Purpose
The biological enhancement of tissue regeneration and healing is an appealing perspective for orthopaedic surgeons. In recent years, publications describing the use of adipose tissue derivates in orthopaedics flourished, thanks to the low harvest morbidity the relative abundance of this tissue. This systematic review aims to describe the global distribution of studies investigating on the use of adipose tissue derivates in orthopaedic surgery, and to provide information on their quality as well as on the products available and on their specific features.
Methods
A systematic review of PubMed/Ovid Medline and EMBASE electronic databases was performed to analyse the use of adipose tissue derivates in patients affected by orthopaedic pathologies.
The quality of the included studies was assessed through the modified Coleman Methodology Score (mCMS) and through the Cochrane risk-of-bias tool for randomized trials for Level I and II trials.
Results
Eigthy-two studies were included (Level I: 12; Level II: 17; Level III: 11; Level IV: 42) for a total of 3594 patients treated. The majority of them was performed in South Korea (16) United States (12) and Italy (11). 70% of the studied investigated on treatment of knee disorders, predominantly osteoarthritis; 26% of all studies dealt with expanded ADSCs, 72 % with SVF or microfractured adipose tissue; 70% described injection of adipose tissue derivates into the affected joint or tendon and 24% arthroscopic procedures augmented with adipose tissue derivates applications. The average mCMS for all included studies was 51.7 ± 21.4 points, with a significantly higher score for the studies dealing with expanded ADSCs as compared to those dealing with SVF or microfractured adipose tissue (average mCMS: 63,9 ± 17,8 and 47,7 ± 21,4 respectively, p = 0,0027).
Conclusions
The most important finding of this study is that the systematic analysis of publications dealing with adipose tissue derivates in orthopaedics shows a high heterogeneity in terms of types of performed procedures as well as choice and processing of adipose tissue derivates. Although high-quality studies have been produced, a high volume of publications show low methodological quality, especially for studies dealing with SVF and microfractured adipose tissue.