Stromal Vascular Fraction Therapy for Knee Osteoarthritis: A Systematic Review

Efficacy of adipose-derived stem cells and stromal vascular fraction for pain relief in Kellgren-Lawrence grade II-III knee osteoarthritis: A systematic review (2019-2024)

Background

Knee osteoarthritis (KOA) is a common degenerative condition, affecting individuals aged 40 and above. Current therapeutic options often fail to prevent disease progression and provide only short-term pain relief, leading to an increasing interest in regenerative medicine. Adipose-derived mesenchymal stem cells (ADMSCs) and stromal vascular fraction (SVF) have emerged as promising alternatives due to their potential to modulate inflammation and promote tissue repair. However, limited studies compare the efficacy of these two therapies for KOA.

Methods

A systematic review (2019-2024) across PubMed, CINAHL, and Embase included studies on patients aged 40+ with Grade II-III knee osteoarthritis (Kellgren-Lawrence) treated with intra-articular ADMSC and SVF injections. Inclusion criteria followed the SPIDER framework, focusing on pain relief and joint function improvement over ≥3 months, measured via VAS, KOOS, and WOMAC. MeSH terms for KOA and ADMSC/SVF therapies were used, with bias assessed via GRADE.

Results

Ten studies, including three randomized controlled trials and two observational studies, met the criteria, encompassing 452 patients. Results indicate that ADMSC therapies demonstrate prolonged pain relief and enhanced joint function up to 24 months post-treatment, with superior outcomes in cartilage regeneration compared to SVF. SVF provided quicker symptom relief due to its diverse cell composition but plateaued around 12 months. Both treatments had minimal adverse effects, with lipoaspiration-related symptoms being the most common.

Conclusion

ADMSC and SVF stem cell therapies represent promising non-surgical options for managing knee osteoarthritis (KOA) in patients over 40. ADMSC demonstrates higher efficacy in sustaining long-term pain relief and joint health, with significant potential for cartilage regeneration. The chondrogenic properties of ADMSCs make them particularly beneficial for patients younger than 62 years old. Conversely, SVF, with its heterogeneous cell composition, provides rapid paracrine effects, offering early symptom relief and broader applicability for older or obese patients, including those with a Body Mass Index (BMI) over 30.

Histological Comparison of Lipofilling and Hyaluronic Acid Filler Injection 30 Days after Simulation in Rats

A histological comparison of lipofilling and hyaluronic acid filler injection was performed in rats. Studies at the histological level showed that, compared with hyaluronic acid filler injection, autologous fat grafting led to a more uniform distribution of adipose tissue at 30 days after treatment and a decrease in the area of sebaceous glands. Compared with lipofilling, the hyaluronic acid filler facilitated an increase in epidermis thickness because the granular layer and dermis grew thicker in addition to the filler injected into the subcutaneous space.

Needle knife therapy combined with chinese herbal medicine in the treatment of knee osteoarthritis: a meta-analysis

OBJECTIVE

To systematically evaluate the effectiveness of the combined Needle Knife Therapy (NKT) and Chinese Herbal Medicine (CHM) treatment for knee osteoarthritis (KOA) and to provide clinical evidence supporting its application in managing the condition.

METHODS

Relevant articles were retrieved from PubMed, Medline, Embase, Wanfang, and China National Knowledge Network (CNKI) from the inception of the databases up to February 18, 2023. Randomized controlled trials (RCTs) on the efficacy of NKT combined with CHM were appraised for inclusion. The meta-analysis was conducted using RevMan 5.3 and was registered with the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY) (202470051).

RESULTS

A total of 11 RCTs involving 880 patients were included. The meta-analysis showed that the combined therapy was superior to NKT alone in the treatment of KOA [relative risk (RR) = 1.09; 95% confidence interval (CI): (1.03, 1.14); P = 0.002]. The combined therapy showed a significant reduction in the Visual Analog Scale (VAS) score [RR = -0.98; 95% CI: -1.12, -0.84; P < 0.00001] and symptom scores [RR = -1.75; 95% CI: (-1.87, -1.63); P < 0.00001] compared to single NT therapy. There was no significant difference in the Traditional Chinese Medicine (TCM) syndrome scores between the two groups [RR = -0.23; 95% CI: (-0.56, 0.10); P = 0.18]. Furthermore, we observed a marked increase in lysholmy scores in the combination group than in the control group [RR = -1.04; 95% CI: (-1.31, -0.77); P < 0.00001].

CONCLUSIONS

The combination of needle-knife therapy and Chinese herbal medicine exhibits promising clinical efficacy in the treatment of KOA.

Adipose-derived stem cells and knee osteoarthritis: New perspectives, old concerns

In this editorial, we comment on the paper by Muthu et al published in the recent issue of the journal. This editorial review focusses on the use of adipose-derived stem cells (ADSCs) in knee osteoarthritis treatment. We discuss the differences between the stromal vascular fraction and microfragmented adipose tissue and highlight the results of clinical studies comparing both treatments and the use of hyaluronic acid, platelet-rich plasma, and bone marrow aspirate concentrate. The use of expanded ADSCs is also discussed; moreover, concerns regarding treatment with ADSCs, particularly the heterogeneity of published studies and the need to standardize protocols to explore clinical potential is explored.

Postoperative Multimodal Approach to Pain Control in Anterior Cruciate Ligament Autograft Surgery: A Single-Center Series

Background: Anterior cruciate ligament (ACL) injuries are prevalent and represent a significant socioeconomic burden, as ACL injuries account for nearly 60% of all knees joint traumas. The purpose of this study is to emphasize the role of arthroscopic ACL reconstruction and the challenges in postoperative pain management. Methods: This study involved 90 patients undergoing ACL reconstruction, categorized into three groups receiving different pain management protocols. The focus was on evaluating the efficacy of multimodal analgesia using lidocaine and magnesium sulfate. The main outcome was pain assessment using the Visual Analog Scale (VAS). Results: Patients receiving fentanyl, lidocaine, and magnesium sulfate (FLM) reported significantly lower pain scores in the postoperative period. Minimal use of additional opioids was observed, suggesting effective pain management with the multimodal analgesia regimen. Conclusions: The study showed that multimodal analgesia, including FLM, effectively manages postoperative pain following ACL reconstruction. This study showed significantly lower pain scores with FLM, highlighting its potential in early postoperative pain relief. Future research should consider long-term outcomes and cost-effectiveness, emphasizing the need for more comprehensive evaluations of multimodal analgesia’s impact.

Arthroscopy With Adipose-Derived Stromal Vascular Fraction Using a Selective Tissue Engineering Photo-Stimulation Technique for the Treatment of Mild to Moderate Knee Osteoarthritis

Osteoarthritis (OA) is characterized by articular cartilage degeneration, synovial inflammation, and subchondral bone thickening, affecting the synovial joint as an organ and leading to pain and disability. Subcutaneous stromal vascular fraction is safe and relieves pain, improves function, and repairs cartilage defects in patients with knee OA. Our goal is to describe step-by-step the arthroscopic treatment of mild to moderate knee OA with photo-stimulated stromal vascular fraction harvested from the thigh using a selective tissue engineering photo-stimulation ("One S.T.E.P.") technique.

Conservative Treatment in Avascular Necrosis of the Femoral Head: A Systematic Review

INTRODUCTION

Avascular necrosis (AVN) of the femoral head is a pressing orthopedic issue, leading to bone tissue death due to disrupted blood supply and affecting the quality of life of individuals significantly. This review focuses on conservative treatments, evaluating their efficacy as mainstay therapies. Enhanced understanding of AVN's pathophysiology and advancements in diagnostic tools have rekindled interest in non-surgical interventions, emphasizing personalized, multidisciplinary approaches for improved outcomes.

MATERIAL AND METHOD

A systematic search was conducted on PubMed, SCOPUS, and Google Scholar databases from January 2020 to August 2023, with the objective of focusing on conservative treatments for AVN of the femoral head. Eligible studies, including original research, case reports, and observational studies, were examined for relevant, well-documented patient outcomes post-conservative treatments, excluding non-English and surgically focused articles without comparative conservative data.

RESULTS

A systematic search yielded 376 records on AVN of the femoral head across multiple databases. After de-duplication and rigorous screening for relevance and quality, 11 full-text articles were ultimately included for a comprehensive qualitative synthesis, focusing on conservatively managing the condition.

CONCLUSIONS

This review evaluates the effectiveness of conservative treatments such as pharmacological interventions and physical modalities in managing AVN of the femoral head. Despite promising results in symptom alleviation and disease progression delay, variability in outcomes and methodological limitations in studies necessitate further rigorous, randomized controlled trials for a robust, patient-centric approach to optimize therapeutic outcomes in AVN management.

Autologization of Exosomes with Deparenchymized Adipose Tissue: An Innovative Approach for Regenerative Medicine and Surgery

Background

Among all regenerative applications developed in recent years, the use of exosomes has generated by far the greatest interest. Exosome products from allogeneic and xenogeneic sources are available on the market. A key challenge is controlling the effects of nonautologous exosomes. We hypothesized that combining exosomes with a patient's own extracellular matrix (ECM) can create "autologization," enabling control over their effects. This study aimed to provide the rationale and a guide for future research exploring the autologization of exosome applications using deparenchymized adipose tissue (DPAT).

Methods

DPAT adipose tissue was achieved using 1200-, 400-, and 35-micrometer blades in an ultrasharp blade system (Adinizer), and then "autologization" was achieved by combining the obtained DPAT with allogeneic exosomes. DPAT was evaluated histochemically, and exosomes were counted and analyzed with the Nanosight device.

Results

The DPAT process using ultrasharp blades is easily performed. DPAT obtained from adipose tissue was then combined with allogenic exosomes. It has been demonstrated histopathologically that adipocytes are eliminated in deparenchymized fat tissue, and only ECM and stromal cells remain. It has also been proven that the number of exosomes is not affected by the combination.

Conclusions

This study introduces two novel concepts previously unknown in the literature, "deparenchymization" and "autologization," representing an innovative approach in plastic surgery and regenerative medicine. Our novel approach enriches regenerative cells while preserving critical ECM signals, overcoming the limitations of existing isolation methods. Extensive research is still needed, but autologization using DPAT ECM holds great promise for translating exosome-based treatments into practice.

Adipose-derived regenerative therapies for the treatment of knee osteoarthritis

Knee osteoarthritis is a degenerative condition with a significant disease burden and no disease-modifying therapy. Definitive treatment ultimately requires joint replacement. Therapies capable of regenerating cartilage could significantly reduce financial and clinical costs. The regenerative potential of mesenchymal stromal cells (MSCs) has been extensively studied in the context of knee osteoarthritis. This has yielded promising results in human studies, and is likely a product of immunomodulatory and chondroprotective biomolecules produced by MSCs in response to inflammation. Adipose-derived MSCs (ASCs) are becoming increasingly popular owing to their relative ease of isolation and high proliferative capacity. Stromal vascular fraction (SVF) and micro-fragmented adipose tissue (MFAT) are produced by the enzymatic and mechanical disruption of adipose tissue, respectively. This avoids expansion of isolated ASCs ex vivo and their composition of heterogeneous cell populations, including immune cells, may potentiate the reparative function of ASCs. In this editorial, we comment on a multicenter randomized trial regarding the efficacy of MFAT in treating knee osteoarthritis. We discuss the study's findings in the context of emerging evidence regarding adipose-derived regenerative therapies. An underlying mechanism of action of ASCs is proposed while drawing important distinctions between the properties of isolated ASCs, SVF, and MFAT.

Comparative Analysis of Stromal Vascular Fraction and Alternative Mechanisms in Bone Fracture Stimulation to Bridge the Gap between Nature and Technological Advancement: A Systematic Review

BACKGROUND

Various stimulation methods, including electrical, ultrasound, mechanical, and biological interventions, are explored, each leveraging intricate cellular and molecular dynamics to expedite healing. The advent of stromal vascular fraction (SVF) marks a significant stride, offering multifarious benefits in bone healing, from enhanced bone formation to optimal vascular integration, drawing a harmonious balance between innate mechanisms and scientific advancements.

METHODS

This systematic review was conducted focusing on literature from 2016 to 2023 and encompassing various bone healing stimulation mechanisms like SVF, electrical, ultrasound, and mechanical stimulation. The extracted data underwent meticulous synthesis and analysis, emphasizing comparative evaluations of mechanisms, applications, and outcomes of each intervention.

RESULTS

The reviewed studies reveal the potential of SVF in bone fracture healing, with its regenerative and anti-inflammatory effects. The purification of SVF is crucial for safe therapeutic use. Characterization involves flow cytometry and microscopy. Studies show SVF's efficacy in bone regeneration, versatility in various contexts, and potential for clinical use. SVF appears superior to electrical, ultrasound, and mechanical stimulation, with low complications.

CONCLUSIONS

This review compares bone healing methods, including SVF. It provides valuable insights into SVF's potential for bone regeneration. However, due to limited human studies and potential bias, cautious interpretation is necessary. Further research is essential to validate these findings and determine the optimal SVF applications in bone healing.

Analyzing the Clinical Potential of Stromal Vascular Fraction: A Comprehensive Literature Review

Background: Regenerative medicine is evolving with discoveries like the stromal vascular fraction (SVF), a diverse cell group from adipose tissue with therapeutic promise. Originating from fat cell metabolism studies in the 1960s, SVF's versatility was recognized after demonstrating multipotency. Comprising of cells like pericytes, smooth muscle cells, and, notably, adipose-derived stem cells (ADSCs), SVF offers tissue regeneration and repair through the differentiation and secretion of growth factors. Its therapeutic efficacy is due to these cells' synergistic action, prompting extensive research. Methods: This review analyzed the relevant literature on SVF, covering its composition, action mechanisms, clinical applications, and future directions. An extensive literature search from January 2018 to June 2023 was conducted across databases like PubMed, Embase, etc., using specific keywords. Results: The systematic literature search yielded a total of 473 articles. Sixteen articles met the inclusion criteria and were included in the review. This rigorous methodology provides a framework for a thorough and systematic analysis of the existing literature on SVF, offering robust insights into the potential of this important cell population in regenerative medicine. Conclusions: Our review reveals the potential of SVF, a heterogeneous cell mixture, as a powerful tool in regenerative medicine. SVF has demonstrated therapeutic efficacy and safety across disciplines, improving pain, tissue regeneration, graft survival, and wound healing while exhibiting immunomodulatory and anti-inflammatory properties.

Study of whey protein on muscle mass and functional rehabilitation in postoperative total knee arthroplasty patients

BACKGROUND

Patients who underwent total knee arthroplasty (TKA) often experience muscle loss due to pain and limited mobility. Nutritional supplementation and rehabilitation may positively affect the decline in muscle function.

OBJECTIVE

The purpose of this study is to evaluate whether whey protein intervention, in addition to conventional rehabilitation training, is beneficial in improving muscle function and quality of life in patients after TKA.

METHODS

72 patients who met the criteria were selected for this randomized controlled study. For the experimental group, whey protein was used as a daily supplement for 12 weeks, while the control group was given a placebo, during which both groups received conventional rehabilitation training. Muscle strength and each of the secondary observables needed to be measured and statistically analyzed preoperatively and at 4, 8, and 12 weeks post-intervention.

RESULTS

In total, 62 subjects completed the study: 32 in the experimental group and 30 in the control group. Both groups showed significant improvement in muscle strength, VAS, ROM, AKS and leg circumference after 12 weeks of treatment. Compared to the control group, patients in the experimental group showed significant improvement in muscle strength, VAS, ROM, AKS and leg circumference (p= 0.001, p= 0.002, p= 0.001, p= 0.001, p= 0.001, respectively) after 12 weeks of treatment.

CONCLUSION

The 12-week intervention of whey protein nutritional supplement showed significant improvement in muscle mass and function among post-TKA patients besides aiding with conventional rehabilitation exercise.