Hu Xinyu, Zhang Zhongyi, Zhang Wen, Wang Ning, Lv Shuaijie, Pan Chentong, Tong Peijian
The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), 54 Youdian Road, Hangzhou, Zhejiang Province, 310053, China.
J Orthop Surg Res. 2025 Jul 12;20(1):646. doi: 10.1186/s13018-025-06006-5.
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.
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.
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.
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.
膝关节骨关节炎（KOA）是一种常见的退行性关节疾病，严重影响生活质量，在老年人中尤为明显，并且由于肥胖和关节损伤等因素，在年轻人群中的发病率也日益增加。传统治疗方法往往效果不佳，这使得人们对再生疗法的兴趣日益浓厚。富含间充质干细胞和生长因子的微片段化脂肪组织（MFAT）已成为一种有前景的用于软骨修复和炎症抑制的生物材料。当与膝关节镜检查（一种微创手术技术）相结合时，MFAT提供了一种通过实现精确递送和提高治疗效果来治疗KOA的新方法。本系统评价评估了MFAT联合膝关节镜检查治疗KOA的疗效和安全性。
按照PRISMA和AMSTAR指南，从数据库创建至2025年2月，在PubMed、Cochrane图书馆数据库、EMBASE和Web of Science数据库中进行了全面检索。纳入的研究需涉及对年龄≥18岁的KOA患者通过膝关节镜注射MFAT，且随访时间至少为6个月。由两名 reviewers 独立进行数据提取和质量评估，如有分歧则由第三名 reviewer 解决。使用Cochrane偏倚风险工具和MINORS标准评估研究质量。
纳入了6项研究（2项随机对照试验和4项回顾性研究），随访期为12至48个月。所有研究均报告疼痛显著减轻（视觉模拟评分（VAS）改善：44.4%-62.2%）以及不同程度的关节功能改善（WOMAC、KOOS、Lysholm评分）。并发症极少，主要包括注射部位的轻度疼痛或肿胀。在一项研究中通过WORMS评分评估的软骨修复显示有显著改善，而骨代谢标志物（CTx-II、PIIINP）未显示出显著变化。
MFAT与膝关节镜检查相结合在缓解疼痛和改善关节功能方面显示出显著的短期疗效，且安全性良好。然而，研究数量有限且随访期相对较短，这突出表明需要进一步开展高质量研究以验证长期疗效并探索潜在机制。未来的研究应专注于优化MFAT处理、探索协同治疗方法以及利用先进的成像技术来评估软骨修复和骨代谢变化。这种治疗方法对KOA患者具有前景，特别是对于那些早期病变或局限性软骨损伤的患者，为关节置换手术提供了一种潜在的替代方案。
