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The aim of this study was to evaluate the medium-term effectiveness and safety of Microfragmented Autologous Fat Tissue (MFAT) injection treatment at 4-year follow-up and to investigate potential correlations among patients\u2019 pre-treatment clinical condition and clinical outcomes to identify possible predicting factors for procedure success or failure.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Patients and methods<\/jats:title>\n                <jats:p>This is a prospective trial enrolling 46 patients with diagnosis of symptomatic knee OA and failure of previous conservative measures who underwent diagnostic arthroscopy and single autologous MFAT injection between June 2017 and July 2018. Patients were assessed with repeated clinical scoring systems at baseline, 6\u00a0months, 1 and 4\u00a0years after surgery. The evaluation included demographic characteristics, arthroscopic findings, and stem cell number from injected tissue.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>No major complications were reported during follow-up period and there was a significant increase of Lysholm knee score from baseline value of 61.7\u2009\u00b1\u200913.8 to 79.5\u2009\u00b1\u200916.9 at 4\u00a0years (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). The WOMAC score increased from a baseline value of 66.5\u2009\u00b1\u200914.7 to 82.8\u2009\u00b1\u200915.7 at 4\u00a0years (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) and there was a significant decrease of VAS pain score from baseline value of 6.3\u2009\u00b1\u20091.5 to 3.5\u2009\u00b1\u20092.6 at 4-year follow-up (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). ROM improved significantly from 118.4\u2009\u00b1\u20092.6 to 122.5\u2009\u00b1\u20092.5 at 12\u00a0months (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), but did not improve at 4\u00a0years (<jats:italic>p<\/jats:italic>\u2009&gt;\u20090.05). 15 patients (32.6%) were considered treatment failures, because they required secondary surgery, further injection therapy or experienced symptoms persistence. Patient with synovitis had 75% failure rate, although synovitis did not result as a statistically significant factor influencing clinical outcome up to 4-year follow-up (<jats:italic>p<\/jats:italic>\u2009=\u20090.058). Age, cartilage defects severity, BMI, concomitant procedures, and stem cell number from injected MFAT did not show any significant correlation with the results.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>MFAT intra-articular injection is a safe procedure with positive improvements up to 4-year follow-up in patients with early knee OA. These findings suggest MFAT could be a minimally invasive treatment of early knee OA with durable benefits at mid-term evaluation.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Trial registration<\/jats:title>\n                <jats:p>IRB number ID-3522.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00402-023-05143-y","type":"journal-article","created":{"date-parts":[[2024,1,11]],"date-time":"2024-01-11T20:02:11Z","timestamp":1705003331000},"page":"3925-3935","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Autologous microfragmented adipose tissue treatment of knee osteoarthritis demonstrates effectiveness in 68% of patients at 4-year follow-up"],"prefix":"10.1007","volume":"144","author":[{"given":"Francesco","family":"Onorato","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimiliano","family":"Rucci","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mattia","family":"Alessio-Mazzola","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Bistolfi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlotta","family":"Castagnoli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Formica","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7654-0327","authenticated-orcid":false,"given":"Riccardo","family":"Ferracini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,1,11]]},"reference":[{"key":"5143_CR1","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1016\/j.berh.2014.01.004","volume":"28","author":"VL Johnson","year":"2014","unstructured":"Johnson VL, Hunter DJ (2014) The epidemiology of osteoarthritis. 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Ethical approval for the present study was requested and obtained from the institutional review board (IRB number ID-3522) from Comitato Etico Regionale Ospedale Policlinico San Martino IRCCS per Oncologia. All patients gave their written informed consent which followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines and checklist.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent for publication of their clinical details and clinical images was obtained from the patients. A copy of the consent form is available for review by the Editor of this journal.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}}]}}