The Case that proved the concept: why MFAT is unique among orthobiologics

The human body is amazing and has an immense capability to heal. Yet oftentimes our healing mechanism either gets stuck and does not reach a resolved healing response and normal tissue function, or injuries can be so severe that the tissue will not be able to heal properly on its own. Also, sometimes physicians forget about this awe inspiring innate healing ability. When patients have pain so severe or some pain for so long that they can’t function properly, that's often when they seek the care of a physician. When it comes to musculoskeletal health, persistent pain, and maintaining health through activity, orthobiologics can be a game changer. These therapies can restore a chronically injured and even torn tissue to its native strength and health. 

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I have two cases that I’d like to share, exemplifying the power of orthobiologic medicine, and which happen to have been some of my first most outstanding outcomes following my residency.

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The first case was a 52 year old male who had had lateral elbow pain off and on (mostly on) over the last 8 years. Patient had normal body habitus without comorbidities. He had tried everything under the sun, including many sessions of highly skilled physical therapy, corticosteroid injections, and all the NSAIDs (oral and topical) that he could get his hands on. By the time he had come to me he was pessimistic, and frankly nearly disabled in the sense that he was unable to do his work maintaining his vineyard. Exam significant for familiar pain elicited with resisted wrist extension, tenderness at the lateral epicondyle, and positive Maudsley’s test. Diagnostic ultrasound demonstrated significant partial tearing of the common extensor tendon. I had discussed with the patient therapies such as a corticosteroid injection, PRP, MFAT+PRP, BMAC+MFAT+PRP, versus referral for surgery. Patient elected for MFAT+PRP, which is what I had recommended. The images below show the diagnostic scan demonstrating the tearing, then post op scans showing the patent adipose graft, then the healed tendon. I’ll save the discussion about differences in the biochemical and physical (biomechanical) properties between the orthobiologics for a different blog. But let’s just say, the MFAT graft is crucial to seeing reproducible tendon healing for partial tendon tears.

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As far as outcome, the imaging is one thing, but if it doesn’t correlate with reduction in pain and increase in function, it doesn’t matter. As one might expect, as the tissues healed, the pain went away, and the patient was able to do every activity–even repetitive motions with wrist extension–without any limitation or pain. 

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The second case was a 35 year old female with right knee pain and persistent knee effusions when she ran. She was an avid runner but had to give it up. MRI demonstrated a patellar chondral defect as well as moderate grade trochlear cartilage loss and a moderate grade effusion. I spoke to the patient about referral to surgery, versus injection therapies. We discussed PRP versus MFAT+PRP versus BMAC+MFAT+PRP. I had recommended at least MFAT+PRP and patients elected for that option as the BMAC+MFAT+PRP was cost prohibitive. 

At the 6 week follow up, the patient had not noticed much improvement. At the 12 week follow up, the patient was running again without pain and without effusions. I typically follow up again at 18 and 24 weeks, yet the patient did not return. 

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Finally, 1.5 years after the knee treatment, the patient return to clinic yet for a new issue of left hip pain. As I was working that up, I asked how the right knee was doing, and she smiled and said, “its fixed”. With that claim, I decided to get a post MRI. 

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In the images on the top row, you can see slices showing both the patellar chondral defect and the trochlear cartilage chondrosis, this was the original diagnostic MRI. The images on the bottom row correlate with the images on top, yet they show filling in of the chondral defect and the trochlear chondrosis. Not only do we have imaging proof of the healing of this cartilage, but also the patient has returned to full sport and activities without any pain or limitations!

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These were two cases early in my career that provided real world evidence to the huge potential for orthobiologics. These two cases should have been surgical, in fact I did have a second opinion on both, and each time the surgeon recommended surgical intervention. Especially in the knee case, surgery would have almost assuredly resulted in advanced patellofemoral OA early in her life and possibly a knee replacement. These cases exemplify how interventional orthobiologics can restore native tissue health, resulting in normal, pain free function, without the need for surgery.