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Knee Surg Sports Traumatol Arthrosc. 2018 Nov;26(11):3499-3507. doi: 10.1007/s00167-018-4955-x. Epub 2018 Apr 30.

Limited evidence for adipose-derived stem cell therapy on the treatment of osteoarthritis.

Author information

1
Hospital for Special Surgery, 523 East 72nd Street, Suite 507, New York, NY, 10021, USA.
2
Royal College of Surgeons in Ireland, Dublin, Ireland.
3
Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan.
4
Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
5
Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam, The Netherlands.
6
Academic Center for Evidence Based Sports Medicine (ACES), Academic Medical Center, Amsterdam, The Netherlands.
7
Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands.
8
Hospital for Special Surgery, 523 East 72nd Street, Suite 507, New York, NY, 10021, USA. KennedyJ@hss.edu.

Abstract

PURPOSE:

The purpose of this systematic review is to evaluate the effects of adipose derived mesenchymal stem cells (ADSCs) in the treatment of osteoarthritis (OA) in the clinical setting.

METHODS:

A literature search was performed in the MEDLINE, EMBASE, and The Cochrane Library Database up to January 2017 for inclusion and exclusion criteria. Criteria for inclusion were clinical studies demonstrating the effects of ADSCs on OA, and written in English. The following variables were analyzed: donor site, volume of adipose tissue, preparation of ADSCs, clinical outcomes, and complication rate.

RESULTS:

Sixteen studies (knee: 14 studies, multiple joints: 1 study, ankle: 1 study) were included in this systematic review. All of the studies prepared ADSCs in the form of the stromal vascular fraction (SVF). Inconsistencies between studies were found with regards to reported clinical variability, donor sites of SVF, and reported clinical outcomes. Nine studies used either platelet-rich plasma (PRP) (7/16) or fibrin (4/16) or both PRP and Fibrin (1/16), as an adjunct at time of SVF injection. All of the studies reported an improvement in clinical outcomes with the use of SVF. Five studies reported a 90% satisfaction rate, and no study reported any complications with liposuction. Five studies reported on complications, with a 5% incidence of swelling and pain.

CONCLUSIONS:

This systematic review demonstrated that ADSCs are currently used in the form of SVF. While SVF may produce favorable clinical outcomes with minimal risk of side effects on osteoarthritis, the variability in the data and the use of biological adjuvants have confounded the effectiveness of ADSCs. This study will help surgeons understand the limitations in the literature on ADSCs.

LEVEL OF EVIDENCE:

Level IV, systematic review of level IV studies.

KEYWORDS:

Adipose-derived stem cells; Cartilage; Osteoarthritis; Systematic review

PMID:
29713784
DOI:
10.1007/s00167-018-4955-x
[Indexed for MEDLINE]

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