Clinical Outcomes of Adipose-Derived Cell-Based Therapies Versus Platelet-Rich Plasma in Knee Osteoarthritis: A Systematic Review.

BACKGROUND: Knee osteoarthritis (OA) is a common degenerative joint condition for which current treatments primarily provide symptom control without restoring cartilage. Biologic injectables such as platelet-rich plasma (PRP) and adipose-derived cellular preparations have gained interest as potential disease-modifying options. This review compares the current clinical evidence regarding their relative effectiveness. METHODS: Following PRISMA 2020 guidelines, PubMed, Scopus, Cochrane Library, Europe PMC, and CNKI were searched. Eligible studies were level 1-2 clinical trials directly comparing PRP with adipose-derived cell-based therapies in knee OA. Pain, function, quality of life, sports activity, and complications were assessed. Quality was evaluated using MINORS. RESULTS: Three studies (two hundred forty-one knees) were included, all high quality (MINORS 19-24). Both PRP and adipose-derived cell-based therapies significantly improved pain, function, and quality of life with no reported complications. Two studies showed no difference between PRP and microfragmented or autologous adipose tissue (MFAT/AAT) at 6-12 months. One study found culture-expanded adipose-derived stem cells (ADSCs) provided greater improvements in pain (WOMAC, VAS), stiffness, and several SF-36 domains compared with PRP at 6 months. CONCLUSION: PRP and adipose-derived cell-based therapies are safe and effective for knee OA. PRP offers a minimally invasive, cost-effective option with outcomes comparable to MFAT and AAT. ADSCs may provide superior symptom relief but involve greater complexity and cost. Larger, standardized trials with longer follow-up are needed to confirm long-term efficacy.