Comparative Clinical and Structural Efficacy of Platelet-Rich Plasma, Standard and Modified Stromal Vascular Fraction in the Treatment of Patellar Chondromalacia

Introduction. Patellar chondromalacia is a leading cause of chronic anterior knee pain in young and working-age individuals. Conventional conservative therapy provides primarily symptomatic relief without proven structure-modifying effects. Comparative data on PRP and SVF for this condition remain scarce. Objective. To compare clinical and morphological outcomes of PRP, standard SVF, and modified SVF in patients with patellar chondromalacia. Materials and methods. A non-randomized retrospective cohort study included 63 patients with grade I–III patellar chondromalacia (Outerbridge, 2021–2024). Group I (n=22) received three PRP injections; Group II (n=20) received a single standard SVF+PRP injection; Group III (n=21) received SVF prepared by a modified protocol (lipoaspirate washing, emulsification through a 0.6 mm mesh, double centrifugation with ACD-A). Follow-up was 12 months; outcomes were assessed by VAS, KOOS-PS, PSS, PGIC, and MRI morphometry of the chondral defect. Results. PRP reduced pain in the early period with a tendency toward partial regression by month 12 and minimal structural changes (defect area −7.5%, volume −15.1%). In both SVF groups, clinical improvement was progressive without regression (VAS median at 12 months — 1.0); defect area decreased by 27.4% and 40.2%, volume by 44.6% and 53.8% for standard and modified SVF, respectively. Mean cartilage thickness gain was 0.37 mm in the standard SVF group and 0.48 mm in the modified SVF group, compared to 0.09 mm in the PRP group (p0.001). Modified SVF produced earlier clinical response at 1 month with comparable long-term morphological outcomes. Conclusion. SVF therapy demonstrated significantly greater and more durable structure-modifying effects than PRP. PRP is appropriate for symptomatic management in early-stage disease; SVF is indicated when structural correction of the chondral defect is required.