Microfragmented Adipose Tissue Versus Platelet-rich Plasma for Knee Osteoarthritis: a Randomized Comparative Trial

Background

Knee osteoarthritis is a leading cause of disability worldwide. Standard of care treatments for knee OA include activity modification, weight loss, therapeutic exercise and injections like corticosteroids and viscosupplement. These commonly used non-operative treatments focus on symptom palliation, but are not disease modifying.

Orthobiologics have emerged as a promising treatment for knee OA. The most widely studied orthobiologic is platelet-rich plasma (PRP). PRP is a dense concentration of platelets derived from autologous whole blood and platelets are concentrated 2-5x compared to baseline. The platelets have demonstrated anti-inflammatory and chondroprotective properties.6 PRP has been shown superior to placebo and viscosupplement for knee OA in several clinical trials.

While PRP is the most widely studied and used orthobiologic, it contains only platelets. Therefore, a simple, office-based intervention able to collect additional reparative cells to treat knee OA would be ideal. Adipose (fat) is a known source of reparative cells like pericytes and it can be easily and safely aspirated in the clinic. The adipose tissue aspiration and processing is accomplished through a simple process. After local anesthesia to the site of adipose aspiration (lower abdomen or buttock), 30ml of adipose is aspirated through a cannula. That adipose is then processed in accordance with FDA guidelines including minimal manipulation to remove oils.. Using minimally manipulated Microfragmented adipose tissue has been shown safe for use as injection therapy for knee OA for 3 years.

Methods:

Patients / Outcome Measures / Sample size: Patients with unilateral symptomatic knee OA will be recruited from the sports medicine and orthopedics clinics, as well as advertising flyers within the clinic. All patients' first visit will include a medical evaluation and assess best treatment plan for that patient, regardless of candidacy for this study. This evaluation includes x-rays of their knees as a standard part of the evaluation. If they meet criteria and choose to enroll, they will be randomly assigned to either the PRP or Microfragmented adipose tissuetreatment group. Patients will complete follow up visits and surveys at defined time points through 12 months.

Inclusion criteria

• Age 25-75 years
• BMI < 40
• Diagnosis of knee OA (primary and post-traumatic)
• Radiographic evidence of OA of the target knee (Kellgren-Lawrence grades 1-4)
• Continued OA pain in the target knee despite at least 6 weeks of 1 of the following nonoperative treatments: activity modification, weight loss attempt, physical therapy, or NSAID / acetaminophen.
• Knee Osteoarthritis Outcomes Score (KOOS)-Pain subscale 20-65
• Working knowledge of English language (to be able to complete all outcome scores)
• Ability to attend all follow-up appointments

Exclusion criteria

• Isolated patellofemoral OA
• 3+ effusion of the target knee (stroke test grading system)
• Significant (10 degree) valgus or varus deformities
• Prior injection therapy:
• Steroid injection in target knee in the last 3 months
• Viscosupplementation in target knee in the last 6 months
• PRP in the target knee in the last 1 year
• No other cellular treatments in index knee (bone marrow, amniotic suspensions etc) all time
• Participation in any experimental device or drug study within 1 year before screening visit
• Oral or IM steroids for last 3 months
• Medical condition that may impact outcomes of procedure including:
• anemia
• thrombocytopenia
• bleeding disorders
• inflammatory disorders like rheumatoid arthritis, lupus
• diabetes
• any history of cancer (other than non-melanoma skin malignancies)
• taking anticoagulants (aspirin, Plavix, eliquis, Xarelto, warfarin, lovenox)
• Taking immunosuppressants, having a severe systemic infection
• Previous cartilage repair procedure on the injured cartilage surface (ie, OATS, ACI, MFX)
• Previous surgery at the target knee within the past 1 year
• Any degree of cognitive impairment.
• OA of either hip
• Pregnancy, lactating, or intent to become pregnant during treatment period
• Gout
• History of infection or current infection at the affected joint
• Smoking