A Deep Dive into the Data Supporting the Use of Mfat in MSK Disorders
One of my day jobs is the Chief Medical Officer of Regenexx, hence I must know what’s been published on every possible technology we could use to help our patients. One of those is called MFat. What’s been published and how does that compare to technologies like PRP? Let’s dig in.
What is MFat?
MFat is short for Micro-fragmented Adipose Tissue. This is created by harvesting fat tissue through liposuction, processing it by a method that chops it finely or creates small particles of fat tissue, and then reinjecting. MFat is a technology similar to Bone Marrow Concentrate with clinicians often opting to use one or the other and sometimes both.
MFat is different from bone marrow concentrate in that it has very few free stem cells available. This means that the mesenchymal stem cells in the sample are mostly still encased in their collagen matrix and very few are available to use, at least based on iv-vitro studies. In BMC those cells are freely available.
The Research on MFat
My focus here for this literature review will be on randomized controlled trials where injection is the main treatment for MSK problems. This excludes surgical studies using MFat. Finally, this only includes papers indexed in PubMed.
Baria et al tested highly concentrated leukocyte-rich platelet-rich plasma versus MFat injected intra-articular for treating knee osteoarthritis (1). While the two groups performed similarly and responded well to each therapy without a statistical difference, the MFat group contained many more severe arthritis patients, so the study was poorly executed. In addition, patients were only followed for 6 months, which is a problem as you would expect the PRP group to have shorter-term positive outcomes than MFat.
In another study, this time by Gobbi et al, one of the problems of the above study was corrected in that the severity of the knee arthritis patients was limited to only mild cases (2). However, this in itself presents a problem in that we know PRP performs well for mild OA and we would expect MFat would as well. In this research, three PRP injections with hyaluronic acid performed as well as MFat injections at two years. The biggest issue with the study is that it used very poorly concentrated “Fake PRP” in using the RegenLab system, which based on other published research isn’t able to obtain a concentration of greater than at least 2X (5).
A third study compared MFat and Platelet Lysate (the study erroneously calls this PRP) when used to treat knee OA, this time the grades of arthritis were a bit better matched than the Baria study (3). Again, both technologies performed similarly and showed efficacy. A secondary analysis showed that twice as many patients with severe arthritis in the MFat group reached the MCID at 6 months when compared to “PRP”. Since the PRP was frozen and then thawed, this is a high-concentration, leukocyte-poor, platelet-lysate, and not PRP.
A study by Peretti used intra-articular injection of MFat versus arthroscopic debridement for severe knee OA patients (4). At the preliminary analysis at 6 months, there was no difference between the groups.
My Analysis of the Research
To date, the published RCT data is mixed. All injection-based RCTs in the world of interventional orthobiologics are in the treatment of knee osteoarthritis with many comparing platelet-based therapies. Most of this research has significant issues:
- Lopsided groups when the severity of knee arthritis is compared. Meaning if you are going to compare MFat to something else, the severity of the knee arthritis needs to be closely matched.
- The minimum follow-up for any knee OA study should be two years. When one technology like PRP has shown positive short-term results and the other is suspected of having better long-term results, a study with a 6-month follow-up is not helpful.
- Using MFat in mild OA is likely overkill. Based on my clinical experience with both PRP and BMC/MFat, the later technologies seem to be more effective in severe arthritis cases. Hence, a study comparing the two in mild OA cases begins with a methodology that makes little sense.
In the end, we don’t have a perfect study that compares knee OA and PRP.
The upshot? Does MFat work? The research is still early. On the other hand, I know many practices that use it for problems like knee OA that report good results, similar to those that have been reported with BMC. I can say that all of the RCTs comparing MFat to PRP have more issues than National Geographic! Hence, more studies that fix these methodologic problems need to be performed.
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(1) Baria M, Pedroza A, Kaeding C, Durgam S, Duerr R, Flanigan D, Borchers J, Magnussen R. Platelet-Rich Plasma Versus Microfragmented Adipose Tissue for Knee Osteoarthritis: A Randomized Controlled Trial. Orthop J Sports Med. 2022 Sep 16;10(9):23259671221120678. doi: 10.1177/23259671221120678. PMID: 36147791; PMCID: PMC9486262.
(2) Gobbi A, Dallo I, D’Ambrosi R. Autologous microfragmented adipose tissue and leukocyte-poor platelet-rich plasma combined with hyaluronic acid show comparable clinical outcomes for symptomatic early knee osteoarthritis over a two-year follow-up period: a prospective randomized clinical trial. Eur J Orthop Surg Traumatol. 2023 Jul;33(5):1895-1904. doi: 10.1007/s00590-022-03356-2. Epub 2022 Aug 23. PMID: 35997833; PMCID: PMC10275803.
(3) Zaffagnini S, Andriolo L, Boffa A, Poggi A, Cenacchi A, Busacca M, Kon E, Filardo G, Di Martino A. Microfragmented Adipose Tissue Versus Platelet-Rich Plasma for the Treatment of Knee Osteoarthritis: A Prospective Randomized Controlled Trial at 2-Year Follow-up. Am J Sports Med. 2022 Sep;50(11):2881-2892. doi: 10.1177/03635465221115821. Epub 2022 Aug 19. PMID: 35984721.
(4) Peretti GM, Ulivi M, De Girolamo L, Meroni V, Lombardo MD, Mangiavini L. Evaluation of the use of autologous micro-fragmented adipose tissue in the treatment of knee osteoarthritis: preliminary results of a randomized controlled trial. J Biol Regul Homeost Agents. 2018 Nov-Dec;32(6 Suppl. 1):193-199. PMID: 30644302.
(5) Magalon J, Bausset O, Serratrice N, Giraudo L, Aboudou H, Veran J, Magalon G, Dignat-Georges F, Sabatier F. Characterization and comparison of 5 platelet-rich plasma preparations in a single-donor model. Arthroscopy. 2014 May;30(5):629-38. doi: 10.1016/j.arthro.2014.02.020. PMID: 24725317.
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