Table 1.
Current use of adipose SVF containing ASCs for orthopedic applications
| Study (yr) | Intervention treatment | Study type | Number of subjects and diseases | Subject characteristic [age (yr); gender] | Previous therapy | Concurrent treatment | Follow-up (mo) | Outcome measures | Results | Authors’ conclusion |
|---|---|---|---|---|---|---|---|---|---|---|
| Pak (2011) [11] | Adipose SVF (ASC) + PRP + HA via percutaneous injections | Case report | 2 OA | 70 and 79; 2 F with chronic knee pain | Various conservative treatments without any success | None | 3 | VAS; functions (FRI, ROM); MRI | VAS/function improvements and MRI evidence of cartilage regeneration | ASC + PRP + HA: potentially effective in regenerating cartilage in humans |
| Pak et al. (2013) [18] | Adipose SVF (ASC) + PRP + HA via percutaneous injections | Retrospective cohort study | 91 various orthopedic applications including OA | Mean 51.23 ± 1.50 (range, 18–78); 45 M and 46 F | Various conservative treatments without any success | None | 26.62 ± 0.32 | VAS; functions | Statistically significant improvement in both VAS and functions | ASC + PRP + HA: safe and potentially effective |
| Pak et al. (2016) [19] | Adipose SVF (ASC) + PRP + HA + ECM via percutaneous injections | Case report | 3 OA | 68; 1 M. 60 and 87; 2 F. |
Various conservative treatments without any success | None | 3.5 | VAS; functions (FRI, ROM); MRI | VAS/function improvements and MRI evidence of cartilage regeneration | ASC + PRP + HA + ECM: potentially effective in regenerating cartilage in humans |
| Koh and Choi (2012) [20] | Adipose SVF (ASC) + PRP via percutaneous injections | Non-randomized, retrospective, comparative study: ASC + PRP vs PRP alone | 25 OA Study group (ASC + PRP): 25; control group (PRP alone): 25 |
Study group: mean 54.1 (range, 34–69); 8 M and 17 F | Various treatments without any success | None | 16.4 | VAS; functions (Lysholm, Tegner) | ASC + PRP: more effective than PRP-control group | ASC + PRP: potentially effective in patients with cartilage defects |
| Koh et al. (2013) [21] | Adipose SVF (ASC) + PRP via percutaneous injections | Case series | 18 OA | Mean 54.6; 6 M and 12 F | Various treatments without any success | Arthroscopic lavage before knee-fat-pad-derived adipose SVF + PRP injection | 24.3 | VAS; functions (WOMAC, Lysholm); MRI | VAS/function/MRI improvements | ASC + PRP: effective in treating OA of knees |
| Koh et al. (2014) [22] | Adipose SVF (ASC) + PRP under arthroscopic guidance | Case series | 35 with 37 knee joints of OA | Mean 57.4 (range, 48–69); 14 M and 21 F | Various treatments without any success | Arthroscopic lavage before adipose SVF + PRP injection | 12.7 | VAS; functions; arthroscopy | 94% patients had excellent clinical improvement; 76% had abnormal repair tissue. | Scaffolds may be needed to treat patients with large cartilage lesions. |
| Koh et al. (2014) [23] | Adipose SVF (ASC) + PRP under arthroscopic guidance | Comparative study: adipose SVF + PRP vs PRP only | 44 OA | ND | Various treatments without any success | Open-wedge high tibial osteotomy | 24 | VAS; functions; arthroscopy | Adipose SVF + PRP is more effective than PRP alone. | ASC therapy, in conjunction with HTO, mildly improved cartilage healing and showed good clinical results compared with PRP only. |
| Koh et al. (2015) [24] | Adipose SVF (ASC) + PRP under arthroscopic guidance | Case series | 30 for adipose SVF + PRP injection; 16 for second look arthroscopy for OA | Mean 70.3 (range, 65–80); 5 M and 25 F | Various treatments without any success | Arthroscopic lavage before ASC + PRP injection | 24 | VAS; functions; 2nd look arthroscopy | VAS/function improvements; improved and maintained cartilage status | ASC + PRP: effective in treating elderly patients with OA |
| Kim et al. (2015) [25] | Adipose SVF (ASC) under arthroscopic guidance | Comparative study: adipose SVF vs adipose SVF + fibrin glue (as a scaffold) |
54 OA | Mean 57.5 ± 5.8; 22 M and 32 F | Various treatments without any success | None | 28.6 | VAS; functions; arthroscopy | No significant difference | Clinical and arthroscopic outcomes of ASC implantation were encouraging for OA knees in both groups, although there were no significant differences in outcome scores between groups. |
| Bui et al. (2014) [26] | Adipose SVF (ASC) + PRP via percutaneous injections | Case series | 21 OA | >18; ND | Various treatments without any success | None | 8.5 | VAS; functions; MRI | VAS/function/MRI improvements | ASC + PRP: effective in treating OA of knees |
| Michalek et al. (2015) [27] | Adipose SVF (ASC) via percutaneous injections | Multi-center case control study | 1114 OA | Median 62 (range, 19–94); 589 M and 525 F | Various treatments without any success | None | Median 17.2 | VAS; functions | VAS/function improvements | Adipose SVF is a novel and promising treatment approach for patients with degenerative OA. ASC is safe and cost-effective. |
| Fodor et al. (2016) [28] | Adipose SVF (ASC) percutaneous injections | Case report | 6 OA | Mean 59 (range, 51–69); 1 M and 5 F | Various conservative treatments without any success | None | 12 | VAS; functions (WOMAC, ROM, TUG); MRI | VAS/function improvements but no MRI evidence of cartilage regeneration | Autologous adipose SVF is a safe and potential new therapy for pain reduction in knee OA. |
| Pak et al. (2013) [32] | Adipose SVF (ASC) + PRP via percutaneous injections | Case series | 3 chondromalacia patellae | 54; 1 M. 43 and 63; 2 F. All with chronic knee pain. |
Various treatments without any success | None | 3 | VAS; functions (FRI, ROM); MRI | VAS/function improvements and MRI evidence of cartilage regeneration | ASC + PRP: effective in treating chondromalacia patellae patients |
| Pak et al. (2014) [37] | Adipose SVF (ASC) + PRP via percutaneous injections | Case report | 1 patient with meniscus tear | 32;1 F with chronic knee pain due to meniscus tear | Various treatments without any success | None | 3 | VAS; functions (FRI, ROM); MRI | VAS/function improvements and MRI evidence of cartilage regeneration | ASC + PRP: effective in treating cartilage defect lesions, including meniscus tear |
| Pak (2011) [11] | Adipose SVF (ASC) + PRP + HA via percutaneous injections | Case report | 2 osteonecrosis of femoral head | 47; 1 M. 29; 1 F. |
Various conservative treatments without any success | None | 3 | VAS; functions (FRI, ROM); MRI | VAS/function improvements and MRI evidence of boneregeneration | ASC + PRP + HA: potentially effective in regenerating bone in humans |
| Pak (2012) [40] | Adipose SVF (ASC) + PRP + HA via percutaneous injections | Case report | 2 osteonecrosis of femoral head | 34 and 39; 2 M | Various conservative treatments without any success | None | 7 and 16 | VAS; functions (FRI, ROM); MRI | VAS/function improvements and MRI evidence of bone regeneration | Regenerated bone by using ASC + PRP + HA may persist, representing potential future therapy for osteonecrosis. |
| Pak et al. (2014) [41] | Adipose SVF (ASC) + PRP + HA via percutaneous injections | Case report | 1 osteonecrosis of femoral head | 43; 1 M | Various conservative treatments without any success | None | 3 | VAS; functions (FRI, ROM); MRI | VAS/function improvements and MRI evidence of bone regeneration | ASC + PRP + HA: potentially effective in regenerating bone in humans |
| Saxer et al. (2016) [42] | Adipose SVF (ASC) + ceramic granules + fibrin gel | Case report | 8 proximal humeral fractures | 68; IM. Mean 70.4 (range, 62–84); 7 F. |
None | Open reduction and internal fixation | 12 | VAS; biopsies; mCT | VAS improvements; biopsies and mCT evidence of bone (tissue) regeneration | Spontaneous bone tissue and vessel formation within a fracture-microenvironment with autologous adipose SVF |
| de Girolamo et al. (2016) [49] | Adipose SVF (ASC) vs PRP | Randomized prospective clinical trial | 56 patients with Achilles tendinopathy PRP group: 28; SVF group: 28 |
PRP group: 46.6 6.2; ND. SVF group: 47.3 3.8; ND |
None | None | 6 | VAS; functions (VISA-A, AOFAS, SF-36); US and MRI | VAS, VISA-A, AOFAS, SF-36 improved and structural changes on US and MRI | Both PRP and adipose SVF are safe and effective for Achilles tendinopathy but adipose SVF yields faster results. |
| Lee et al. (2015) [50] | Allogeneic adipose ASC + fibrin glue | Open-label pilot study | 12 patients with lateral epicondylosis | Mean 51.8 ± 9.5; 5 M and 7 F | None | None | 13 | VAS; functions (MEPI); US | VAS, MEPI improved; tendon defects improved | Allogeneic ASC is safe and effective in treating lateral epicondylosis |
SVF stromal vascular fraction, ASC adipose tissue-derived stem cells, PRP platelet-rich plasma, HA hyaluronic acid, ECM extracellular matrix, OA osteoarthritis, yr year, mo month, M male, F female, ND not described, MRI magnetic resonance imaging, mCT microcomputed tomography, US ultrasonography, HTO high tibial osteotomy, VAS visual analogue scale, FRI functional rate index, ROM range of motion, WOMAC western Ontario and McMaster Universities osteoarthritis index, Lysholm Lysholm scores, Tegner Tegner activity scale, TUG Timed up-and-go, MEPI mayo elbow performance index, AOFAS American Orthopaedic Foot & Ankle Society, SF-36 Short Form-36, VISA-A Victorian Institute of Sport Assessment for Achilles tendinopathy