1. Randomized Controlled Trial (Arthroscopic Debridement ± MFAT)

Title: Micro-fragmented adipose tissue (mFAT) associated with arthroscopic debridement provides functional improvement in knee osteoarthritis: a randomized controlled trial

Journal: Ortopedia internazionale

Design: 78 patients with knee OA grade 3–4 randomized to arthroscopic debridement (AD) alone or AD + MFAT.

Follow-up: 6 months and ~26 months.

Outcomes: At 6 months, the AD + MFAT group had greater improvement in:

  • KOOS-PS (+24.4 vs +11.7, p = 0.024).
  • KSS (+24.8 vs +14.9, p = 0.046).

At ~24 months:

  • KOOS-PS Function favored the MFAT group (p = 0.012).
  • MRI T2-mapping showed better cartilage quality in the MFAT group (p < 0.001).

Conclusion: MFAT combined with arthroscopic debridement improved functional scores and cartilage imaging over debridement alone.

Link: https://pubmed.ncbi.nlm.nih.gov/36040510

2. Prospective Cohort Study

Title: Risultati precoci del trattamento con lipoaspirato microframmentato intra-articolare in pazienti con osteoartrite del ginocchio in fase avanzata: uno studio prospettico

Journal: Croatian Medical Journal (2019)

Design: 20 patients (4 grade III, 16 grade IV) treated with intra-articular MFAT.

12-month Follow-up:

85% (17/20) avoided knee replacement.

VAS improved by ~54–82%; WOMAC and KOOS showed ~40–176% improvement (p < 0.001).

Conclusion: MFAT led to strong clinical improvement and high rates of surgical avoidance.

Link: https://pubmed.ncbi.nlm.nih.gov/31187950

3. Open-Label Cohort with dGEMRIC MRI Evaluation

Title: L'effetto dell'iniezione intra-articolare di tessuto adiposo autologo microframmentato sulla sintesi dei proteoglicani in pazienti con osteoartrite del ginocchio

Journal: Genes (2017)

Design: Single MFAT injection in patients with grades II–IV OA.

Outcomes:

MRI with dGEMRIC showed evidence of proteoglycan synthesis.

Conclusion: MFAT appears safe and may support cartilage matrix maintenance.

Link: https://www.mdpi.com/2073-4425/8/10/270

4. Medium-Term Prospective Trial (~4 Years)

Title: Autologous microfragmented adipose tissue treatment of knee osteoarthritis demonstrates effectiveness in 68% of patients at 4-year follow-up

Journal: Archives of Orthopaedic and Trauma Surgery (2023)

Design: 46 patients with diagnostic arthroscopy + MFAT injection.

Outcomes:

  • Lysholm score: 61.7 → 79.5 (p < 0.001)
  • WOMAC: 66.5 → 82.8 (p < 0.001)
  • VAS: 6.3 → 3.5 (p < 0.001)

33% required additional intervention over 4 years.

Conclusion: Durable symptom relief seen in the majority of patients.

Link: https://link.springer.com/article/10.1007/s00402-023-05143-y

5. Systematic Review (2024) – Jointechlabs study

Title: Frazione vascolare stromale autologa e tessuto adiposo microframmentato per i disturbi muscoloscheletrici: Una revisione narrativa

Journal: Arthroscopy, Sports Medicine and Rehabilitation

Conclusions:

MFAT significantly reduces pain and improves function.

Key Insights:

Efficacy: MFAT improves pain (VAS), function (WOMAC, KOOS), and protect cartilage.

Severity: Even patients with advanced OA (stage 3–4) benefit significantly.

Safety: Minimal adverse events reported across studies.

Link: https://crimsonpublishers.com/epmr/fulltext/EPMR.000602.php

Conclusion: MFAT shows strong potential in managing stage 3–4 knee osteoarthritis, especially in improving function and delaying joint replacement.