Summary

This retrospective observational study shows the outcome at 1 year follow-up of a single intra-articular injection of autologous micro-fragmented adipose tissue in severe knee chondral lesions. We used a minimal manipulation technique. The results obtained are very satisfactory with low percentage of complications. The main indication is II/III, III and III/V ICRS stage chondral lesions.

Abstract

Introduction

Mesenchymal stem has recently been identified as an ideal population for cartilage tissue repair. Moreover, Adipose-derived stem cells are found in higher concentrations than in bone marrow and its number slowly decrease with the age. Many studies show the importance of vascular stromal niche for mesenchymal cells and tissue repair. Autologous micro-fragmented adipose tissue obtained with Lipogems® system seems to preserve vascular stromal fraction (VSF).

Purpose

Our aim is to evaluate the efficacy and safety of using autologous micro-fragmented adipose tissue in the treatment of degenerative cartilage lesions of the knee.

Methods

AND MATERIALS
We analyzed retrospectively the 1-year outcome of 40 consecutive patients affected by severe knee chondral lesions treated with autologous micro-fragmented adipose tissue between 1st January 2014 and 31st December 2014. Micro-fragmented adipose tissue was obtained using a minimal manipulation technique in a closed system (Lipogems®), without the addition of enzymes or any other additives. We performed the injection of autologous adipose tissue in arthroscopy and in seven patients we performed associated surgery, too. All of patients were treated at our Orthopedic department. We used the following evaluation scales for preoperative and one year follow-up assessment: IKDC-subjective, KOOS, VAS pain scale, Tegner Lysholm Knee. We considered as clinically relevant an improvement of 10% of the scores at the final follow-up.

Results

At final follow-up, 36 out of 40 patients were evaluated. Few complications were recorded: two cases of organized hemathoma after harvesting the abdominal fat: the first patient had a coagulation problem and the other was particularly skinny. one case of recurrent effusions in the first 30 days. No cases of post operative infection, algodystrophy or stiffness. We observed a better postoperative recovery in the early 15 days compared to those who did not receive the Lipogems® procedure. Results were improved at 3 and 6 months follow-up and stable at 12 months. No patient is clinically worsened compared to preoperative condition. We recorded an improvement of more than 10% of the final score in about 60% and 64% of the patients respectively in KOOS and IKDC. The highest percentage of improvement was demonstrated in VAS and Lysholm score, where 78% of patients showed an improvement over 10% compared to pre-op values.

Conclusions

The results of this study show the safety of the use of autologous micro-fragmented adipose tissue with Lipogems® procedure which is minimally invasive, simple, with low percentage of complications. After at least one year follow-up, the results obtained are very satisfactory. A large limit of this study is the heterogeneity of the population, either for cartilage defect treated than for the associated surgery. Randomized controlled studies are needed to understand what may be the real indications. This treatment has been reserved for patients with advanced and extended chondropathy. In our department after this study, the main indication for using this procedure is chondral lesions II/III, III and III/IV ICRS stage, aged between 30 and 60 years, in most cases with an arthroscopic debridement.