environment may not adequately address coexisting ligamentous or capsular pain generators. Microfragmented adipose tissue has been explored as an autologous orthobiologic option for symptomatic knee osteoarthritis, while dextrose prolotherapy has been used for chronic musculoskeletal pain and ligamentous or capsular pain generators. We report the case of a 63-year-old woman with symptomatic right knee osteoarthritis who presented with a 12-month history of right knee pain beginning in May 2023, which worsened after a walking-related injury episode. She had osteoporosis, dyslipidemia, gastroesophageal reflux disease, a history of breast cancer surgery, and previous contralateral unicompartmental knee arthroplasty. Baseline radiographs demonstrated Kellgren-Lawrence grade III right knee osteoarthritis. Because she wished to delay arthroplasty due to previous postoperative pain and prolonged rehabilitation after contralateral knee surgery, she underwent intra-articular injection of 10 mL of autologous microfragmented adipose tissue processed by Adinizer (BSL Co. Ltd., Busan, KOR). Activities of daily living were resumed immediately as tolerated. Rehabilitation progressed from hip abductor and adductor isometric exercises to proprioceptive neuromuscular facilitation and band-resistance exercises. Nonsteroidal anti-inflammatory drugs were discontinued during follow-up. At three and six months, adjunctive prolotherapy was performed to clinically selected ligamentous and capsular targets, including the anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament, lateral collateral ligament, and coronary ligament regions. Dextrose prolotherapy was not performed as a general non-targeted intra-articular osteoarthritis injection protocol. At the latest clinical follow-up, the visual analog scale (VAS) pain score improved from 8 to 2. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) subscores improved from 12 to 4 for pain, 6 to 1 for stiffness, and 38 to 11 for physical function. The total WOMAC score improved from 56 to 16. No donor-site pain, swelling, infection, or clinically significant adverse event was observed. Radiographs obtained in March 2026, approximately 22 months after treatment, showed persistent osteoarthritic changes without obvious radiographic progression. This report should not be interpreted as evidence that this combined intervention is effective for Kellgren-Lawrence grade III knee osteoarthritis in general or as support for a standardized treatment protocol. Rather, it describes a highly selected, arthroplasty-averse patient in whom a staged, individualized orthobiologic approach supplemented by clinically guided periarticular and capsuloligamentous prolotherapy was associated with sustained symptomatic improvement.