P186 - Autologous adipose-derived stromal cell injection in the knee: Patient characteristics, early results and complications.
Abstract
Purpose
There is expanding utilization of autologous adipose-derived stromal cells (ADSCs) in the management of degenerative knee pathology. This study reports our early clinical experience with ADSC injection for management of knee pathology.
Methods and Materials
Between March 2016 and October 2018, 40 knees (35 pts) underwent ADSC injection as either closed injection (5 knees) or adjunct to knee arthroscopy (35 knees) performed by a single orthopaedic surgeon using Lipogems. Average follow-up was 5 months (range 1- 25 mos), including 18 knees with minimum 3-month follow-up. Patient characteristics, radiographic imaging, and operative records were reviewed. ICRS cartilage grade and MOAKS criteria for effusion synovitis and Hoffa pad synovitis were graded by a board-certified radiologist. Complications and subsequent operations were reported.
Results
Patient characteristics are reported in Table 1. Preoperative MRI was available for 36 knees. Radiographic evidence of effusion synovitis or Hoffa pad synovitis (grade 1 or higher) was present in 31 knees (86.1%). ICRS grade 4 cartilage lesions were present in 28 knees (77.8%). There were 7 post-operative MRIs available. Within this small post-operative subset, there was no progression in ICRS grade in all compartments. No perioperative or post-operative adverse events related to adipose tissue harvesting were reported. At last follow-up, 28/40 patients reported symptom improvement. The remaining patients reported either no improvement (10/40 knees) or worsening symptoms (2/40 knees). There were 7 subsequent operations in 5 patients (Table 2). There was one postoperative infection in a patient with history of 10 prior knee surgeries. This was treated with arthroscopic I&D and 6 weeks of intravenous antibiotics.
Conclusion
ADSC injection for knee synovitis or chondromalacia had no harvest-related complications. Early satisfactory results were reported for most patients. Post-operative MRIs didn’t show alteration in the natural history of OA. A follow-up study is ongoing to determine the duration of symptom relief in this cohort.
