Predictors of Non-Response to Microfragmented Adipose Tissue Treatment in Knee Osteoarthritis Patients: A Retrospective Analysis
M. Mascarenhas, C.B.G. Leite, C.C. Kaleka, P.D.V. Silva, C. Lattermann, G. MedinaObjective:
To identify clinical, radiographic, and treatment-related factors associated with non-response and durability of response to intra-articular microfragmented adipose tissue (MFAT) in patients with knee osteoarthritis (OA).
Methods:
This retrospective cohort study included patients with knee OA treated with a standardized intra-articular MFAT protocol at a large academic healthcare system. Eligible patients had at least one pre-procedure and two post-procedure visits with ≥3 months of follow-up. Responders were classified using adapted OMERACT–OARSI criteria.
Results:
Of 1,118 screened records, 53 patients met inclusion criteria. Overall, 71.7% were classified as responders and 28.3% as non-responders. Responders had higher BMI (p = 0.019), were more likely to have received prior intra-articular HA injection (p = 0.041), and less likely to present advanced radiographic OA (KL 3–4: p = 0.031). In multivariable analysis, prior HA injection (p = 0.048) and higher MFAT volume (OR 2.83 per mL; p = 0.041) independently increased the odds of response, whereas KL grade 3–4 markedly decreased it (OR 0.04; p = 0.009). Among 38 responders, 14 (36.8%) were Type 1 and 24 (63.2%) Type 2. Type 2 responders received higher MFAT volumes than non-responders and Type 1 responders (p = 0.009), supporting a dose-response relationship.
Conclusions:
Intra-articular MFAT provided clinically meaningful improvement in most patients with knee OA. Advanced radiographic severity predicted non-response, while higher injection volume and prior HA exposure independently predicted greater likelihood and durability of benefit. These factors may help personalize MFAT indication and dosing and should be prospectively evaluated in controlled, dose-ranging trials.