SLR - September 2022 - Deven Patel, DPM
Reference: Shimozono Y, Dankert JF, Kennedy JG. Arthroscopic Debridement and Autologous Micronized Adipose Tissue Injection in the Treatment of Advanced-Stage Posttraumatic Osteoarthritis of the Ankle. Cartilage. 2021 Dec;13(1_suppl):1337S-1343S. doi: 10.1177/1947603520946364. Epub 2020 Aug 6. PMID: 32757620; PMCID: PMC8808881.Level of Evidence: IV
Science Literature Review
Reviewed By: Deven Patel, DPM
Residency: The Jewish Hospital, Cincinnati OH
Podiatric Relevance: Osteoarthritis (OA) is one of the leading musculoskeletal disorders in the adult population. Up to 90 percent of OA in the ankle joint is posttraumatic in nature. Many nonsurgical treatment paradigms are available for the treatment of posttraumatic osteoarthritis (PTOA); however most are temporary and none have proven to prevent the progression of the disease. Orthobiologic treatments have recently been added as therapeutic modalities to combat OA. Micronized adipose tissue (MAT) injection was introduced and has been shown to be safe for treatment for knee osteoarthritis; however, there is a paucity of studies reporting the effects of MAT injection for ankle OA. The purpose of the study was to evaluate the effect of intra-articular injection of autologous MAT with arthroscopic debridement in patient with advanced stage ankle PTOA would reduce the pain and improve the quality of life for patients with PTOA.
Methods: A level IV retrospective comparative study was performed for all patients treated with intra-articular injection of autologous MAT with arthroscopic debridement for ankle PTOA between 2017 and 2019. A total of 19 patients (19 ankles) who underwent arthroscopic debridement and autologous MAT injection for ankle arthritis with Kellgren-Lawrence (KL) grade 3 to 4 were included in the analysis. Outcomes were evaluated using the Foot and Ankle Outcome Score (FAOS) scores and visual analogue scale (VAS) for pain which were evaluated pre-operatively, at 6 months and at the final follow-up visit. Patients were surveyed via email on a 5-point Likert-type scale regarding satisfaction with their ankle following procedure.
Results: This retrospective study of 19 patients indicated that the mean FAOS score of pain and quality significantly improved postoperatively but did not significantly improve for the FAOS subscale scores of symptoms and daily activities. The mean VAS scores significantly decreased at the 6 month follow up time, but trended upwards at final follow up and were not statistically significant. On a 5-point Likert-type scale only 8 patients were “very satisfied” or “satisfied” with procedure. About 1/3 of the patients were unsatisfied with the results of the outcome of the procedure.
Conclusion: This study is one of the first to evaluate the use of MAT for the management of ankle PTOA. Although patients reported a statistically significant improvement in FAOS subscales of pain and quality of life, no significant change was noted for the other subscales of daily activities and symptoms. Additionally, the procedure may be more beneficial for KL grade 3 patients than grade 4 patients. There were a number of limitations including a small cohort size and short follow-up. Thus, further studies analyzing long-term effects and prognostic factors from MAT injection for PTOA are warranted. One should consider this treatment in patients with lesser graded OA in KL score of 3 rather than 4.