This is a prospective pilot study to evaluate the safety and efficacy of autologous, micro fragmented adipose tissue (Lipogems®) injection under continuous ultrasound guidance for knee pain secondary to meniscal tear(s). 20 subjects will be enrolled who present for evaluation and treatment of knee pain with associated meniscal tear despite prior conservative management. Failure of conservative management was defined as persistent pain despite the use of anti-inflammatory or other medications for pain, physical therapy, corticosteroid injections, or hyaluronic acid injections. This also included patients who were told that they were a candidate for arthroscopic surgery by an orthopedic surgeon due to failure of conservative measures. Micro-fragmented adipose tissue will be obtained by using a minimal manipulation technique in a closed system (Lipogems®), without the addition of enzymes or any additives. 1-2 mLs of micro-fragmented adipose tissue will be injected directly into visualized meniscal tears using continues ultrasound guidance. The remaining injectate will be administer into the knee joint by lateral suprapatellar approach. Post-injection guidelines including weight bearing restrictions--non-weightbearing with crutches for one week, then weight bearing as tolerated for simple daily activities--refraining from running and jumping activities and refraining from repetitive flexion beyond 90 degrees for 4 weeks total. If there was no significant pain, swelling, joint-line tenderness, and near full range of motion, unrestricted activities were allowed at the 6-8-week time-frame. Complications of both the harvest and injection sites were recorded via questionnaire at 1 and 4-week follow-up. Subjects were seen for initial follow-up at 4 weeks. They then completed surveys at 3, 6, and 12 months, including the Knee Injury and Osteoarthritis Outcome Scale (KOOS) subscales and the numerical pain scale (NPS). The NPS is one of the most common measures of pain intensity and is used frequently in both research and clinical practice. The scale is a well validated and reliable for determining change in pain over time. Pain is rated on an 11-point scale, 0-10, with 0 representing "no pain" and 10 representing "worst imaginable pain". It is well suited to this study given ease of administration in person or in online survey format. The minimum clinically important difference (MCID) for patients with knee pain secondary to osteoarthritis has been established as 2. The KOOS is also widely used in research and clinical practice, including in large-scale databases and registries. It is intended to be used in the setting of knee pain or injury that can result in post-traumatic osteoarthritis including meniscus tears. It can be used over short and long-term intervals and to asses change over time. It consists of 5 subscales; Pain, other Symptoms, Function in daily living (ADL), Function in Sport and recreation (Sport/Rec) and knee related Quality of life (QOL). The re-test reliability has also been well established in patients with knee injuries and the MCID has been established as 8-10.
