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Off-the-Shelf Allograft Adipose Matrix Injections as a Treatment Method for Carpometacarpal Arthritis: A Prospective Study
Jacqueline Stoneburner
*1, Theodore M. Brown
2, Kylie Tanabe
2, David A. Kulber
2, Meghan C. McCullough
21Surgery, University of Southern California, Los Angeles, CA; 2Cedars-Sinai Medical Center, Los Angeles, CA
Introduction: Carpometacarpal (CMC) joint arthritis is the most common arthritic condition of the hand and can be disabling to patients as well as costly to our healthcare system. Autologous fat grafting to the joint has been studied as a possible regenerative surgical approach. Allograft adipose matrix (AAM) presents an off-the-shelf alternative that avoids the associated potential complications, cost and logistics associated with obtaining autograft. We present our findings utilizing direct injection of AAM into the joint for the treatment of early-stage CMC arthritis.
Methods: This prospective study recruited patients at a tertiary referral center hand clinic with radiographic diagnosis of CMC arthritis. Patients were offered traditional treatment options as alternatives and were fully informed of the investigational, off-label nature of AAM use in joint lipofilling. Under fluoroscopic guidance, 1 cc of AAM was injected into the joint. DASH score, VAS pain scale score, grip and pinch strength measures were recorded pre-injection as well as 6-weeks and 6 months post-injection. Strength measures were compared to the contralateral hand for internal control. Postoperative complications were also analyzed.
Results: Eighteen patients underwent AAM injection. The mean patient age was 65.. DASH score was reduced by an average of 7.21 (SD 8.30) at 6 weeks and 18.75 (SD 9.48) at 6 months. VAS score decreased by an average of 1.11 (SD 2.13) at 6 weeks and 1.8 (SD 2.28) at 6 months. Grip and pinch strength remained equal to preoperative measures at 6 weeks but increased by 5.7 lbs (SD 15.12) for grip strength and 2.41 lbs (SD 3.27) for pinch strength at 6 months. No procedural complications were noted. High subjective patient satisfaction was noted. No patients withdrew from the study.
Conclusion: Our trial suggests that AAM injected directly into the joint can reduce pain and increase strength measures in CMC arthritis. It may offer a safe, off-the-shelf alternative to current treatment options and avoid inherent risks associated with more invasive surgical intervention.
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