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 |