Richter, Dustin L.

Purpose To evaluate the effectiveness of microfragmented adipose tissue (MFAT) for pain relief and improved joint functionality in osteoarthritis (OA) of the knee in a randomized controlled clinical trial with 1‐year follow‐up. Methods Seventy‐five patients were stratified by baseline pain level and randomized to 1 of 3 treatment groups: MFAT, corticosteroid (CS), or saline control (C) injection. Patients 18 years of age or older, diagnosed with symptomatic OA of the knee, with radiographic evidence of OA of the knee and a visual analog pain scale score of 3 of 10 or greater were included. Patients were excluded if they had any previous intra‐articular knee injection, current knee ligamentous instability, or an allergy to lidocaine/corticosteroid. The visual analog pain scale, Western Ontario and McMaster Universities Osteoarthritis Index, and the Knee Injury and Osteoarthritis Outcome score (KOOS) were recorded preprocedure and at 2 weeks, 6 weeks, 3 and 6 months, and 1‐year follow‐up. Results MFAT demonstrated consistent and statistically significant improvements across all primary outcome measures for joint pain and functionality compared with C. For MFAT, there was a significant improvement over baseline at each follow‐up, with median (95% confidence interval) KOOS Pain score changes of 18.1 (11.1‐26.4) at week 2 to 27.8 (19.4‐37.5) at 1 year. For CS, the median KOOS pain score reached a maximum of 22.2 (15.3‐30.6) at week 2, only to level off to 13.9 (–2.8 to 29.2), a level not statistically different from baseline, at 1 year. The median changes for C hovered around 6 to 11 points, with statistically significant improvements over baseline indicating a placebo effect. Similar trends were seen for the Western Ontario and McMaster Universities Osteoarthritis Index Pain score and VAS Pain score. Conclusions In this study, MFAT demonstrated a clinically significant improvement in primary outcome scores compared with the C group, whereas the CS group only showed statistically significant improvement compared with the C group at 2 and 6 weeks. This finding indicates that MFAT may be a viable alternative treatment for patients with OA of the knee who fall into the orthopaedic treatment gap. Level of Evidence Level II, partially blinded, randomized controlled clinical trial.

Update This article was updated on May 12, 2023, because of a previous error. In the Note on page 612, Byson P. Lesniak, MD, had not been listed as a member of the STaR Trial for Multiple Ligament Knee Injuries Network. The Note now reads “The STaR Trial for Multiple Ligament Knee Injuries Network includes Robert Arciero, MD; Brandee S. Black, MD; Catherine M. Coady, MD, FRSCS; Jonathan M. Cooper, DO; Katherine J. Coyner, MD; Cory M. Edgar, MD, PhD; Al M.J. Getgood, MD, FRCS(Tr&Orth); Joe M. Hart, PhD, ATC; Jonathan D. Hodax, MD, MS; Jonathan D. Hughes, MD; Cale A. Jacobs, PhD, ATC; Darren L. Johnson, MD; Ryan M. Khan, MSc, CCRP; Byson P. Lesniak, MD; Jeffrey A. Macalena, MD; Robert G. Marx, MD; Mark D. Miller, MD; Bradley Nelson, MD; Alicia Oostdyk, PhD; Charity G. Patterson, PhD, MSPH; Adam J. Popchak, PT, PhD; Anil S. Ranawat, MD; Michael J. Stuart, MD; Caroline E. Taber, AB; Ryan J. Warth, MD; Daniel B. Whelan, MD, MSc, FRCSC; and Isabel Wolfe, BS.” An erratum has been published: J Bone Joint Surg Am. 2023 Jun 21;105(12):e33. Background: Multiple ligament knee injuries (MLKIs) represent a spectrum of injury patterns that are often associated with concomitant musculoskeletal and neurovascular injuries, complex treatment, and postoperative complications. However, there has not been high-level evidence describing the presentation and treatment of MLKIs. The purpose of this multicenter retrospective study was to describe characteristics of MLKIs, their management, and related complications using a pathoanatomic MLKI classification system based on the Schenck Knee Dislocation classification system. Methods: This review identified and analyzed MLKIs that occurred between 2011 and 2015. Cases with an MLKI were included in this study if there was a complete tear of ≥2 ligaments and at least 1 ligament was repaired or reconstructed. Cases in which a ligament was deemed clinically incompetent due to a partial ligament tear and required surgical repair or reconstruction were considered equivalent to grade-III tears for inclusion and classification. Demographic information, the mechanism of injury, times from injury to presentation to an orthopaedic surgeon and to surgery, the ligament injury pattern, associated injuries, surgical procedures, and complications were captured. Data were analyzed descriptively. Results: A total of 773 individuals from 14 centers who underwent surgery for an MLKI were reviewed. The mean age of the individuals was 30.5 ± 12.7 years, and 74.2% were male. The most common mechanism involved sports (43.2%). The median time from injury to presentation to the orthopaedic surgeon was 11 days (interquartile range [IQR], 3 to 48 days), and the time to initial ligament surgery was 64 days (IQR, 23 to 190 days). While the most common injury patterns were an anterior cruciate ligament tear combined with either a medial-sided (MLK 1-AM, 20.7%) or lateral-sided (MLK 1-AL, 23.2%) injury, one-third (34.7%) were bicruciate injuries. Associated injuries most often involved menisci (55.6%), nerves (18.5%) and tendons (15.6%). The method of surgical intervention (repair versus reconstruction), external fixator use, and staging of procedures varied by MLKI classification. Loss of motion (11.4%) was the most common postoperative complication. Conclusions: A better understanding of the clinical characteristics and management of the various MLKI patterns can be used to support clinical decision-making and individualized treatment of these complex injuries, and may ultimately lead to enhanced outcomes and reduced associated risks. Level of Evidence: Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.