Autologous Micro-Fragmented Adipose Tissue Combined with Arthroscopy for Knee Osteoarthritis

Eight in ten patients saw meaningful improvement at two years

This Italian study followed 49 patients (50 knees) with moderate-to-severe knee osteoarthritis. All patients had previously been recommended for knee replacement surgery but chose to try a different approach. They received a single injection of their own processed fat tissue (called micro-fragmented adipose tissue or MFAT) along with a knee arthroscopy procedure. The results showed that 80% of patients achieved meaningful pain relief and improved function that lasted at least two years.

Combination approach addresses both symptoms and joint damage

The treatment combined two procedures done during the same surgery. First, surgeons performed arthroscopy to clean up damaged tissue in the knee joint. This included washing out the joint, smoothing rough cartilage surfaces, and treating any torn meniscus tissue. In eight cases, surgeons also performed micro-drilling to stimulate healing in areas of severe cartilage loss. After this work, approximately seven milliliters of processed fat tissue was injected directly into the joint.

The fat tissue was harvested from each patient's own abdomen. It was then processed using a mechanical technique that preserves the natural healing components. This includes pericytes (cells that support blood vessel health) and mesenchymal stem cells (regenerative cells found naturally in fat tissue).

Most patients avoided knee replacement surgery

• Only four out of 50 knees (8%) eventually needed total knee replacement

• The remaining 92% of patients maintained their natural knee at two years

• No major complications or serious side effects occurred throughout the study

This is particularly notable because all patients in this study had already been recommended for knee replacement. The severity of their arthritis was confirmed by X-rays showing Kellgren-Lawrence grade III or IV disease. This is the most advanced stage of osteoarthritis, typically characterized by significant cartilage loss and bone-on-bone contact.

Patient-reported scores showed substantial gains

Researchers measured outcomes using two well-established questionnaires. The KOOS (Knee Injury and Osteoarthritis Outcome Score) evaluates pain, symptoms, daily activities, sports function, and quality of life. The IKDC (International Knee Documentation Committee) score provides an overall assessment of knee function.

At one year after treatment:

• 84% of patients achieved meaningful improvement on the KOOS score

• 74% achieved meaningful improvement on the IKDC score

At two years after treatment:

• 80% maintained meaningful improvement on the KOOS score

• 76% maintained meaningful improvement on the IKDC score

Cartilage damage severity influenced results

The study found that patients with less severe cartilage damage had better outcomes. Those with the most advanced cartilage loss (Outerbridge grade IV lesions) showed statistically lower scores at two years compared to patients with less damage. This suggests the treatment may work best when some cartilage remains in the joint.

Patient age and the complexity of the arthroscopic procedure did not significantly affect the results. This means older patients and those needing more extensive joint cleanup still benefited from the treatment.

What this means for patients considering treatment

This study adds to the evidence supporting the use of processed fat tissue for knee osteoarthritis. The combination of arthroscopy with MFAT injection appears safe and effective for patients with moderate-to-severe arthritis who want to delay or avoid knee replacement.

Important considerations include:

• Study limitations: This was a retrospective study without a comparison group. Researchers reviewed past records rather than following patients prospectively.

• Patient selection: All participants had refused knee replacement, which may indicate higher motivation for alternative treatments.

• Best candidates: Results suggest patients with some remaining cartilage may benefit most from this approach.

The treatment offers a minimally invasive option that uses your body's own healing resources. For patients with moderate-to-severe knee arthritis, this approach may provide meaningful relief while preserving the natural joint.

Source: Giorgini et al., BMC Musculoskeletal Disorders, 2022.