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Scientific literature review: Autologous Conditioned Plasma + Stromal Vascular Fraction(ACP-SVF) for the treatment of osteoarthritis

Abdominal fat is an easily accessible source of mesenchymal stem cells. Adding platelet-rich plasma (PRP) combines the regenerative potential of adipose stem cells (SVF) with the benefits of the growth factors in the PRP (ACP). This is a very new treatment with a lot of potential. Little published research exists so far, but the available trial results demonstrate significant improvements in pain and function in patients with osteoarthritis of the knee. All studies so far demonstrate that the treatment is safe without any obvious side effects or complications.

Treatment of Osteoarthritis. Adipose Derived Stem Cell & PRP Therapy

Konrad Słynarski, Filip Baszczeski, Lukasz Lipinski (2017)

The authors treated 18 patients with a diagnosis of osteoarthritis of the knee with ACP-SVF. This combines the benefits of adipose tissue derived stem cells (SVF) with the effect of platelet-rich plasma (PRP/ACP). 3 months following the procedure the authors reported improvements in pain, stiffness and function. There were no adverse reactions. The authors concluded: We believe ACP-SVF is safe and provides quantifiable benefits for pain relief and functional improvement in the treatment of knee osteoarthritis.

At the Orthobiologics Clinic we like the fact that harvesting adipose cells from the abdomen is much easier, less painful and less invasive than harvesting bone marrow from the pelvis. Combining the benefits of adipose derived stem cell precursors with the benefits of platelet-rich plasma results in a very potent treatment for patients with osteoarthritis. We were please to see the benefits to patients in this study group and felt reassured that the treatment is safe without adverse side effects. At the same time, we felt that the number of patients was small and the follow up of 3 months was rather short. We are looking forward to future trials with a larger cohort of patients, a longer follow up and a control group.

Comparative Clinical Observation of Arthroscopic Microfracture in the Presence and Absence of a Stromal Vascular Fraction Injection for Osteoarthritis

Phu DINH Nguyen, Tung Dand Xuan Tran, Huynh Ton-Ngoc Nguyen, Hieu Trung Vu, Phuong Thi-Bich Le, Nhan Lu-Chinh Phan, Ngoc Bich Vu, Ngoc Kim Phan, Phuc Van Pham (2016)

The authors studied 30 patients who underwent microfracture treatment for osteoarthritis of the knee. Half of these patients had additional treatment with ACP-SVF. No adverse effects were noted. After 18 months those patients who had the additional ACP-SVF injection showed significantly better results in terms of pain and function compared to those who didn’t have the injection. The investigating team also noticed that patients in the ACP-SVF group showed an increase in cartilage thickness on MRI scans after 12 and 18 months.

At the Orthobiologics Clinic we were pleased to see the improved outcomes in the group of patients undergoing treatment with ACP-SVF. Although the number of patients is small, the addition of a control group with patients who didn’t receive ACP-SVF adds a lot of support to the use of ACP-SVF in patients undergoing microfracture treatment for osteoarthritis of the knee.While the authors claim that the cartilage thickness on MRI scans increased in the study group, they don’t provide any data and we are therefore wondering how valid and significant this claim is..

Intra‑articular injection in the knee of adipose derived stromal cells (stromal vascular fraction/SVF) and platelet rich plasma (PRP/ACP) for osteoarthritis

Himanshu Bansal, Kristin Comella, Jerry Leon, Poonam Verma, Diwaker Agrawal, Prasad Koka and Thomas Ichim (2017)

10 patients (13 knees) with osteoarthritis of the knee underwent injection treatment with ACP-SVF. All patients were followed up for 2 years including a repeat MRI scan at 1 year. The findings were:

  1. Patients experienced a significant improvement in function scores
  2. Pain scores improved significantly
  3. The 6-minute walking distance improved significantly
  4. MRI scans at 1 year showed an increase in cartilage thickness in 6 patients, 2 were unchanged and in 2 patients there was a decrease in cartilage thickness of 0.2mm
  5. All patients were pleased with the results

The authors concluded that this clinical study of a combined intra-articular injection of SVF and PRP into the knee suggests a promising minimally invasive therapy for OA patients.

At the Orthobiologics Clinic we were happy to see a trial with a long 2-year follow-up, although we would have liked to see more patients enrolled. We were also wondering how reliable the assessment of cartilage thickness on MRI scans is, especially if the measured differences were as small as 0.2mm. The lack of a control group also makes it difficult to ascertain the true treatment benefits over and above a placebo effect. Nevertheless, the study demonstrates the benefits from a single injection with ACP-SVF in patients with osteoarthritis of the knee. We look forward to seeing more trials like this, ideally with a randomised control group.

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