Microfat injection with or without PRP may be safe, offer clinical improvement in knee OA
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Published results showed a single intra-articular injection of microfat with or without platelet-rich plasma may be safe and offer significant clinical improvement among patients with knee osteoarthritis.
Researchers randomly assigned 30 patients with symptomatic grade 2 to 4 knee OA to receive a single injection of microfat mixed with either saline, pure PRP containing 1 billion platelets (MF/PRP LD group) or pure PRP containing 3 billion platelets (MF/PRP HD group). Researchers prospectively assessed patients at baseline and at 3- and 6-month follow-up with the primary endpoint of change in maximum of value of cartilage relaxation time in T2 mapping sequence (T2max) at 3 months. Researchers considered MRI grade severity and joint space assessment, WOMAC score, pain evaluation, knee range of motion and patient satisfaction as secondary endpoints. Researchers also collected adverse events and assessed complete cell counts and growth factors content of injected products to analyze the potential relationship with MRI/clinical outcomes.
Results showed no significant change in T2max during the study in all of the groups. At 3 and 6 months, researchers found all treatments had significant improvements in knee functional status and symptom relief. All patients in the MF/PRP HD group were responders at 3 months and were significantly higher compared with patients in the MF/PRP LD group, according to results. Researchers noted half of the injected PRP in the MF/PRP LD group displayed more than 8% of red blood cell contamination which correlated with an impairment of T2max.
“These findings should be carefully interpreted knowing the substantial placebo effect in arthrosis care, which could reach a mean improvement in WOMAC total score of 11.34,” the authors wrote. “Furthermore, long-term comparison with more accessible and cost-effective injectable drugs (steroid, [hyaluronic acid] HA or PRP alone) will be necessary to ensure the interest of [microfat] MF injection.”
Perspective
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Pain and disability related to knee OA is, unfortunately, common and remains a difficult problem with limited reliable treatment options. In recent years, various orthobiologic injections (eg, PRP, bone marrow aspirate concentrate, microfragmented adipose tissue) have been shown to improve pain and function in knee OA patients. However, none of these products have resulted in reliable structural changes in OA patients. In addition, we have limited data on comparative efficacy or optimal composition of these various types of biologic injectables. Finally, there are few data on using biologics in combination.
In this double-blind, randomized comparative study by Marie Laure Louis, MD, and colleagues, patients with moderate to advanced knee OA were treated with either microfragmented adipose tissue alone, microfragmented adipose tissue plus “high dose” (high platelet) PRP or microfragmented adipose tissue plus “low dose” (low platelet) PRP. The primary outcome of MRI cartilage mapping (T2 max) at 3 months did not change any of the groups, which is disappointing, but consistent with previous orthobiologic studies. However, all treatments resulted in significant pain and functional improvements through the end of the study at 6 months. The microfragmented adipose tissue/high-dose PRP group had a higher treatment response rate at 3 months, but there were no statistically significant differences in response between the groups by 6 months.
So, this study reinforces previous literature showing that microfragmented adipose tissue injection can improve pain and function in knee OA. However, the addition of PRP, regardless of high- or low-platelet dose, may not provide additional benefit beyond microfragmented adipose tissue alone.
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