A single intra‐articular stromal vascular fraction with platelet‐rich plasma injection yields superior clinical outcomes than a hyaluronic acid injection in patients with knee osteoarthritis: A prospective comparative study

Abstract Purpose The present study aimed to compare the efficacy and safety of a combined injection of stromal vascular fraction (SVF) and platelet rich plasma (PRP) versus a high molecular weight (HMW) hyaluronic acid (HA) injection in patients with knee osteoarthritis (KOA). Methods A prospective comparative analysis was conducted for patients with KOA who underwent either a single intra‐articular mechanical SVF combined with PRP injection (Group A) or a single intra‐articular injection of HMW HA (Group B). The Knee Injury and Osteoarthritis Outcome Score (KOOS), the visual analogue scale (VAS) and the EuroQol EQ‐5D (EQ‐5D‐5L) were assessed at baseline, 3, 6 and 12 months postinjection. PRP was coded according to the DEPA classification. Results The study included 108 knees from 67 patients (Group A: 31; Group B: 36). The VAS, KOOS total and EQ‐5D‐5L scores significantly improved within each group in every timepoint compared to baseline. The SVF‐PRP group significantly outperformed the HMW‐HA group in VAS, KOOS total and EQ‐5D‐5L scores at 6 months and 12 months follow‐up. The proportion of patients who achieved Minimal Clinically Important Difference (MCID) at 12 months was 87.0% versus 57.4% ( p = 0.0003) in KOOS, 74.1% versus 61.1% in VAS ( p = 0.152) and 64.8% versus 40.7% ( p = 0.005) in EQ‐5D‐5L, for the SVF‐PRP vs HA group, respectively. No serious adverse events were reported in either group. Minor local adverse events were more common in the SVF‐PRP group and spontaneously resolved within days. The implemented PRP was coded as CCA. Conclusion Both SVF‐PRP and HA injections are safe treatments, with no serious adverse events, and significantly improve pain, function and quality of life in patients with KOA. The SVF‐PRP outperformed the HA group in all three PROMs at 6 months and 12 months follow‐up, and in the proportion of patients who achieved MCID at 12 months postinjection. Level of Evidence Level II.