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Assessment of safety and efficacy of intra-articular injection of stromal vascular fraction for the treatment of knee osteoarthritis—a systematic review

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Abstract

Purpose

Stromal vascular fraction (SVF) as an injectable regenerative therapy for knee osteoarthritis (OA) has gained recent popularity. However, there is no clear consensus on the outcomes of such treatment. We systematically reviewed available evidence on the use of SVF injection in the treatment of knee OA.

Methods

The study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, with keyword search in PubMed, Scopus, and the Cochrane Library Database and related article search in Google Scholar. Clinical studies demonstrating effects of SVF in knee OA and published in English literature were included. Risk of bias assessment was done with modified Coleman Methodology Scoring (CMS).

Results

Eleven studies (9 prospective, 2 retrospective) that contributed to 290 knees in 200 patients were included. Two studies that contributed to 3718 knee injections were excluded from pooled analysis and were scrutinized separately. Majority of patients reported improvement in pain, range of motion (ROM), functional rating, six metre walking distance, and functional outcome scores. There was no major donor-site morbidity. There was only one reported case of knee joint infection and no case of tumour formation in relation to SVF injection.

Discussion

Intra-articular injection of SVF can be a simple, affordable, and minimally invasive treatment that could serve as an interim option for patients who failed other conservative and arthroscopic options.

Conclusion

Intra-articular injection of SVF is a safe and effective technique for the management of knee OA. However, comparative Level I studies are needed to support the use of adjuvants with SVF and also to compare the use of SVF (with or without adjuvants) with ADMSCs, PRP, and bone marrow concentrate.

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Data availability

Compilation of data extracted from the studies of the systematic review is available for submission when needed.

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Author information

Authors and Affiliations

  1. Department of Orthopaedics, Apollo Hospital, Muscat, Sultanate of Oman

    Saseendar Shanmugasundaram

  2. Department of Orthopedics, Indraprastha Apollo Hospitals, New Delhi, India

    Abhishek Vaish

  3. Department of Community Medicine, Indira Gandhi Medical College and Research Institute, Pondicherry, India

    Vijay Chavada

  4. Abu Dhabi Knee and Sports Medicine, Healthpoint Hospital, Abu Dhabi, United Arab Emirates

    William D Murrell

  5. Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Fort Bliss, El Paso, TX, USA

    William D Murrell

  6. Department of Orthopaedics, Indraprastha Apollo Hospital, New Delhi, India

    Raju Vaishya

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  1. Saseendar Shanmugasundaram
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  2. Abhishek Vaish
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  3. Vijay Chavada
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  4. William D Murrell
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  5. Raju Vaishya
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Contributions

Conceptualization: Dr. WDM, Dr. RV

Data curation: Dr. SS, Dr. AV, Dr. VC

Supervision: Dr. WDM, Dr. RV

Statistical analysis: Dr. VC

Writing original draft: Dr. SS, Dr. VC, Dr. AV

Critical review: Dr. WDM, Dr. RV

Corresponding author

Correspondence to Saseendar Shanmugasundaram.

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The authors declare that they have no conflict of interest.

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Not applicable as it is a systematic review and not a research paper.

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Not applicable as it is a systematic review and did not involve direct patient care.

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Not applicable as it is a systematic review and did not involve direct patient care.

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Level of evidence: Level IV, systematic review of levels II–IV studies

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Shanmugasundaram, S., Vaish, A., Chavada, V. et al. Assessment of safety and efficacy of intra-articular injection of stromal vascular fraction for the treatment of knee osteoarthritis—a systematic review. International Orthopaedics (SICOT) 45, 615–625 (2021). https://doi.org/10.1007/s00264-020-04926-x

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