微碎屑脂肪组织在治疗症状性膝骨关节炎方面的临床疗效与其他矫形生物注射剂相当。I-IV级临床研究的系统回顾。

IF 4.4 1区医学 Q1 ORTHOPEDICS

Arthroscopy-The Journal of Arthroscopic and Related Surgery Pub Date : 2025-02-01 DOI:10.1016/j.arthro.2024.03.002

Erik Hohmann M.D., Ph.D., F.R.C.S., F.R.C.S. (Tr & Orth), M.B.B.S. , Natalie Keough Ph.D., M.Sc. , Rachel M. Frank M.D. , Scott Rodeo M.D.

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引用次数: 0

摘要

目的：对使用微碎屑抽吸脂肪（MFAT）治疗症状患者的临床疗效进行系统回顾：方法：筛选Medline、Embase、Scopus和Google Scholar上2000年至2023年的研究。使用 Cochrane 协作组织的工具和 ROBINS-I 工具评估偏倚风险（ROB）。研究质量采用改良科尔曼方法（CMS）和 MINORS 评分进行评估。使用χ2和I2统计量评估异质性。其中 1 项研究的 ROB 为高，1 项研究的 ROB 为临界，3 项研究的 ROB 为严重，16 项研究的 ROB 为中等。Coleman 评分的平均值为 58 分，表明研究质量尚可；MINORS 评分的平均值为 13 分，表明总体质量尚可。最佳证据综合显示证据中等。在 6 个月和 12 个月时，VAS 评分从 5.2 分提高到 3.2 分。KOOS 分量表 ADL 在 6 个月和 12 个月时分别从 58.8 分和 67.5 分提高到 70.2 分。KOOS 疼痛分量表从 54.3 分提高到 6 个月时的 70.2 分和 12 个月时的 72.4 分。KOOS 分量表 QOL 从 33.1 分提高到 6 个月时的 43.6 分和 12 个月时的 42.9 分。KOOS 运动分量表从 23.7 分提高到 6 个月时的 43.6 分和 12 个月时的 57.4 分。KOOS 分量表中的症状在 6 个月和 12 个月时分别从 55.3 分和 67.9 分提高到 70.1 分。KOOS 疼痛分量表从 54.3 分提高到 6 个月时的 70.2 分和 12 个月时的 72.4 分。WOMAC评分从基线时的61.8分稳步上升至12个月时的78.4分：结论：MFAT注射疗法治疗有症状的膝关节骨性关节炎效果显著，可改善疼痛和功能。中度的研究质量加上中度的偏倚风险、中度的证据确定性和中度的最佳综合证据降低了外部有效性。因此，对结果的解释应持谨慎态度。

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Micro-Fragmented Adipose Tissue Demonstrates Comparable Clinical Efficacy to Other Orthobiologic Injections in Treating Symptomatic Knee Osteoarthritis: A Systematic Review of Level I to IV Clinical Studies

Purpose

To perform a systematic review of clinical outcomes in patients who underwent treatment with micro-fragmented aspirated tissue for symptoms of knee osteoarthritis.

Methods

Medline, Embase, Scopus, and Google Scholar were screened for studies from 2000 to 2023. Risk of bias (ROB) was assessed using the Cochrane Collaboration’s tools and the Risk Of Bias In Non-randomised Studies-of Interventions tool. Study quality was assessed with the modified Coleman Methodology Score and Methodological Index for Non-Randomized Studies score. Heterogeneity was assessed using χ² and I² statistics.

Results

Twenty-one studies were included. One study had a high ROB, 1 had a critical ROB, 3 had serious ROB, and 16 had a moderate ROB. The mean Coleman score was 58, demonstrating fair study quality; the Methodological Index for Non-Randomized Studies score had a mean value of 13, indicating overall fair quality. Best evidence synthesis revealed moderate evidence. The visual analog scale score improved from 5.2 to 3.2 at 6 and 12 months. Knee injury and Osteoarthritis Outcome Score (KOOS) activities of daily living subscore improved from 58.8 to 70.2 at 6 months and 67.5 at 12 months. KOOS pain subscore improved from 54.3 to 70.2 at 6 months and 72.4 at 12 months. KOOS quality of life subscore improved from 33.1 to 43.6 at 6 months and 42.9 at 12 months. KOOS sports subscore improved from 23.7 to 43.6 at 6 months and 57.4 at 12 months. KOOS symptoms subscore improved from 55.3 to 70.1 at 6 months and 67.9 at 12 months. The Western Ontario and McMaster Universities Osteoarthritis Index score steadily increased from 61.8 at baseline to 78.4 at 12 months.

Conclusions

micro-fragmented aspirated tissue injection therapy for the treatment of symptomatic knee osteoarthritis is effective and improves pain and functional outcomes. Moderate study quality combined with a moderate risk of bias, moderate certainty of evidence, and moderate best synthesis evidence reduces external validity. Therefore, the results should be interpreted with a degree of caution.

Level of Evidence

Level IV, systematic review of Level I-IV studies.

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来源期刊

Arthroscopy-The Journal of Arthroscopic and Related Surgery 医学-外科

CiteScore

9.30

自引率

17.00%

发文量

555

审稿时长

58 days

期刊介绍： Nowhere is minimally invasive surgery explained better than in Arthroscopy, the leading peer-reviewed journal in the field. Every issue enables you to put into perspective the usefulness of the various emerging arthroscopic techniques. The advantages and disadvantages of these methods -- along with their applications in various situations -- are discussed in relation to their efficiency, efficacy and cost benefit. As a special incentive, paid subscribers also receive access to the journal expanded website.