Intra-Articular Implantation of Stromal Vascular Fraction Plus Platelet Rich Plasma in a Degenerative Meniscal Injury

Abstract

Regenerative medicine and specifically stem cell therapy is growing in popularity in a variety of orthopedic conditions including meniscal injuries. Stromal vascular fraction (SVF) which is easily obtained from adipose (fat tissue) is a mixture of adipose derived stem cells/mesenchymal stem cells, pericytes, fibroblasts, progenitor/endothelial cells, and other cells. A mini-lipoaspiration procedure to obtain a small sample of fat can be completed using a cannula under local anesthesia. The SVF is separated from the adipocytes (fat cells) using enzyme digestion and centrifugation. Platelet rich plasma (PRP) from the peripheral blood is a mixture of growth factors and cytokines. We present a case study and to our knowledge first in man with a before and after arthroscopic evaluation showing the repair of a meniscal tear using SVF plus PRP. Adipose tissue (65 mL) was removed via a mini-lipoaspirate procedure under local anesthesia. Approximately 5 mL of whole fat was washed and prepared for injection. For the remaining 60 mL of fat, the adipocytes were removed after enzyme digestion and centrifugation to isolate the SVF. PRP (approximately 4 mL) was used to resuspend the cells for an intra-articular injection. The patient received five additional PRP injections of 2.5 mL at 3 - 4 week intervals. The patient was monitored over a 12-month period for safety (including severe adverse events (SAEs) and adverse events) and quality of life parameters. In addition, an arthroscopic evaluation was completed at baseline and 9 months post procedure. There were no reported SAEs or other safety complications during the procedure or the follow-up time period. The patient demonstrated reduction of pain with clearly visible repair on the arthroscopic evaluation. The patient expressed an overall improvement in quality of life and willingness to repeat PRP treatments. Based on the outcomes of this case study, intra-articular injection of SVF plus PRP could be a feasible treatment plan for a patient with chronic meniscus injury. J Med Cases. 2018;9(7):221-225 doi: https://doi.org/10.14740/jmc3091w