Fat-Tissue Treatment Boosts Cartilage Repair Results
Salvatore Bisicchia, Gabriele Bernardi, Susanna M. Pagnotta, Cosimo Tudisco · Knee Surgery, Sports Traumatology, Arthroscopy · 2019
When you have a damaged area of cartilage in your knee, a common surgical fix is called microfracture. This involves making tiny holes in the bone to stimulate healing. But researchers wanted to know: could adding processed fat tissue from your own body make this treatment work even better?
Study Compared Standard Surgery With and Without Fat Injection
This randomized trial enrolled 40 patients with focal cartilage damage in their knees. All patients received the same arthroscopic microfracture surgery. Half also received an injection of micro-fragmented adipose tissue (specially processed fat from their own abdomen) at the end of the procedure. The other half received microfracture surgery alone. Researchers then tracked both groups for one year.
The fat tissue was processed using the Lipogems® system. This technology gently breaks down fat into tiny clusters. These clusters contain regenerative cells that support healing. The entire process happens during a single surgery—no lab processing or waiting required.
Patients Who Received Fat Tissue Scored Better at One Year
The study's main goal was to compare knee function scores at 12 months. Patients who received the fat tissue injection had significantly better WOMAC scores. This is a standard measure of pain, stiffness, and physical function. Their average score was 17.7, compared to 25.5 for surgery alone. Lower scores mean better function.
The fat tissue group also scored better on the Oxford Knee Score
Quality of life measures (EQ-5D) showed greater improvement
All improvements showed a "moderate effect size"—meaning real, noticeable differences
Pain Relief Appeared Earlier in the Fat Tissue Group
By three months after surgery, both groups had improved from their starting point. However, patients who received the fat injection reported less pain. Their average pain score was 4.2 out of ten. The surgery-only group averaged 5.9. This difference was statistically significant.
This earlier pain relief continued. At six months and 12 months, the fat tissue group consistently reported better outcomes across all measures. Both groups used similar amounts of pain medication throughout the study.
No Safety Concerns Were Identified
Throughout the entire year of follow-up, researchers found no adverse reactions to the fat tissue injection. The procedure involves harvesting fat from your own abdomen during the same surgery. A small cannula collects between 15 and 50 cubic centimeters of fat tissue. This is then processed and injected into the knee joint.
Because the tissue comes from your own body (autologous), there is no risk of rejection. The study adds to growing evidence that this approach is safe for joint treatment.
What This Means for Your Treatment Decision
This is a Level 1 study—the highest quality of clinical evidence. It suggests that adding micro-fragmented fat tissue to standard microfracture surgery produces better outcomes than surgery alone. The benefits include:
Better knee function at one year
Less pain as early as three months
Improved quality of life measures
No additional safety risks
If you have a focal cartilage defect in your knee and are considering microfracture surgery, this research suggests that combining it with a Lipogems® injection may give you better results. The treatment uses your body's own healing resources to support cartilage repair.
Talk with your doctor about whether this combined approach might be right for your specific situation. Factors like the size and location of your cartilage damage, your age, and your activity goals all play a role in choosing the best treatment plan.
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Source: Bisicchia et al., Knee Surgery, Sports Traumatology, Arthroscopy, 2019.
Original Publication
Micro-fragmented stromal-vascular fraction plus microfractures provides better clinical results than microfractures alone in symptomatic focal chondral lesions of the knee
Salvatore Bisicchia, Gabriele Bernardi, Susanna M. Pagnotta, Cosimo Tudisco · Knee Surgery, Sports Traumatology, Arthroscopy · 2019
This prospective randomized controlled single-blind trial evaluated clinical outcomes over 1 year in patients with symptomatic focal chondral lesions of the knee. Two groups of 20 patients underwent arthroscopic microfracture treatment. The experimental group received additional intra-articular injection of micro-fragmented stromal-vascular fraction at surgery's end, while the control group received microfractures alone. The primary endpoint was WOMAC score at 12 months; secondary endpoints included adverse events, Oxford Knee Score, EQ-5D score, VAS for pain, and analgesic consumption. All 40 patients completed 12-month follow-up with no adverse reactions reported. At 1 month, no differences existed between groups. At 3 months, both groups improved from baseline, with the experimental group showing significantly lower VAS pain scores (4.2±3.2 vs. 5.9±1.7, p=0.04). At 6 and 12 months, the experimental group demonstrated superior outcomes across all measures with moderate effect sizes. The primary endpoint was achieved, with better WOMAC scores at 12 months in the experimental group (17.7±11.1 vs. 25.5±12.7, p=0.03). The study concludes that micro-fragmented stromal-vascular fraction injection combined with microfractures is safe and clinically more effective than microfractures alone for treating symptomatic focal chondral knee lesions, providing valuable information for patient counseling regarding adipose-derived mesenchymal stem cells.