Efficacy of adipose-derived stem cells and stromal vascular fraction for pain relief in Kellgren-Lawrence grade II-III knee osteoarthritis: A systematic review (2019-2024)

Abstract

Background: Knee osteoarthritis (KOA) is a common degenerative condition, affecting individuals aged 40 and above. Current therapeutic options often fail to prevent disease progression and provide only short-term pain relief, leading to an increasing interest in regenerative medicine. Adipose-derived mesenchymal stem cells (ADMSCs) and stromal vascular fraction (SVF) have emerged as promising alternatives due to their potential to modulate inflammation and promote tissue repair. However, limited studies compare the efficacy of these two therapies for KOA.

Methods: A systematic review (2019-2024) across PubMed, CINAHL, and Embase included studies on patients aged 40+ with Grade II-III knee osteoarthritis (Kellgren-Lawrence) treated with intra-articular ADMSC and SVF injections. Inclusion criteria followed the SPIDER framework, focusing on pain relief and joint function improvement over ≥3 months, measured via VAS, KOOS, and WOMAC. MeSH terms for KOA and ADMSC/SVF therapies were used, with bias assessed via GRADE.

Results: Ten studies, including three randomized controlled trials and two observational studies, met the criteria, encompassing 452 patients. Results indicate that ADMSC therapies demonstrate prolonged pain relief and enhanced joint function up to 24 months post-treatment, with superior outcomes in cartilage regeneration compared to SVF. SVF provided quicker symptom relief due to its diverse cell composition but plateaued around 12 months. Both treatments had minimal adverse effects, with lipoaspiration-related symptoms being the most common.

Conclusion: ADMSC and SVF stem cell therapies represent promising non-surgical options for managing knee osteoarthritis (KOA) in patients over 40. ADMSC demonstrates higher efficacy in sustaining long-term pain relief and joint health, with significant potential for cartilage regeneration. The chondrogenic properties of ADMSCs make them particularly beneficial for patients younger than 62 years old. Conversely, SVF, with its heterogeneous cell composition, provides rapid paracrine effects, offering early symptom relief and broader applicability for older or obese patients, including those with a Body Mass Index (BMI) over 30.

Keywords: Adipose-derived mesenchymal stem cells (ADMSC); Biologic joint preservation; Cartilage regeneration; Cell-based therapy in sports medicine; Chondrogenesis; Intra-articular injection; Joint function improvement; Kellgren-Lawrence grading; Knee osteoarthritis (KOA); Minimally invasive therapy; Non-surgical KOA treatment; Orthobiologics; Osteoarthritis rehabilitation; Pain management; Paracrine effects of SVF; Regenerative medicine; Sports-related degenerative joint disease; Stem cell therapy for KOA; Stromal vascular fraction (SVF); Tissue engineering.