BACKGROUND

Knee osteoarthritis (KOA) is a prevalent degenerative joint disease that significantly impairs quality of life, particularly in the elderly and increasingly in younger populations due to factors like obesity and joint injuries. Traditional treatments often fall short, leading to a growing interest in regenerative therapies. Micro-fragmented adipose tissue (MFAT), rich in mesenchymal stem cells and growth factors, has emerged as a promising biological material for cartilage repair and inflammation suppression. When combined with knee arthroscopy, a minimally invasive surgical technique, MFAT offers a novel approach to treating KOA by enabling precise delivery and enhanced therapeutic outcomes. This systematic review evaluates the efficacy and safety of MFAT combined with knee arthroscopy for KOA treatment.

METHODS

Following PRISMA and AMSTAR guidelines, a comprehensive search was conducted across PubMed, Cochrane Library, EMBASE, and Web of Science databases from inception until February 2025. Studies were included if they involved MFAT injection via knee arthroscopy in patients aged ≥18 years with KOA, with a minimum follow-up of 6 months. Data extraction and quality assessment were performed independently by two reviewers, with disagreements resolved by a third. The Cochrane Risk of Bias Tool and MINORS criteria were used to assess study quality.

RESULTS

Six studies (2 RCTs and 4 retrospective studies) were included, with follow-up periods ranging from 12 to 48 months. All studies reported significant pain reduction (VAS score improvement: 44.4%-62.2%) and varying degrees of joint function improvement (WOMAC, KOOS, Lysholm scores). Complications were minimal, primarily involving mild pain or swelling at the injection site. Cartilage repair, assessed via WORMS scores in one study, showed significant improvement, while bone metabolism markers (CTx-II, PIIINP) did not exhibit significant changes.

DISCUSSION

The combination of MFAT and knee arthroscopy demonstrates significant short-term efficacy in pain relief and joint function improvement, with a favorable safety profile. However, the limited number of studies and relatively short follow-up periods highlight the need for further high-quality research to validate long-term outcomes and explore underlying mechanisms. Future studies should focus on optimizing MFAT processing, exploring synergistic therapies, and utilizing advanced imaging techniques to assess cartilage repair and bone metabolism changes. This treatment approach holds promise for KOA patients, particularly those with early-stage lesions or localized cartilage damage, offering a potential alternative to joint replacement surgery.