Abstract

Articular cartilage disorders remain a major challenge in orthopedic practice due to the limited intrinsic healing capacity of hyaline cartilage and the complex pathophysiology of joint degeneration. Among orthobiologic strategies, adipose-derived mesenchymal stromal cells (MSCs) have gained increasing interest as a readily available and abundant source of progenitor cells. Their therapeutic potential appears to rely mainly on paracrine and immunomodulatory activity, rather than direct structural tissue regeneration. Adipose tissue can be processed through enzymatic isolation of stromal vascular fraction, mechanical micro-fragmentation, or culture expansion, each approach presenting specific biological, technical, and regulatory implications.

Preclinical studies consistently support a potential disease-modifying effect in treating cartilage lesions, showing improvements in cartilage structure, inflammatory environment, and biomarker profiles in osteoarthritis models. Clinical evidence on knee osteoarthritis indicates a favorable safety profile and overall improvement in pain and function in the short to mid-term. However, the heterogeneity of available studies, including differences in processing techniques, cell composition, dosing, and outcome measures, limits the interpretation of results. In focal cartilage lesions, adipose-derived MSCs have been proposed mainly as biological adjuncts to reparative procedures, such as bone marrow stimulation, with the aim of enhancing the local reparative environment. Although early clinical results are encouraging, evidence remains limited and lacks robust long-term comparative data.

Overall, adipose-derived MSC-based therapies represent a biologically sound and clinically feasible approach in cartilage treatment. Nevertheless, their current role should be considered mainly adjunctive, and further high-quality studies are required to better define optimal indications, standardize processing methods, and clarify their long-term clinical impact.