Fat Harvesting for Micro-Fragmented Adipose Tissue Injections: A Pilot Study Comparing Safety in Procedures Performed by Orthopedic and Plastic Surgeons

Bruno Butturi Varone; Rodrigo Bernstein Conde; Chilan B. G. Leite; Pedro Nogueira Giglio; Riccardo Gomes Gobbi; Marco Kawamura Demange

doi:10.1055/s-0045-1813003

Revista Brasileira de Ortopedia, Table of Contents

CC BY 4.0 · Rev Bras Ortop (Sao Paulo) 2025; 60(05): s00451813003
DOI: 10.1055/s-0045-1813003

Original Article

Fat Harvesting for Micro-Fragmented Adipose Tissue Injections: A Pilot Study Comparing Safety in Procedures Performed by Orthopedic and Plastic Surgeons

Coleta de gordura para injeções de tecido adiposo microfragmentado: Estudo piloto de comparação da segurança de procedimentos realizados por cirurgiões ortopédicos ou plásticos

Authors

Bruno Butturi Varone

¹Knee Group, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas (HCFMUSP), Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
Rodrigo Bernstein Conde

²Instituto Universitario de Ciencia de la Salud Fundación H. A. Barceló, Facultad de Medicina, Buenos Aires, Argentina
Chilan B. G. Leite

¹Knee Group, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas (HCFMUSP), Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil

³Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
Pedro Nogueira Giglio

¹Knee Group, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas (HCFMUSP), Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
Riccardo Gomes Gobbi

¹Knee Group, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas (HCFMUSP), Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
Marco Kawamura Demange

¹Knee Group, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas (HCFMUSP), Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil

Abstract

Objective

To compare short-term complication rates of small-volume adipose tissue harvesting for micro-fragmented adipose tissue (mFAT) knee injections performed by orthopedic surgeons with those performed by plastic surgeons. Additionally, to evaluate the orthopedic surgeon's learning curve.

Methods

The present case-control study enrolled patients with knee osteoarthritis. All patients underwent a single-stage procedure consisting of abdominal adipose tissue harvesting, processing of the extracted material using the Lipogems (Lipogems International SpA) device to obtain mFAT, which was then injected intra-articularly into the knee. The patients were divided into a test group, with harvesting being performed by a recently trained orthopedic surgeon, and a control group, in which the procedure was performed by an experienced plastic surgeon. Short-term adverse effects, minor and major complications related to harvesting, were assessed intraoperatively and at 7-day follow-up.

Results

No major complications (fat embolism, thromboembolic events, abdominal perforation, wound infection, dehiscence, or cosmetic changes) were observed in either group. Abdominal discomfort during harvesting, classified as a minor complication, showed no statistically significant difference between groups (p = 0.362). Postoperative adverse effects, such as abdominal ecchymosis (p = 0.362) and discomfort (p = 0.342), were equivalent in both groups and resolved within 7 days.

Conclusion

The present pilot study suggests that, with adequate training, orthopedic surgeons can perform small-volume adipose tissue harvesting with low complication rates, comparable to those achieved by plastic surgeons experienced in liposuction.

Resumo

Objetivo

Este estudo teve como objetivo comparar as taxas de complicações em curto prazo da coleta de tecido adiposo em pequeno volume para injeções de tecido adiposo microfragmentado (mFAT) no joelho realizada por um cirurgião ortopédico ou um cirurgião plástico, além de avaliar a curva de aprendizado de cirurgiões ortopédicos.

Métodos

Este estudo de caso-controle incluiu pacientes com osteoartrite de joelho. Todos os pacientes foram submetidos a um procedimento em estágio único composto por coleta de tecido adiposo abdominal, processamento do material extraído com o dispositivo Lipogems (Lipogems International SpA) para obtenção de mFAT, que foi injetada via intra-articular no joelho. Os pacientes foram divididos em grupo teste, no qual a coleta foi realizada por um cirurgião ortopédico recém-treinado; e grupo controle, no qual o procedimento foi feito por um cirurgião plástico com experiência. Efeitos adversos em curto prazo e complicações mais e menos sérias relacionadas à coleta foram avaliados no período intraoperatório e à consulta de acompanhamento 7 dias após a cirurgia.

Resultados

Nenhum paciente apresentou complicações mais sérias (embolia gordurosa, eventos tromboembólicos, perfuração abdominal, infecção da ferida, deiscência ou alterações estéticas). A taxa de desconforto abdominal durante a coleta, classificado como complicação menor, não apresentou diferença estatisticamente significativa entre os grupos (p = 0,362). Os efeitos adversos pós-operatórios, como equimoses (p = 0,362) e desconforto (p = 0,342) abdominais, foram equivalentes em ambos os grupos e se resolveram em 7 dias.

Conclusão

Este estudo piloto sugere que, com treinamento adequado, cirurgiões ortopédicos podem realizar a coleta de tecido adiposo em pequeno volume com baixas taxas de complicações, comparáveis às observadas em procedimentos realizados por cirurgiões plásticos experientes em lipoaspiração.

Keywords

adipose tissue - osteoarthritis - osteoarthritis, knee

Palavras-chave

osteoartrite - osteoartrite do joelho - tecido adiposo

Bibliographical Record
Bruno Butturi Varone, Rodrigo Bernstein Conde, Chilan B. G. Leite, Pedro Nogueira Giglio, Riccardo Gomes Gobbi, Marco Kawamura Demange. Fat Harvesting for Micro-Fragmented Adipose Tissue Injections: A Pilot Study Comparing Safety in Procedures Performed by Orthopedic and Plastic Surgeons. Rev Bras Ortop (Sao Paulo) 2025; 60: s00451813003.
DOI: 10.1055/s-0045-1813003

Full Text

References

References
1 Nelson AE, Hu D, Arbeeva L. et al. The Prevalence of Knee Symptoms, Radiographic, and Symptomatic Osteoarthritis at Four Time Points: The Johnston County Osteoarthritis Project, 1999-2018. ACR Open Rheumatol 2021; 3 (08) 558-565 Doi: 10.1002/acr2.11295
2 Yu Y, Lu Q, Li S. et al. Intra-articular injection of autologous micro-fragmented adipose tissue for the treatment of knee osteoarthritis: a prospective interventional study. J Pers Med 2023; 13 (03) 504
3 Ulivi M, Meroni V, Viganò M. et al. Micro-fragmented adipose tissue (mFAT) associated with arthroscopic debridement provides functional improvement in knee osteoarthritis: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 2023; 31 (08) 3079-3090
4 Freitag J, Bates D, Wickham J. et al. Adipose-derived mesenchymal stem cell therapy in the treatment of knee osteoarthritis: a randomized controlled trial. Regen Med 2019; 14 (03) 213-230
5 Hong Z, Chen J, Zhang S. et al. Intra-articular injection of autologous adipose-derived stromal vascular fractions for knee osteoarthritis: a double-blind randomized self-controlled trial. Int Orthop 2019; 43 (05) 1123-1134
6 Borić I, Hudetz D, Rod E. et al. A 24-Month Follow-Up Study of the Effect of Intra-Articular Injection of Autologous Microfragmented Fat Tissue on Proteoglycan Synthesis in Patients with Knee Osteoarthritis. Genes (Basel) 2019; 10 (12) 1051
7 Wu CZ, Shi ZY, Wu Z. et al. Mid-term outcomes of microfragmented adipose tissue plus arthroscopic surgery for knee osteoarthritis: A randomized, active-control, multicenter clinical trial. World J Stem Cells 2023; 15 (12) 1063-1076
8 Richter DL, Harrison JL, Faber L. et al. Microfragmented Adipose Tissue Injection Reduced Pain Compared With a Saline Control Among Patients With Symptomatic Osteoarthritis of the Knee During 1-Year Follow-Up: A Randomized Controlled Trial. Arthroscopy 2025; 41 (02) 248-260
9 Wu S, Coombs DM, Gurunian R. Liposuction: Concepts, safety, and techniques in body-contouring surgery. Cleve Clin J Med 2020; 87 (06) 367-375 Erratum in: Cleve Clin J Med 2020;87(8):476
10 Hudetz D, Borić I, Rod E. et al. The Effect of Intra-articular Injection of Autologous Microfragmented Fat Tissue on Proteoglycan Synthesis in Patients with Knee Osteoarthritis. Genes (Basel) 2017; 8 (10) 270 Doi: 10.3390/genes8100270
11 Hudetz D, Borić I, Rod E. et al. Early results of intra-articular micro-fragmented lipoaspirate treatment in patients with late stages knee osteoarthritis: a prospective study. Croat Med J 2019; 60 (03) 227-236 Doi: 10.3325/cmj.2019.60.227
12 Klein JA. The tumescent technique. Anesthesia and modified liposuction technique. Dermatol Clin 1990; 8 (03) 425-437 Doi: 10.1016/S0733-8635(18)30474-1
13 Malanga GA, Bemanian S. Microfragmented adipose injections in the treatment of knee osteoarthritis. J Clin Orthop Trauma 2019; 10 (01) 46-48 Erratum in: J Clin Orthop Trauma 2020;11(6):1175 DOI: 10.1016/j.jcot.2020.10.023
14 Tremolada C, Colombo V, Ventura C. Adipose Tissue and Mesenchymal Stem Cells: State of the Art and Lipogems® Technology Development. Curr Stem Cell Rep 2016; 2 (03) 304-312
15 Aljerian A, Abi-Rafeh J, Hemmerling T, Gilardino MS. Complications of Aesthetic Liposuction Performed in Isolation: A Systematic Literature Review and Meta-Analysis. Plast Surg (Oakv) 2024; 32 (01) 19-32 Doi: 10.1177/22925503221078693
16 Chow I, Alghoul MS, Khavanin N. et al. Is There a Safe Lipoaspirate Volume? A Risk Assessment Model of Liposuction Volume as a Function of Body Mass Index. Plast Reconstr Surg 2015; 136 (03) 474-483 Doi: 10.1097/PRS.0000000000001498
17 Klein JA. Tumescent technique for regional anesthesia permits lidocaine doses of 35 mg/kg for liposuction. J Dermatol Surg Oncol 1990; 16 (03) 248-263
18 Dall'Oca C, Breda S, Elena N, Valentini R, Samaila EM, Magnan B. Mesenchymal Stem Cells injection in hip osteoarthritis: preliminary results. Acta Biomed 2019; 90 (1-S): 75-80
19 D'Ambrosi R, Indino C, Maccario C, Manzi L, Usuelli FG. Autologous Microfractured and Purified Adipose Tissue for Arthroscopic Management of Osteochondral Lesions of the Talus. J Vis Exp 2018; (131) 56395 Doi: 10.3791/56395
20 Barfod KW, Blønd L. Treatment of osteoarthritis with autologous and microfragmented adipose tissue. Dan Med J 2019; 66 (10) A5565
21 Shoukrie SI, Venugopal S, Dhanoa RK. et al. Safety and Efficacy of Injecting Mesenchymal Stem Cells Into a Human Knee Joint To Treat Osteoarthritis: A Systematic Review. Cureus 2022; 14 (05) e24823 Doi: 10.7759/cureus.24823
22 Panchal J, Malanga G, Sheinkop M. Safety and Efficacy of Percutaneous Injection of Lipogems Micro-Fractured Adipose Tissue for Osteoarthritic Knees. Am J Orthop (Belle Mead NJ) 2018; 47 (11)
23 Russo A, Condello V, Madonna V, Guerriero M, Zorzi C. Autologous and micro-fragmented adipose tissue for the treatment of diffuse degenerative knee osteoarthritis. J Exp Orthop 2017; 4 (01) 33
24 Cattaneo G, De Caro A, Napoli F, Chiapale D, Trada P, Camera A. Micro-fragmented adipose tissue injection associated with arthroscopic procedures in patients with symptomatic knee osteoarthritis. BMC Musculoskelet Disord 2018; 19 (01) 176
25 Russo A, Screpis D, Di Donato SL, Bonetti S, Piovan G, Zorzi C. Autologous micro-fragmented adipose tissue for the treatment of diffuse degenerative knee osteoarthritis: an update at 3 year follow-up. J Exp Orthop 2018; 5 (01) 52
26 Onorato F, Rucci M, Alessio-Mazzola M. et al. Autologous microfragmented adipose tissue treatment of knee osteoarthritis demonstrates effectiveness in 68% of patients at 4-year follow-up. Arch Orthop Trauma Surg 2024; 144 (09) 3925-3935