Arthroscopic Ankle Cartilage Repair Using Your Own Fat Tissue
Riccardo D'Ambrosi, Cristian Indino, Camilla Maccario, Luigi Manzi, Federico Giuseppe Usuelli · Journal of Visualized Experiments · 2018
A minimally invasive approach combines keyhole surgery with regenerative cells
This study describes a new surgical technique for treating cartilage damage in the ankle. Researchers from Italy developed a method that pairs arthroscopic (keyhole) surgery with processed fat tissue from the patient's own body. The fat tissue contains special regenerative cells that may help heal damaged cartilage in the talus—the bone that connects your foot to your leg.
Fat tissue offers thousands of healing cells per gram
Your body's fat tissue is a rich source of stem cells called adipose-derived stem cells (ADSCs). These cells can transform into different tissue types, including cartilage. Fat makes up ten to thirty percent of normal body weight. Each gram contains roughly 5,000 regenerative cells. This makes fat an easily accessible and abundant source for healing treatments. The cells behave similarly to stem cells found in bone marrow but are much easier to collect.
The procedure takes about 15-20 minutes to process tissue
The technique involves two main steps. First, doctors harvest fat from the abdomen through tiny incisions near the belly button. They collect about 40-45 milliliters of fat tissue using a gentle suction method. The fat then goes through a special processing system that:
Filters and washes the tissue
Breaks down fat clusters into smaller pieces
Removes oil and blood contamination
Preserves the healing cells and their protective environment
This processing happens in a closed system without chemicals or enzymes. The result is a purified product rich in pericytes (cells that support blood vessel healing) and stem cells.
Keyhole surgery means faster recovery than open procedures
The surgical portion uses arthroscopy—a technique where surgeons work through small incisions using a tiny camera. This approach offers several advantages over traditional open surgery:
Less damage to surrounding soft tissue
Better visualization of the joint
Faster recovery time
Reduced scarring
During the procedure, surgeons first identify and prepare the damaged cartilage area. They create small holes in the bone to stimulate healing. Then, working in a dry environment, they inject the processed fat tissue directly onto the lesion.
All four patients improved with no complications reported
Between January and September 2016, four patients underwent this combined treatment. At their six-month follow-up appointments, all patients showed clinical improvement. Doctors measured progress using three standard assessment tools:
AOFAS score (measures ankle and hindfoot function)
VAS pain score (rates pain on a scale)
SF-12 survey (evaluates overall quality of life)
The results were encouraging. Patients experienced reliable pain relief and improved function. No complications occurred during or after the procedures.
This technique targets active patients seeking lasting relief
Osteochondral lesions of the talus (OLTs) typically affect young, active people. These injuries often follow ankle sprains and cause ongoing pain, swelling, stiffness, and joint locking. Traditional treatments focus on either repairing damaged tissue or replacing it with grafts. This regenerative approach offers a third option—using the body's own healing cells to rebuild damaged cartilage.
The study confirms that arthroscopic treatment combined with processed fat tissue provides a viable treatment pathway. The minimally invasive nature means less disruption to daily life. Using your own tissue eliminates concerns about donor rejection. While this was a small case series, the positive outcomes support further research into this promising technique for ankle cartilage injuries.
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Source: D'Ambrosi et al., Journal of Visualized Experiments, 2018.
Original Publication
Autologous Microfractured and Purified Adipose Tissue for Arthroscopic Management of Osteochondral Lesions of the Talus
Riccardo D'Ambrosi, Cristian Indino, Camilla Maccario, Luigi Manzi, Federico Giuseppe Usuelli · Journal of Visualized Experiments · 2018
In recent years, regenerative techniques have been increasingly studied and used to treat osteochondral lesions of the talus. In particular, several studies have focused their attention on mesenchymal stem cells derived from adipose tissue. Adipose-derived stem cells (ADSCs) exhibit morphological characteristics and properties similar to other mesenchymal cells, and are able to differentiate into several cellular lines. Moreover, these cells are also widely available in the subcutaneous tissue, representing 10 - 30% of the normal body weight, with a concentration of 5,000 cells per gram of tissue. In the presented technique, the first step involves harvesting ADSCs from the abdomen and a process of microfracture and purification; next, the surgical procedure is performed entirely arthroscopically, with less soft tissue dissection, better joint visualization, and a faster recovery compared with standard open procedures. Arthroscopy is characterized by a first phase in which the lesion is identified, isolated, and prepared with microperforations; the second step, performed dry, involves injection of adipose tissue at the level of the lesion. Between January 2016 and September 2016, four patients underwent arthroscopic treatment of osteochondral lesion of the talus with microfractured and purified adipose tissue. All patients reported clinical improvement six months after surgery with no reported complications. Functional scores at the latest follow-up are encouraging and confirm that the technique provides reliable pain relief and improvements in patients with osteochondral lesion of the talus.