Micro-Fragmented Adipose Tissue Demonstrates Comparable Clinical Efficacy to Other Orthobiologic Injections in Treating Symptomatic Knee Osteoarthritis: A Systematic Review of Level I to IV Clinical Studies

Abstract

Purpose

To perform a systematic review of clinical outcomes in patients who underwent treatment for symptoms with micro-fragmented aspirated fat (MFAT).

Methods

Medline, Embase, Scopus, and Google Scholar were screened for studies from 2000 to 2023. Risk of bias (ROB) was assessed using the Cochrane Collaboration's tools and the ROBINS-I tool. Study quality was assessed with the modified Coleman Methodology (CMS) and MINORS score. Heterogeneity was assessed using χ² and I² statistics.

Results

21 studies were included. One study had a high ROB, one had a critical ROB, 3 had serious ROB and 16 had a moderate ROB. The mean Coleman score was 58 demonstrating fair study quality; the MINORS score a mean value of 13 indicating overall fair quality. Best evidence synthesis revealed moderate evidence. VAS score improved from 5.2 to 3.2 at 6 and 12 months. KOOS subscale ADL improved from 58.8 to 70.2 at 6 months and 67.5 at 12 months. KOOS subscale pain improved from 54.3 to 70.2 at 6 months and 72.4 at 12 months. KOOS subscale QOL improved from 33.1 to 43.6 at 6 months and 42.9 at 12 months. KOOS subscale sports improved from 23.7 to 43.6 at 6 months and 57.4 at 12 months. KOOS subscale symptoms improved from 55.3 to 70.1 at 6 months and 67.9 at 12 months. KOOS subscale pain improved from 54.3 to 70.2 at 6 months and 72.4 at 12 months. The WOMAC score steadily increased from 61.8 at baseline to 78.4 at 12 months.

Conclusion

MFAT injection therapy for the treatment of symptomatic knee osteoarthritis is effective and improves pain and functional outcomes. Moderate study quality combined with a moderate risk of bias, moderate certainty of evidence and moderate best synthesis evidence reduces external validity. Therefore, the results should be interpreted with a degree of caution.