Joint care is our specialty. Hundreds of knee and hip pain patients have benefited from the micro-fractionated adipose tissue graft procedure we use at Oregon Regenerative Medicine. What follows is another study in which PRP was added to the micro-fragmented adipose and compared in 30 patients with knee osteoarthritis (KOA).
What they found was that even though all patients benefited functionally from treatment, standard PRP containing RBCs (red blood cells) inhibited the MRI-measured benefits of the graft, whereas the addition of RBC-free PRP improved MRI knee outcomes. This fits with our experience, as we have been combining RBC-free PRP with our autologous microfat graft stem cell treatments since 2012.
Researchers at the Sport and Orthopedics Surgery Institute in Marseille, France, sought to compare a single abdominal-sourced microfat (MF) injection containing adipose-derived stem cells, mixed with or without PRP Low Dose (LD) or High Dose (HD) for improving MRI parameters as well as relieving pain and improving functional capacity in knee osteoarthritis (OA). Knee OA is classified from Grade 1 to 4, with 4 being late-stage destruction of cartilage and severe pathologic changes to the joint. Thirty patients with symptomatic grade 2 to 4 knee OA were enrolled in the study.
Three groups of ten patients were administered a single injection of 10 cc of a 1:1 mix comprising either MF-Saline, MF-PRP LD or MF-PRP HD. A significant improvement in knee functional status as well as symptoms relief at 3 and 6 months were conferred by all treatments. Findings revealed that a single intra-articular injection of MF with or without PRP is not only safe but also resulted in a significant clinical joint improvement in patients suffering from OA.
Patients were assessed at baseline, at 3 and 6 months of follow-up. The primary endpoint was the change in maximum of value of cartilage relaxation time in T2 mapping sequences (T2max) at 3 months. (T2 mapping is an MRI technique that evaluates changes in the biochemical composition of cartilage and menisci.) Secondary factors evaluated were MRI-grade severity, joint space assessment, WOMAC score, pain evaluation, knee range of motion and patient’s satisfaction. The complete cell counts and growth factors content of injected products were assessed to analyze their potential relationship with MRI/clinical outcomes. Adverse events were also collected.
All joint treatments significantly improved knee functional status and symptoms relief at 3 and 6 months.
Three groups of 10 patients received a single injection of 10 cc of a 1:1 mix containing either MF-Saline, MF-PRP LD or MF-PRP HD. T2max did not change notably over time for any of the groups. All treatments improved knee functional status and symptoms relief at 3 and 6 months. All patients were responders in the MF/PRP HD at 3 months and significantly higher compared to MF/PRP LD. Half of the injected PRP in the MF/PRP LD group displayed RBCs contamination of over 8%, which was correlated with an impairment of T2max.
A single intra-articular injection of MF with or without PRP is safe and often offers significant clinical joint improvement in patients with OA.
Dr. Noel Peterson, ND, DAAPM, is the founder and medical director of Oregon Regenerative Medicine.
- Marie Laure Louis, M.D.; Robinson Gravier Dumonceau, M.Sc. et al. Intra-Articular Injection of Autologous Microfat and Platelet-Rich Plasma in the Treatment of Knee Osteoarthritis: A Double-Blind Randomized Comparative Study. arthroscopyjournal.org. April 19, 2021. Accessed April 5, 2023. https://doi.org/10.1016/j.arthro.2021.03.074
- Lu, L., Dai, C., Zhang, Z. et al. Treatment of knee osteoarthritis with intra-articular injection of autologous adipose-derived mesenchymal progenitor cells: a prospective, randomized, double-blind, active-controlled, phase IIb clinical trial. Stem Cell Res Ther10, 143 (2019). https://doi.org/10.1186/s13287-019-1248-3