Microfragmented Adipose Tissue Versus Platelet-rich Plasma for Knee Osteoarthritis: a Randomized Comparative Trial

The Ohio State University

Status: Completed

Conditions: Platelet-Rich Plasma; Microfragmented Adipose Tissue; Osteoarthritis, Knee

Treatments: Device: Platelet Rich Plasma

Study type: Interventional

Funder types: Other

Identifiers

NCT04351087

2019H0448

Details and patient eligibility

About

The study aims to conduct a randomized trial comparing the clinical outcomes of PRP (standard intervention) versus Microfragmented adipose tissue (investigational) for the treatment of knee osteoarthritis.

Hypothesis: Both interventions will result in significant improvement in patient-reported outcomes. We hypothesize that Microfragmented adipose tissue will provide superior outcomes.

Full description

Background

Knee osteoarthritis is a leading cause of disability worldwide. Standard of care treatments for knee OA include activity modification, weight loss, therapeutic exercise and injections like corticosteroids and viscosupplement. These commonly used non-operative treatments focus on symptom palliation, but are not disease modifying.

Orthobiologics have emerged as a promising treatment for knee OA. The most widely studied orthobiologic is platelet-rich plasma (PRP). PRP is a dense concentration of platelets derived from autologous whole blood and platelets are concentrated 2-5x compared to baseline. The platelets have demonstrated anti-inflammatory and chondroprotective properties.6 PRP has been shown superior to placebo and viscosupplement for knee OA in several clinical trials.

While PRP is the most widely studied and used orthobiologic, it contains only platelets. Therefore, a simple, office-based intervention able to collect additional reparative cells to treat knee OA would be ideal. Adipose (fat) is a known source of reparative cells like pericytes and it can be easily and safely aspirated in the clinic. The adipose tissue aspiration and processing is accomplished through a simple process. After local anesthesia to the site of adipose aspiration (lower abdomen or buttock), 30ml of adipose is aspirated through a cannula. That adipose is then processed in accordance with FDA guidelines including minimal manipulation to remove oils.. Using minimally manipulated Microfragmented adipose tissue has been shown safe for use as injection therapy for knee OA for 3 years.

Methods:

Patients / Outcome Measures / Sample size: Patients with unilateral symptomatic knee OA will be recruited from the sports medicine and orthopedics clinics, as well as advertising flyers within the clinic. All patients' first visit will include a medical evaluation and assess best treatment plan for that patient, regardless of candidacy for this study. This evaluation includes x-rays of their knees as a standard part of the evaluation. If they meet criteria and choose to enroll, they will be randomly assigned to either the PRP or Microfragmented adipose tissuetreatment group. Patients will complete follow up visits and surveys at defined time points through 12 months.

Enrollment: 79 patients

Sex: All

Ages: 25 to 75 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Age 25-75 years
• BMI < 40
• Diagnosis of knee OA (primary and post-traumatic)
• Radiographic evidence of OA of the target knee (Kellgren-Lawrence grades 1-4)
• Continued OA pain in the target knee despite at least 6 weeks of 1 of the following nonoperative treatments: activity modification, weight loss attempt, physical therapy, or NSAID / acetaminophen.
• Knee Osteoarthritis Outcomes Score (KOOS)-Pain subscale 20-65
• Working knowledge of English language (to be able to complete all outcome scores)
• Ability to attend all follow-up appointments

Exclusion criteria

• Isolated patellofemoral OA
• 3+ effusion of the target knee (stroke test grading system)
• Significant (10 degree) valgus or varus deformities
• Prior injection therapy:
• Steroid injection in target knee in the last 3 months
• Viscosupplementation in target knee in the last 6 months
• PRP in the target knee in the last 1 year
• No other cellular treatments in index knee (bone marrow, amniotic suspensions etc) all time
• Participation in any experimental device or drug study within 1 year before screening visit
• Oral or IM steroids for last 3 months
• Medical condition that may impact outcomes of procedure including:
• anemia
• thrombocytopenia
• bleeding disorders
• inflammatory disorders like rheumatoid arthritis, lupus
• diabetes
• any history of cancer (other than non-melanoma skin malignancies)
• taking anticoagulants (aspirin, Plavix, eliquis, Xarelto, warfarin, lovenox)
• Taking immunosuppressants, having a severe systemic infection
• Previous cartilage repair procedure on the injured cartilage surface (ie, OATS, ACI, MFX)
• Previous surgery at the target knee within the past 1 year
• Any degree of cognitive impairment.
• OA of either hip
• Pregnancy, lactating, or intent to become pregnant during treatment period
• Gout
• History of infection or current infection at the affected joint
• Smoking

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

---

79 participants in 2 patient groups

Platelet Rich Plasma

Active Comparator group

Description:

157cc of whole blood will be harvested via standard venipuncture from the antecubital fossa and mixed with 24cc ACD-A (manufacturer recommends 8cc ACD-A per 52cc of whole blood). 156ml of whole blood will be processed in the FDA Cleared Angel cPRP system at 2% hematocrit. 1ml of whole blood and the resultant PRP will be analyzed in the Sysmex XN-350 for complete analysis (platelet, leukocyte, red blood cell counts). The remaining PRP will be injected under sterile technique using ultrasound-guidance through a superolateral approach. For patient comfort, 2cc of 1% lidocaine can be administered using a 26-gauge needle (into soft tissues only). PRP will then be injected using a 25-guage needle. A maximum of 6ml of PRP will be injected. Injection site will be cleaned and bandaged and patient will be dismissed with post-injection precautions and 1 month follow-up scheduled.

Treatment:

Device: Platelet Rich Plasma

Microfragmented adipose tissue

Active Comparator group

Description:

Adipose is aspirated from the subcutaneous tissue of the buttock or abdomen. Aspiration site is injected with 10ml 1% lidocaine with epinephrine. A small poke incision is made with an 11-blade scalpel. Then 120ml of Klein solution is injected into the adipose tissue. Solution sits for 15 minutes to allow for adequate anesthesia. Aspiration cannula is inserted and moved in a back and forth motion for 2 minutes to allow for adipose aspiration. 30ml fat will be aspirated. Aspiration site is cleaned and bandaged. The aspirated fat is processed using the Lipogems system. 30ml of adipose is transferred to the device, saline is run through the device to remove oils and then approximately 5-7ml of adipose tissue is removed and ready for injection. The Microfragmented adipose tissue are then injected in identical fashion to the PRP above.

Treatment:

Device: Platelet Rich Plasma