Micro-Fragmented Adipose Tissue demonstrates comparable clinical efficacy to other orthobiologics injections in treating symptomatic knee osteoarthritis. A systematic review of level I-IV clinical studies.

PURPOSE: To perform a systematic review of clinical outcomes in patients who underwent treatment for symptoms with micro-fragmented aspirated fat (MFAT).

METHODS: Medline, Embase, Scopus, and Google Scholar were screened for studies from 2000 to 2023. Risk of bias (ROB) was assessed using the Cochrane Collaboration's tools and the ROBINS-I tool. Study quality was assessed with the modified Coleman Methodology (CMS) and MINORS score. Heterogeneity was assessed using χ2 and I2 statistics.

RESULTS: 21 studies were included. One study had a high ROB, one had a critical ROB, 3 had serious ROB and 16 had a moderate ROB. The mean Coleman score was 58 demonstrating fair study quality; the MINORS score a mean value of 13 indicating overall fair quality. Best evidence synthesis revealed moderate evidence. VAS score improved from 5.2 to 3.2 at 6 and 12 months. KOOS subscale ADL improved from 58.8 to 70.2 at 6 months and 67.5 at 12 months. KOOS subscale pain improved from 54.3 to 70.2 at 6 months and 72.4 at 12 months. KOOS subscale QOL improved from 33.1 to 43.6 at 6 months and 42.9 at 12 months. KOOS subscale sports improved from 23.7 to 43.6 at 6 months and 57.4 at 12 months. KOOS subscale symptoms improved from 55.3 to 70.1 at 6 months and 67.9 at 12 months. KOOS subscale pain improved from 54.3 to 70.2 at 6 months and 72.4 at 12 months. The WOMAC score steadily increased from 61.8 at baseline to 78.4 at 12 months.

CONCLUSION: MFAT injection therapy for the treatment of symptomatic knee osteoarthritis is effective and improves pain and functional outcomes. Moderate study quality combined with a moderate risk of bias, moderate certainty of evidence and moderate best synthesis evidence reduces external validity. Therefore, the results should be interpreted with a degree of caution.