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Table 1 Current use of adipose SVF containing ASCs for orthopedic applications

From: Current use of autologous adipose tissue-derived stromal vascular fraction cells 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
  1. 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