Department of Surgical Sciences, University of Genova, Largo Rosanna Benzi 10, 16134, Genoa, Italy.
Ospedale Koelliker, Corso Galileo Ferraris 247/255, 10134, Turin, Italy.
Knee Surg Sports Traumatol Arthrosc. 2023 Sep;31(9):3655-3664. doi: 10.1007/s00167-022-07139-4. Epub 2022 Sep 10.
This study aims to assess the effectiveness of Microfragmented Autologous Fat Tissue (MFAT) treatment for knee osteoarthritis and to investigate whether patients' pre-treatment clinical condition, such as synovitis, correlates with clinical outcomes, to identify potential predicting factors for the success or failure of the treatment.
In this prospective Cohort Study Level II multicentric trial, consecutive patients with a diagnosis of early/mild osteoarthritis and failure of previous conservative measures were enrolled to undergo diagnostic arthroscopy and a single MFAT injection. Patients were assessed with repeated scoring systems at baseline, 6 months, and 12 months after surgery. The demographic features, the arthroscopic findings, the immunophenotype of injected tissue and the histologic examination of synovia of failed patients were analyzed.
Data from 91 patients showed a significant improvement in Lysholm, WOMAC scores at 1-year follow-up (p < 0.001). A significant decrease in VAS score was observed, while a significant improvement of measured flexion angle was registered at 1 year (p < 0.001). No major complications were reported. Age and synovitis were identified as significant factors influencing the clinical outcome (p < 0.05). Body mass index, previous or concomitant procedures, and specific cartilage defects had no influence. The mean number of injected adipose tissue-derived mesenchymal stem cells seem not to correlate with the clinical outcome.
MFAT is effective in reducing pain when used with a single dose injection in early/mild OA of the knee, without major complications. Age over 60 and synovitis may be predictive for persistent pain at one year and should be considered before indications.
本研究旨在评估微粉碎自体脂肪组织（MFAT）治疗膝骨关节炎的有效性，并探讨患者治疗前的临床状况（如滑膜炎）是否与临床结果相关，以确定治疗成功或失败的潜在预测因素。
在这项前瞻性队列研究 II 级多中心试验中，连续招募了诊断为早期/轻度骨关节炎且先前保守治疗失败的患者，进行诊断性关节镜检查和单次 MFAT 注射。患者在基线、术后 6 个月和 12 个月时接受重复评分系统评估。分析了患者的人口统计学特征、关节镜检查结果、注射组织的免疫表型以及失败患者的滑膜组织学检查结果。
91 例患者的数据显示，在 1 年随访时 Lysholm 和 WOMAC 评分显著改善（p<0.001）。VAS 评分显著下降，而测量的膝关节屈曲角度在 1 年时显著改善（p<0.001）。未报告重大并发症。年龄和滑膜炎被确定为影响临床结果的重要因素（p<0.05）。体重指数、先前或同时进行的手术以及特定的软骨缺损对治疗无影响。注射的脂肪组织源性间充质干细胞数量与临床结果似乎没有相关性。
MFAT 在治疗早期/轻度膝关节骨关节炎时，单次注射可有效减轻疼痛，且无重大并发症。60 岁以上的年龄和滑膜炎可能是 1 年后持续性疼痛的预测因素，在制定适应证前应予以考虑。
