Abstract
PurposeThis study aimed to report the clinical and functional results of a series of patients with isolated primary patellofemoral osteoarthritis (PFOA) treated with intraarticular injection of microfragmented autologous adipose tissue plus knee arthroscopy. The results were also analyzed in relation to the age and body mas index (BMI) of patients, and to the stage of PFOA.MethodsTwenty-three patients with early-to-moderate (stage 1–3 according to the Iwano classification system) PFOA who received this treatment were retrospectively analyzed, with a mean follow-up of 22.1 ± 4.2 months. Patients were assessed using the International Knee Society (IKS) knee and function and visual analog scale (VAS) scores, and relative to their capacity for climbing stairs. Differences in improvements of IKS and VAS scores in relation to age (< 60 versus ≥ 60 years), BMI (< 30 versus ≥ 30 kg/m2), and stage of PFOA (stages 1–2 versus stage 3) were finally analyzed.ResultsThe mean IKS knee score significantly improved from 35.6 ± 14.9 points preoperatively to 61.9 ± 17.8 points at the latest follow-up, while the mean IKS function score significantly improved from 52.0 ± 14.7 points preoperatively to 82.3 ± 19.1 points at the latest follow-up. The mean VAS score significantly decreased from 8.7 ± 2.2 preoperatively to 5.2 ± 2.5 at the latest follow-up. A significant improvement in the capacity to climb stairs was found. No significant differences in improvements of IKS knee and function and VAS scores were found in relation to age, BMI, or stage of PFOA.ConclusionIntraarticular injection of microfragmented autologous adipose tissue following arthroscopic debridement significantly improved overall clinical and functional scores in patients with early or moderate isolated primary PFOA at a mean follow-up of almost 2 years. Improvements were not significantly affected by age, BMI, or stage of PFOA.Level of evidenceLevel IV, retrospective case series.
Highlights
Patellofemoral osteoarthritis (PFOA) is involved in more than 45% of knee osteoarthritis (OA) cases, either isolated or associated with femorotibialVasso et al Journal of Orthopaedics and Traumatology (2022) 23:7 degeneration [24]
Several studies have already shown promising results in patients with knee OA treated with intraarticular injection of adipose tissue rich in adipose-derived stem cells (ASCs) associated or not to arthroscopic debridement [1, 11, 15, 16, 21, 22, 26, 34], the use of this treatment is not yet supported by strong scientific evidence [17], especially regarding PFOA
The mean International Knee Society (IKS) knee score improved from 35.6 ± 14.9 points preoperatively to 61.9 ± 17.8 points at the latest follow-up (p < 0.001), while the mean IKS function score improved from 52.0 ± 14.7 points preoperatively to 82.3 ± 19.1 points at the latest follow-up (p < 0.001)
Summary
Patellofemoral osteoarthritis (PFOA) is involved in more than 45% of knee osteoarthritis (OA) cases, either isolated (half of those cases) or associated with femorotibialVasso et al Journal of Orthopaedics and Traumatology (2022) 23:7 degeneration [24]. The management of isolated primary PFOA is still highly controversial, especially in patients with early or moderate patellofemoral degeneration In these patients, results of conservative treatment [physiotherapy and/or taping, intraarticular injections with hyaluronic acid and/or platelet-rich plasma (PRP)] or nonreplacement surgery (arthroscopy, chondroplasty, lateral facetectomy) are often ineffective, while replacement surgery is certainly premature [37]. Adipose-derived stem cells (ASCs) present a higher proliferation and chondrogenic potential than other human MSCs, and this potential is less affected by the age of the patient-donors [5, 7, 20] It has been reported how intraarticular injection of autologous adipose tissue rich in ASCs in patients with knee OA increased glycosaminoglycan and type II collagen content in hyaline cartilage [16, 27], and resulted in radiological evidence of improved cartilage volume and confirmed hyalinelike cartilage on histology [22].
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