What question did this study set out to answer?

The study aims to evaluate the impact of adding microfracture to an SVF-based treatment for knee osteoarthritis.

March 15, 2026Knee Surgery Sports Traumatology Arthroscopy0 citations

Adding microfracture to an SVF‐based arthroscopic pathway was associated with greater 24‐month improvements in pain, function and MRI cartilage morphology in KL II–III knee osteoarthritis: A randomized controlled trial

MYMehmet Yağız Yenigün MDMehmet Demirel SBSerkan Bayram

Key Points

The study aims to evaluate the impact of adding microfracture to an SVF-based treatment for knee osteoarthritis.
Conducted as a randomized controlled trial
Participants with KL II-III knee osteoarthritis
Intervention included SVF-based therapy with or without microfracture
Follow-up assessments at 24 months focused on pain, function, and MRI findings.
Patients receiving microfracture showed significant improvements in pain scores after 24 months
Functionality measurements improved in the microfracture group versus the control
MRI assessments indicated better cartilage morphology in the group that received microfracture.

Abstract

Abstract Purpose To determine whether adding arthroscopic microfracture provides incremental clinical and magnetic resonance imaging (MRI)‐based structural benefit within a standardized stromal vascular fraction (SVF)–based arthroscopic treatment pathway for moderate knee osteoarthritis. Methods In this prospective, single‐centre randomized controlled trial, patients with Kellgren–Lawrence grade II–III knee osteoarthritis and a contained, full‐thickness chondral lesion confirmed at arthroscopy were randomized to (1) arthroscopic debridement plus intra‐articular SVF (SVF‐only) or (2) the same debridement protocol augmented with microfracture followed by SVF (microfracture + SVF). SVF was harvested from subcutaneous abdominal adipose tissue and processed intraoperatively; the injectate volume was standardized to 5 mL. Total nucleated cell count (TNCC) was quantified for quality control. Outcomes included Visual Analogue Scale (VAS) pain, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Lysholm scores. MRI structural outcomes were assessed at baseline, 12 and 24 months using the Whole‐Organ Magnetic Resonance Imaging Score (WORMS) cartilage morphology domain by blinded musculoskeletal radiologists. Results Fifty patients completed 24‐month follow‐up. Mean TNCC in the 5‐mL injectate was 7.32 × 10 7 ± 2.47 × 10 7 cells and did not differ between groups ( p = 0.42). At 24 months, the microfracture + SVF group demonstrated greater improvement in pain and osteoarthritis‐specific function (VAS and WOMAC) than SVF‐only. MRI outcomes also favoured microfracture + SVF, with a greater improvement in WORMS cartilage morphology over time. Lysholm scores improved in both groups but did not distinguish between groups at mid‐ or long‐term follow‐up. Conclusion In patients with moderate knee osteoarthritis treated within a standardized SVF‐based arthroscopic pathway, adding microfracture was associated with superior 24‐month pain and WOMAC improvement and more favourable MRI‐based cartilage morphology compared with SVF without microfracture. Longer‐term and component‐isolating studies are needed to confirm durability and clarify the contribution of each treatment element. Level of Evidence Level I, randomized controlled trial.

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