Clinical use of autologous micro-fragmented fat progressively restores pain and function in shoulder osteoarthritis

Summited to Future Medicine (Dec 2020)

Aim: We aim to show that the use of nondigested micro-fragmented adipose tissue (MFat™, Lipogems®) is a viable alternative for treatment of joint pain and inflammation associated dysfunction in shoulder osteoarthritis (OA). Materials & methods: A total of 25 subjects with OA received an injection of MFat™ and were followed at 6, 18 and 52 weeks intervals. Quantitative analysis of pain and function modalities were performed using the visual analog scale and the disabilities of the arm, shoulder and hand, respectively. Results: All study participants reported significant progressive improvement (p < 0.001) from baseline in visual analog scale and disabilities of the arm, shoulder and hand in shoulder OA cases up to a year post. Conclusion: MFat™ therapy improves pain and function in patients with shoulder OA and can provide a long-term alternative to surgical intervention.

Osteoarthritis (OA) is one of the most common chronic and debilitating conditions seen in the orthopedic setting. This disease results in damage to the articular cartilage and inflammation and successive damage of the joint itself. Shoulder OA can be debilitating with loss of shoulder function leading to depression, anxiety, activity limitations and job-performance problems. Cartilage degradation in shoulder OA can cause subchondral bone remodeling, and ultimate loss in sphericity and congruity of the joint [1]. The joint capsule can thicken, leading to further loss of shoulder rotation [2,3].

Successful treatment of OA remains a challenge particularly due to a lack of blood supply and limited capacity of self-repair in articular cartilage [4,5]. Traditional treatment is aimed at symptom management to control pain and restore function but nothing reparative in nature to alter the progression of disease. Although steroid injections are commonly given to provide pain relief by decreasing joint inflammation, often patients require numerous injections, which has been shown to accelerate OA progression and result in bone loss over time [6]. More advanced cases of OA can develop resistance or are unresponsive to traditional pharmacological methods warranting surgical intervention, which leads many patients searching for less invasive alternative treatment options.

Orthobiologic regenerative medicine approaches have recently emerged as innovative nonsurgical reparative options for the treatment of OA through the use of mesenchymal stem cells (MSCs). The therapeutic use of MSCs and other reparative pericytes is traditionally related to both their anti-inflammatory activity and multilineage differentiation, including their chondrogenic potential [7–11]. Adipose tissue has emerged as an easily accessible, rich source of these reparative cells and can serve as an excellent option in regenerative medicine because of the minimally invasive harvesting procedure and is currently being utilized in several OA studies [12–19]. In this prospective nonrandomized clinical study of 25 patients, we investigate the use of autologous micro-fragmented adipose tissue (MFat™) obtained through a minimal manipulation technique in a closed, full-immersion Lipogems® system and quantified the clinical effectiveness of its use for the treatment of joint pain and inflammation associated dysfunction in patients with OA of the glenohumeral shoulder joint. We propose that the use of this technology improves pain, function and quality of life in patients with mild-to-moderate shoulder OA and can provide a long term alternative to surgical intervention.

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