Maeda Takuma, Sobajima Satoshi, Matsumoto Tomoyuki, Tsubosaka Masanori, Matsushita Takehiko, Iwaguro Hideki, Kuroda Ryosuke
Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Department of Orthopaedic Surgery, Sobajima Clinic, Higashiosaka, Japan.
Regen Ther. 2025 Mar 12;29:91-99. doi: 10.1016/j.reth.2025.02.013. eCollection 2025 Jun.
Stromal vascular fraction (SVF) cells and micro-fragmented adipose tissue (MFAT) have potential for treating knee osteoarthritis (OA), but their efficacy has not been compared. This study aimed to compare the clinical outcomes of SVF and MFAT for knee OA. We hypothesized that SVF provides stronger short-term effects, while MFAT offers more sustained benefits.
A retrospective single-center cohort study was conducted on patients with knee OA, with 36 SVF and 36 MFAT cases selected through propensity score matching between September 2017 and February 2022. Patients with KL grades I-IV varus knee OA, significant pain (VAS ≥40), and functional impairment despite conservative treatments were included. Those with knee trauma, severe bony defects, infections, genu valgus, osteonecrosis, rheumatoid arthritis, or severe deformities were excluded. Clinical outcomes were assessed using the visual analog scale, KOOS, knee range of motion, extension/flexion strength, and MRI T2 mapping.
SVF and MFAT groups demonstrated significant improvements in VAS ( < 0.01 for both groups). Both groups showed notable improvements in extension angle, extension/flexion muscle strength, and KOOS, with no significant differences between them. However, the MFAT group demonstrated significantly greater improvement in flexion angle compared to the SVF group ( = 0.03). No serious adverse events were reported. T2 mapping showed significant improvements in cartilage quality in both groups, with the MFAT group demonstrating superior improvements in specific lateral regions. Responder rate in SVF group initially improved but declined over time; however, the MFAT group showed sustained improvement from six months onward.
T2 mapping revealed that MFAT had better cartilage preservation than that of SVF cells in less-loaded areas, with a potentially longer-lasting therapeutic effect. These findings offer important insights for clinicians to tailor treatment strategies based on patient needs and disease progression.
基质血管成分（SVF）细胞和微片段化脂肪组织（MFAT）具有治疗膝关节骨关节炎（OA）的潜力，但尚未对它们的疗效进行比较。本研究旨在比较SVF和MFAT治疗膝关节OA的临床结局。我们假设SVF具有更强的短期效果，而MFAT则能带来更持久的益处。
对膝关节OA患者进行一项回顾性单中心队列研究，在2017年9月至2022年2月期间，通过倾向得分匹配选取了36例SVF和36例MFAT病例。纳入KL分级I-IV级内翻膝关节OA、疼痛明显（视觉模拟评分法[VAS]≥40）且尽管接受保守治疗仍有功能障碍的患者。排除有膝关节创伤、严重骨缺损、感染、膝外翻、骨坏死、类风湿关节炎或严重畸形的患者。使用视觉模拟量表、膝关节损伤和骨关节炎疗效评分（KOOS）、膝关节活动范围、屈伸力量和磁共振成像（MRI）T2映射评估临床结局。
SVF组和MFAT组的VAS均有显著改善（两组均P<0.01）。两组的伸展角度、屈伸肌肉力量和KOOS均有显著改善，两组之间无显著差异。然而，MFAT组的屈曲角度改善明显大于SVF组（P=0.03）。未报告严重不良事件。T2映射显示两组的软骨质量均有显著改善，MFAT组在特定外侧区域的改善更为显著。SVF组的反应率最初有所改善，但随时间下降；然而，MFAT组从6个月起持续改善。
T2映射显示，在负荷较小的区域，MFAT比SVF细胞具有更好的软骨保存效果，其治疗效果可能更持久。这些发现为临床医生根据患者需求和疾病进展制定治疗策略提供了重要见解。
