Autologous Micro-fragmented Adipose Tissue in Patients With Knee Osteoarthritis: A Systematic Review and Meta-analysis

Abstract:

Background: Microfragmented adipose tissue (MFAT)-containing mesenchymal stem cells (MSCs) combined with surgery is a promising strategy for the early management of knee osteoarthritis (KOA). This study aimed to explore the efficacy and safety of autologous MFAT-MSCs for the management of knee KOA.

Methods: PubMed, Embase, the Cochrane Library, and Web of Science for potentially eligible studies published up to June 2021. The primary outcome was the Knee injury and Osteoarthritis Outcome Score (KOOS). The secondary outcomes were pain assessed by visual analog scale (VAS)/numeric rating scale (NRS), quality of life (QOL) (apart from the KOOS), and adverse events (AEs). The random-effects model was used in all analyses.

Results: Eight studies (331 patients) were included. The mean differences in KOOS scores between pre-operation and post-operation (mean, 95%CI) were 22.1 (18.7, 25.3), 19.5 (15.4, 23.6), 23.0 (19.0, 26.9), 30.8 (25.5, 35.8), and 29.9 (24.8, 35.0) for pain, symptoms, ADL, sports/recreation, and QOL, respectively. The mean differences in pain VAS between pre-operation and post-operation were -3.026 (-3.884, -2.202). The mean differences in QOL between pre-operation and post-operation (mean, 95%CI) were -25.10 (-29.95, -20.20), 0.039 (-0.079, 0.170), and 0.33 (-0.99, 1.6) for the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), EQ-5D, and University of California in Los Angeles (UCLA), respectively. The use of MFAT-MSCs was not associated with bruising, bleeding, hematoma, drainage, infection, and swelling but was associated with soreness, pain, and stiffness.

Conclusions: MFAT-MSC has potential benefits for KOA while being safe. A long-term follow-up and randomized controlled trials are necessary for confirmation.