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World J Meta-Anal. Feb 28, 2021; 9(1): 29-39
Published online Feb 28, 2021. doi: 10.13105/wjma.v9.i1.29
Biofat grafts as an orthobiologic tool in osteoarthritis: An update and classification proposal
Rafael da Rocha Macedo, Lucas Furtado da Fonseca, José Fábio Santos Duarte Lana, Tomas Mosaner, Joseph Purita, MAP de Andrade, Luciano Miller Rodrigues, Patricio Centurion
Rafael da Rocha Macedo, Department of Orthopedics, Rede D’Or unidade IFOR Hospital, São Bernardo do Campo 09715-021, São Paulo, Brazil
Lucas Furtado da Fonseca, Department of Orthopedics, Escola Paulista de Medicina da Universidade Federal de São Paulo, São Paulo 04024-002, Brazil
José Fábio Santos Duarte Lana, Tomas Mosaner, Department of Orthopedics, The Bone and Cartilage Institute, Indaiatuba 13334-170, São Paulo, Brazil
Joseph Purita, Department of Orthopedics, Institute of Regenerative Medicine, Boca Raton, FL 33432, United States
MAP de Andrade, Department of Orthopedics, Federal University of Minas Gerais, Belo Horizonte 30130-100, Minas Gerais, Brazil
Luciano Miller Rodrigues, Orthopedic Department, Faculdade de Medicina do ABC, Santo André 09060-870, São Paulo, Brazil
Patricio Centurion, Aesthetic and Reconstructive Plastic Surgery, Ricardo Palma University, Lima 15023, Peru
Author contributions: Purita J wrote the manuscript; Lana JFSD proposed the research subtopics; Fonseca LFD was responsible for navigating the literature and sharing the relevant studies that were included in this review; de Andrade M and Rodrigues LM shared significant knowledge regarding the use of orthobiologics in regenerative medicine; Mosaner T formatted the citations and compiled the references; Centurion P and Purita J revised and formatted the body of the manuscript, verifying spelling, punctuation and grammatical errors; Macedo RDR created Table 1 and was also responsible for reviewing and approving all the modifications made to the manuscript, from draft to final version.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Rafael da Rocha Macedo, MD, Surgeon, Department of Orthopedics, Rede D’Or unidade IFOR Hospital, 596 Américo Brasiliense Street, São Bernardo do Campo 09715-021, São Paulo, Brazil. rrochamacedo@yahoo.com.br
Received: October 14, 2020
Peer-review started: October 14, 2020
First decision: December 24, 2020
Revised: January 11, 2021
Accepted: February 28, 2021
Article in press: February 28, 2021
Published online: February 28, 2021
Processing time: 138 Days and 16.6 Hours
Abstract

Among degenerative musculoskeletal disorders, osteoarthritis remains one of the main causes of pain and disability in the adult population. Current available alternatives to alleviate symptoms include conservative treatments such as physical therapy, anti-inflammatory drugs and an educational approach to lifestyle modification. The use of certain analgesics, such as opiates and corticosteroids offer short-term results but does not address the etiological source of pain and disability. In addition, prolonged use of such medications can cause additional complications. Therefore, the demand for regeneration of joint cartilage has led to an alternative approach called "orthobiologics". This alternative is based on cellular and molecular components capable of inducing and promoting tissue repair. Products derived from adipose tissue have been studied as an excellent source of orthobiologics in an attempt to promote joint cartilage repair. However, the lack of standardization regarding collection and processing protocols presents a challenge for the generalization of study results and determination of effectiveness. To the best of our knowledge, orthobiologics derived from fat have not yet been classified. Therefore, this manuscript proposes the HGS classification system which aims to describe certain parameters that are relevant to the quality of organic products regarding harvesting techniques (H), graft type (G), and number of centrifugations (S). The more parameters used would imply greater characterization and complexity of the evaluation of the biological product used. The HGS classification may provide a valuable contribution to the understanding of clinical procedures and research results, aiming to ultimately usher in a standardization of optimal practice.

Keywords: Orthobiologics; Adipose tissue; Mesenchymal stem cells; Regenerative medicine; Musculoskeletal disorders; Orthopedics

Core Tip: Chronic musculoskeletal disorders remain one of the top causes of pain and disability in the adult population. The demand for musculoskeletal tissue regeneration has led to an alternative approach referred to as orthobiologics, which is based on cellular and molecular components capable of inducing and enhancing regenerative cascades in injured tissues. Adipose tissue-derived biological components are current orthobiologic tools being extensively studied and evaluated by regenerative medicine experts for their potential to treat musculoskeletal conditions. Since adipose tissue-derived orthobiologics have not yet been classified, to the best of our knowledge, this manuscript aims to propose the HGS classification system.