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The use of intra-articular injection of autologous micro-fragmented adipose tissue as pain treatment for ankle osteoarthritis: a prospective not randomized clinical study

International Orthopaedics volume 45, pages 2239–2244 (2021)Cite this article

Abstract

Purpose

The objective of this study was to evaluate the safety and the efficacy of intra-articular injections of autologous micro-fragmented adipose tissue in patients affected by early or moderate ankle osteoarthritis (AOA).

Methods

A total of 31 symptomatic patients, aged 28–71 years, affected by AOA, were treated with 5 ml of autologous micro-fragmented adipose tissue. Clinical evaluations before the treatment and after six, 12, and 24 months were performed through American Orthopaedic Foot and Ankle Society (AOFAS) scale, the Foot and Ankle Disability Index (FADI), and Visual Analogue Scale (VAS) scores. Adverse events were recorded.

Results

No severe complications were noted during the treatment and the follow-up period. A statistically significant improvement from basal evaluation to the six, 12-, and 24-month follow-up visit was observed, whereas a statistically significant worsening from the 12-month to the 24-month follow-up visit was showed.

Conclusion

The autologous micro-fragmented adipose tissue for the treatment of pain in ankle osteoarthritis seems safe and able to provide positive clinical outcomes, potentially offering a new minimally invasive therapeutic option for patients who are not eligible for more invasive approaches. Further high-quality studies are needed to confirm these findings.

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Fig. 1

Data Availability

Data are available if required.

References

  1. Barg A, Pagenstert GI, Hügle T et al (2013) Ankle osteoarthritis: etiology, diagnostics, and classification. Foot Ankle Clin 18:411–426

    Article  PubMed  Google Scholar 

  2. Brown TD, Johnston RC, Saltzman CL, et al (2006) Posttraumatic osteoarthritis: a first estimate of incidence, prevalence, and burden of disease. In: Journal of Orthopaedic Trauma. J Orthop Trauma

  3. Valderrabano V, Hintermann B, Horisberger M, Tak SF (2006) Ligamentous posttraumatic ankle osteoarthritis. Am J Sports Med 34:612–620. https://doi.org/10.1177/0363546505281813

    Article  PubMed  Google Scholar 

  4. Valderrabano V, Horisberger M, Russell I et al (2009) Etiology of ankle osteoarthritis. Clin Orthop Relat Res 467:1800–1806. https://doi.org/10.1007/s11999-008-0543-6

    Article  PubMed  Google Scholar 

  5. Daniels T, Thomas R (2008) Etiology and biomechanics of ankle arthritis. Foot Ankle Clin 13:341–352

    Article  PubMed  Google Scholar 

  6. Thomas RH, Daniels TR (2003) Ankle arthritis. J Bone Jt Surg Ser A 85:923–936

    Article  Google Scholar 

  7. Witteveen AGH, Hofstad CJ, Kerkhoffs GMMJ (2015) Hyaluronic acid and other conservative treatment options for osteoarthritis of the ankle. Cochrane Database Syst. Rev. https://doi.org/10.1002/14651858.CD010643.pub2

  8. Repetto I, Biti B, Cerruti P et al (2017) Conservative treatment of ankle osteoarthritis: can platelet-rich plasma effectively postpone surgery? J Foot Ankle Surg 56:362–365. https://doi.org/10.1053/j.jfas.2016.11.015

    Article  PubMed  Google Scholar 

  9. Orozco L, Munar A, Soler R et al (2013) Treatment of knee osteoarthritis with autologous mesenchymal stem cells: a pilot study. Transplantation 95:1535–1541. https://doi.org/10.1097/TP.0b013e318291a2da

    Article  CAS  PubMed  Google Scholar 

  10. Zellner J, Johnstone B, Barry F, Madry H (2019) Mesenchymal stem cell based regenerative treatment of the knee: from basic science to clinics. Stem Cells Int 2019:1–1. https://doi.org/10.1155/2019/7608718

    Article  Google Scholar 

  11. Senesi L, De Francesco F, Farinelli L, et al (2019) Mechanical and enzymatic procedures to isolate the stromal vascular fraction from adipose tissue: preliminary results.Front Cell Dev Biol 7.https://doi.org/10.3389/fcell.2019.00088

  12. De Francesco F, Ricci G, D’Andrea F et al (2015) Human adipose stem cells: from bench to bedside. Tissue Eng Part B Rev 21:572–584

    Article  PubMed  Google Scholar 

  13. De Francesco F, Matta C, Riccio M et al (2021) Reevolution of tissue regeneration: from recent advances in adipose stem cells to novel therapeutic approaches. Stem Cells Int 2021:1–3. https://doi.org/10.1155/2021/2179429

    Article  Google Scholar 

  14. Prè ED, Busato A, Mannucci S, et al (2020) In vitro characterization of adipose stem cells non-enzymatically extracted from the thigh and abdomen.Int J Mol Sci 21.https://doi.org/10.3390/ijms21093081

  15. Busato A, De Francesco F, Biswas R, et al (2020) Simple and rapid non-enzymatic procedure allows the isolation of structurally preserved connective tissue micro-fragments enriched with SVF.Cells 10.https://doi.org/10.3390/cells10010036

  16. Russo A, Condello V, Madonna V et al (2017) Autologous and micro-fragmented adipose tissue for the treatment of diffuse degenerative knee osteoarthritis. J Exp Orthop 4:33. https://doi.org/10.1186/s40634-017-0108-2

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Russo A, Screpis D, Di Donato SL, et al (2018) Autologous micro-fragmented adipose tissue for the treatment of diffuse degenerative knee osteoarthritis: an update at 3 year follow-up.J Exp Orthop 5.https://doi.org/10.1186/s40634-018-0169-x

  18. Tsubosaka M, Matsumoto T, Sobajima S et al (2020) The influence of adipose-derived stromal vascular fraction cells on the treatment of knee osteoarthritis. BMC Musculoskelet Disord 21:207. https://doi.org/10.1186/s12891-020-03231-3

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Shimozono Y, Dankert JF, Kennedy JG (2020) Arthroscopic debridement and autologous micronized adipose tissue injection in the treatment of advanced-stage posttraumatic osteoarthritis of the ankle. Cartilage. https://doi.org/10.1177/1947603520946364

    Article  PubMed  PubMed Central  Google Scholar 

  20. Bianchi F, Maioli M, Leonardi E et al (2013) A new nonenzymatic method and device to obtain a fat tissue derivative highly enriched in pericyte-like elements by mild mechanical forces from human lipoaspirates. Cell Transplant 22:2063–2077. https://doi.org/10.3727/096368912X657855

    Article  PubMed  Google Scholar 

  21. Sun SF, Chou YJ, Hsu CW et al (2006) Efficacy of intra-articular hyaluronic acid in patients with osteoarthritis of the ankle: a prospective study. Osteoarthr Cartil 14:867–874. https://doi.org/10.1016/j.joca.2006.03.003

    Article  Google Scholar 

  22. Chamberlain G, Fox J, Ashton B, Middleton J (2007) Concise review: mesenchymal stem cells: their phenotype, differentiation capacity, immunological features, and potential for homing. Stem Cells 25:2739–2749. https://doi.org/10.1634/stemcells.2007-0197

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Orthopaedics, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Italy

    Simone Natali, Daniele Screpis, Venanzio Iacono, Vittorio Vacca & Claudio Zorzi

  2. Clinical Ortopaedics, Department of Clinical and Molecular Sciences, Università Politecnica Delle Marche, Ancona, Italy

    Luca Farinelli & Antonio Gigante

Authors
  1. Simone Natali
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  2. Daniele Screpis
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  3. Luca Farinelli
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  4. Venanzio Iacono
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  5. Vittorio Vacca
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  6. Antonio Gigante
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  7. Claudio Zorzi
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by L. Farinelli, S. Natali and V. Vacca. Statistical analysis was performed by V. Iacono. The first draft of the manuscript was written by L. Farinelli and D. Screpis. A. Gigante and C. Zorzi commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Simone Natali.

Ethics declarations

Ethical approval

The present study was approved by the Ethics Committee of Verona and Rovigo, Italy (protocol n. 61386–19/09/2018).

Conflict of interest

Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

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Level of Evidence: II, prospective cohort study

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Natali, S., Screpis, D., Farinelli, L. et al. The use of intra-articular injection of autologous micro-fragmented adipose tissue as pain treatment for ankle osteoarthritis: a prospective not randomized clinical study. International Orthopaedics (SICOT) 45, 2239–2244 (2021). https://doi.org/10.1007/s00264-021-05093-3

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  • DOI: https://doi.org/10.1007/s00264-021-05093-3

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