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Autologous Fat-Derived Expanded Stem Cell Therapy as a Non-Surgical Approach for Musculoskeletal Conditions

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Hassan Mubark

Submitted: 05 February 2026 Reviewed: 13 February 2026 Published: 07 April 2026

DOI: 10.5772/intechopen.1015045

Advancements in Stem Cell Treatments IntechOpen
Advancements in Stem Cell Treatments Edited by Mani T. Valarmathi

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Advancements in Stem Cell Treatments [Working Title]

Dr. Mani T. Valarmathi

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Abstract

Autologous fat-derived expanded mesenchymal stem cell therapy (MSCs) has been recognized as a significant non-surgical regenerative therapy for a variety of musculoskeletal and autoimmune diseases. Expanded MSCs have shown strong paracrine, anti-inflammatory, angiogenic, and immunomodulatory effects that can promote repair, pain relief, and possibly alter disease progression, especially when used early in the pathological process. Clinical experience with advanced imaging has shown that resolution of bone marrow oedema and subchondral cysts in knee osteoarthritis, regeneration of tendon structure in rotator cuff and Achilles tendinosis, fracture healing, and sustained functional results with MSC implantation can now be accomplished. The use of three-dimensional (3D) scaffolds of collagen and hyaluronic acid has now been shown to provide successful healing of extensive labral tears and paralabral cysts in hip disease. The intravenous route of delivery of expanded MSCs has also demonstrated a good safety profile with encouraging immunomodulatory effects in inflammatory conditions such as rheumatoid arthritis, systemic lupus erythematosus, psoriatic arthritis, inclusion body myositis, etc. The present chapter attempts to offer a clinical-academic synthesis of biological mechanisms, laboratory expansion methods, patient selection, delivery methods, imaging, and safety, which places autologous expanded MSC therapy as a developing concept of biologics for joint and tissue preservation.

Keywords

  • expanded mesenchymal stem cells
  • MSC
  • regenerative medicine
  • osteoarthritis
  • tendon regeneration
  • labral repair
  • orthobiologics

1. Introduction

Musculoskeletal disorders have been recognized as a significant cause of chronic pain, physical disability, and healthcare utilization on a global scale, contributing to the socioeconomic burden of health care in both developing and developed countries. Osteoarthritis (OA), tendon degeneration, and injuries have been identified as the most common musculoskeletal disorders that cause disability and affect productivity on a global scale [1].

OA accounts for hundreds of millions of people worldwide. OA is characterized by cartilage loss, changes in bone, inflammation of the synovial membrane, and variations in periarticular tissues. Its impact in clinical practice is marked by pain, stiffness, loss of movement, and a significant impact on the quality of life, especially in older people. The prevalence of OA is increased by the rising rates of obesity and injuries resulting from sports and work activities [2].

The existing conventional management methods, such as pain relief, the use of non-steroidal anti-inflammatory drugs, physiotherapy, and corticosteroid injections, are more focused towards the symptomatic treatment of the disease and are not aimed towards altering its course. While these methods may provide symptomatic relief for a time, the degenerative process is neither arrested nor reversed. Moreover, these approaches may lead to cumulative adverse side effects [3].

In advanced or refractory cases, the definitive treatment is still surgery. However, there are inherent risks in the procedure, long periods of rehabilitation, and high financial costs. There are also variable success rates, especially in cases of degenerative joint disease, where tissue quality is poor. In addition, there is a high percentage of patients who are not good candidates for surgery or who do not want to change their natural joint [4].

These limitations have sparked interest in regenerative medicine interventions that can repair tissue integrity, modify the local inflammatory response, and act early in the disease process before structural damage occurs. Regenerative medicine has the ability to target the biological process of musculoskeletal degeneration and take the science of musculoskeletal medicine from the treatment of symptoms to the treatment of disease [5].

2. Biological rationale and mechanisms of action of expanded MSCs

Autologous MSCs are multipotent stromal cells that have the potential to self-renew and can differentiate into cells of mesodermal origin, such as chondrocytes, osteoblasts, myocytes, tenocytes, etc. The potential of MSCs to differentiate into different lineage cells has been useful in tissue engineering for musculoskeletal disorders. MSCs have demonstrated that they possess the ability to differentiate into various types of cells [6]. However, studies have indicated that the potential of MSCs is primarily due to the paracrine effect rather than cell replacement or engraftment. Once injected into the body, MSCs act as ‘biologically active signalling hubs’ that respond to the inflammatory environment of the body and initiate the healing process by secreting various factors [7].

The expansion of MSCs has been observed to lead to the secretion of different bioactive molecules, including cytokines, chemokines, growth factors, and membrane-bound particles like exosomes. The secreted bioactive molecules have been observed to impact inflammation, inhibit catabolic processes, and promote anabolic processes [8].

Through such paracrine mechanisms, MSCs regulate processes such as angiogenesis, apoptosis, innate and adaptive immune cell responses, and the role of resident progenitors in tissue repair and remodelling. This complex mechanism of MSCs is highly relevant in the context of degenerative conditions characterized by chronic inflammation and impaired endogenous healing processes [9].

The ability to expand the MSCs in the lab setting permits the administration of a higher dose of stem cells compared to the minimally processed stromal vascular fraction. This is because it allows better standardization and quality control. This is significant for reproducibility, which is essential for any therapeutic approach, including the one involving enhanced MSCs, which promises to be reproducible in terms of dosages and potency, thus offering potential as a therapeutic approach for musculoskeletal medicine in the future [10, 11].

3. Technique of cells expansion

MSCs are processed in a licensed biologic laboratory following written informed consent. The adipose tissue is processed by washing and enzymatic digestion with a solution containing collagenase. MSCs are isolated from the stromal vascular fraction and expanded in culture in Dulbecco’s Modified Eagle Medium (DMEM) with human platelet lysate. This process takes about 6–8 weeks. Standard two-dimensional (2D) stem cells are cryopreserved. Before the day of clinical use, the cells are thawed and filtered. The number of cells required for the process is determined both manually and by a haemocytometer. Viability of the cells is checked by a trypan blue exclusion assay before the cells are re-suspended in a physiological carrier solution. MSCs are expanded in a conventional 2D monolayer culture (Figure 1). Subsequently, when a 3D approach is used for MSC expansion, the cells are cultured in a non-adherent system in a hydrogel matrix, which is a mixture of collagen and hyaluronic acid. This allows for isotropic (360-degree) growth of the cells in a three-dimensional manner, which simulates the in vivo cellular micro-environment (Figure 2).

Figure 1.

Two-dimensional (2D) monolayer culture of mesenchymal stem cells demonstrating 60% confluence.

Figure 2.

3D cell culture and spheroid formation.

4. Clinical use of cellular therapy in musculoskeletal conditions

4.1 Cartilage healing and regeneration

The intrinsic healing potential of articular cartilage is limited due to its avascular (lack of vessels) and aneural (lack of nerves) nature, which makes the process of healing less likely to occur if degeneration has already started [12–14].

Bone marrow oedema (BMO) is recognized as a process that occurs early during OA development. BMO represents a process of subchondral bone injury and inflammation and can occur prior to cartilage loss on radiographs. BMO is strongly associated with pain, progression of cartilage degeneration, and progression of OA, thereby supporting the concept of OA as a disease of the entire joint, with early involvement of subchondral bone [15].

Studies carried out through magnetic resonance imaging have established that the persistence of bone marrow oedema is significantly associated with increased rates of cartilage loss and the progression of OA [16].

It has also been observed that intervention during an early stage of OA using orthobiologic therapies, such as autologous expanded MSC-based therapies, can modulate the subchondral inflammatory microenvironment, aid in the resolution of bone marrow oedema, and stabilize the bone-cartilage unit, thus interrupting the pathological communication between the bone and cartilage, leading to the progression of OA [17, 18].

Resolution of bone marrow oedema following treatment with MSCs (Figure 3) is a major therapeutic goal for the treatment of early OA, as the pathology of subchondral bone is now recognized as preceding and causing the progression and pain of OA [19].

Figure 3.

MRI demonstrates the resolution of bone marrow oedema and subchondral changes.

The emerging evidence, therefore, supports a paradigm shift in the approach to early orthobiologics intervention, in which the treatment of subchondral bone pathology, rather than the end-stage cartilage loss, is considered the key to disease modification in OA [20].

Osteochondral lesions are focal lesions involving the articular cartilage and subchondral bone. These lesions are usually associated with trauma, ischemia, and early degenerative joint diseases, and they represent a distinct pathological entity [21].

The subchondral bone plays a critical role in osteochondral lesions. It is known that the bone structure and lesions in the bone marrow cause pain and lead to OA [22].

Biologic treatments using MSCs include the entire osteochondral unit through paracrine effects, immune modulation, chondrogenic, and osteogenic pathways. These treatments, when combined with osteochondral and bilayer biological scaffolds, allow spatially organized tissue regeneration, thereby integrating cartilage and bone tissues [23–25].

4.2 Meniscus tear and healing

Meniscal tears affect the distribution of forces and stability of the knee joint. The low intrinsic healing potential of meniscal tears, particularly in the avascular zone, makes the patient more susceptible to cartilage deterioration and OA [26].

The conventional approach of partial meniscectomy has been consistently associated with rapid deterioration of joint degeneration and unfavourable long-term results when compared with tissue-sparing techniques [27].

Expanded MSCs have been recognized as a potential therapeutic intervention, with the possibility of improving meniscal healing through immune modulation, production of the extracellular matrix, and differentiation into fibrochondrocytes [26].

Preclinical studies have indicated that stem cell therapy, both alone and in conjunction with meniscal repair, has the potential to improve the quality of collagen synthesis, vascular response, and biomechanical properties in meniscal tissues [28].

Tissue engineering using a combination of MSCs and a biological scaffold has demonstrated its potential for improving cell retention and integration, thereby facilitating the structural healing of meniscal tissues [29].

Clinical studies have indicated that stem cell therapy has the potential to improve pain and functionality while preserving meniscal tissues [30].

4.3 Labral tear healing and joint preservation

Labral tears of the hip and shoulder change biomechanics by affecting the labral seal, resulting in abnormal transmission of loads, joint instability, and accelerated degeneration of the joint cartilage, thereby leading to degenerative joint disease. Labrum lesions are now being recognized as an early cause of hip degeneration. Tears of the acetabular labrum have been found to occur before cartilage loss, thereby highlighting the importance of labral pathology in the early degenerative hip disease process [31]. Femoroacetabular impingement has been identified as an important cause of labral pathology, with abnormal hip morphology resulting in mechanical conflict, leading to labral damage and subsequent cartilage loss [32].

Complete resolution of an extensive labral tear and associated paralabral cysts by MRI has been observed with autologous expanded MSC therapy using a three-dimensional collagen-based scaffold for labral repair, indicating the potential for tissue repair through biologic therapy for fibrocartilaginous tissues (Figure 4) [33]. Three-dimensional scaffolds made of collagen and hyaluronic acid enhance cell retention and viability, creating a biologically favourable microenvironment for tissue repair by remodelling the extracellular matrix [34, 35]. Biologic labral repair is a promising technique for joint preservation, with the potential to delay or prevent surgical interventions and the onset of OA [36].

Figure 4.

T1 coronal MRI demonstrating complete healing of the labral tear 23 weeks after treatment with 3D collagen-based expanded stem cell therapy.

4.4 Bone and fracture healing

The structural bone injury resulting from a subchondral fracture occurs in the bone area just below the joint surface. This type of fracture usually results from an acute injury, such as a fall or a blow during a sport. The most common areas for a subchondral fracture are the knee and, less often, the ankle, hip, or shoulder joints [37].

The process of healing a subchondral fracture is a complex process of regenerating bone that occurs as a result of a fracture haematoma and the concerted action of various inflammatory cells, stem cells, endothelial cells, and growth factors that work together in a coordinated manner for bone healing [38].

The conventional treatment for a subchondral fracture includes joint unloading, immobilization, pain or inflammation relief, and, in cases where there is no healing or bone collapse, surgery and bone grafting. This approach results in various complications from bone grafts and surgery [39].

The new regenerative treatments for a subchondral fracture, such as expanded autologous stem cell therapies, have been proven effective in healing a subchondral fracture without surgery. This is exemplified by a case study of a talonavicular subchondral fracture, in which a single MSC dose resulted in the structural bone restoration of the fractured area (Figure 5) [40].

Figure 5.

Sagittal T2 MRI showing healing of a talonavicular subchondral fracture 26 weeks post-expanded stem cell therapy.

4.5 Spinal cellular therapy

Lumbar disc prolapse is an important cause of chronic backache and sciatica. Though various conventional treatments like physiotherapy, analgesics, epidural injections, and surgery may provide relief, recurrence and disability persist [41].

Adipose tissue-derived mesenchymal stem cells (ADSCs) are considered an important tool for regeneration. Initial clinical trials with intradiscal stromal vascular fraction combined with platelet-rich plasma have shown promising results for degenerative disc disease (DDD) [42]. ADSCs exert their effects through paracrine action, thereby inhibiting inflammation, disc cell apoptosis, and repairing the extracellular matrix [43].

Both preclinical and clinical trials have demonstrated good results regarding pain, functional disability, disc hydration, and MRI morphology with ADSC therapy [44].

Results of recent clinical trials indicate that ADSC therapy for DDD has an excellent safety and efficacy profile. Enhanced clinical results were achieved with the use of biological carriers, such as platelet-rich plasma or hyaluronic acid, for delivering ADSC, thereby proving the tissue engineering approach for DDD [45, 46].

Recently, a case study was published which showed the symptomatic improvement and MRI findings of the complete resolution of a treatment-resistant case of lumbar disc bulge following a single epidural injection of expanded MSC therapy, proving the viability of minimally invasive regenerative medicine therapy for the treatment of disc diseases (Figure 6) [47].

Figure 6.

Axial T2 MRI shows reduced L5/S1 disc protrusion and nerve compression at 26 weeks post-epidural expanded stem cell therapy.

4.6 Tendon, muscle, ligament, and bursa healing

Tendons are well-recognized for their poor vascular supply, cellularity, and metabolic activity, and hence have minimal repair, which is more likely to be fibrotic rather than reparative [48]. Degenerative tears are not likely to heal and can even worsen with long-term conservative management for tendinopathies that have longstanding and/or dynamic loading [49].

Expanded MSC therapy has been shown to be effective for partial-thickness tears of the rotator cuff, with structural repair evident on MRI, reestablishing tendon-to-tendon continuity (Figure 7) [50, 51].

Figure 7.

Coronal T2 MRI at 14 weeks post-culture-expanded mesenchymal stem cell therapy, demonstrating supraspinatus tendon healing with resolution of subacromial bursitis.

However, more impressive results have been obtained in full-thickness rotator cuff tears, in which tendon-bone interface regeneration has been achieved, as in surgical procedures, and this has been verified by follow-up imaging studies (Figure 8) [52].

Figure 8.

Coronal T2-weighted MRI demonstrating healing of a full-thickness supraspinatus tendon tear, 8 months following expanded stem cell therapy.

Other tendons for which positive results have been obtained using MSC treatment for their corresponding tendinopathies include gluteal tendinopathy, lateral and medial epicondylitis, and Achilles tendon tears, in which pathological scar tissue has been replaced by normal tissue [53–55].

Animal models have shown that adipose-derived stem cells (ADSCs) improve ligament healing through increased collagen remodelling, improved alignment, and enhanced mechanical strength of the injured ligaments [56].

In a well-validated anterior cruciate ligament (ACL) injury model, ADSCs have shown improved structural integrity and increased load to failure compared to untreated controls. Biomaterial-supported ADSC delivery has been demonstrated to facilitate ligament regeneration through enhanced cellular integration, neovascularization, and extracellular matrix deposition [57].

Collectively, experimental and early clinical data indicate that therapeutic strategies involving ADSCs can promote the regenerative healing of injured ligaments, offering a therapeutic option to reconstructive surgery.

Bursitis, especially subacromial bursitis, is a common clinical condition that can progress to a state of resistance to conventional conservative management, including physiotherapy and corticosteroid injections. In these treatment-resistant syndromes, therapeutic strategies in the field of regenerative medicine can offer a novel therapeutic option compared to conventional surgical interventions (Figure 7) [50].

4.7 Dupuytren’s contracture and non-surgical regenerative approach

Dupuytren’s contracture is a fibroproliferative disease caused by the continuous activation of myofibroblasts and the deposition of extracellular matrix in the palmar fascia. Transcriptomic analysis has revealed that ADSCs have the ability to detect fibrotic, pro-inflammatory, and hypoxic environments and can initiate immunomodulatory and tissue remodelling pathways, as well as inhibit profibrotic activities. This anti-fibrotic action of ADSC, depending on the environment, can be a rationale for investigating ADSC as a treatment option for Dupuytren’s contracture [58].

Platelet-rich plasma is a platelet concentrate that contains a rich amount of autologous growth factors and can activate local MSCs. In addition, platelet-rich plasma can be used as a treatment option for Dupuytren’s contracture, as it can soften tissues. A clinical report on a patient undergoing treatment with platelet-rich plasma showed significant improvement in contracture two years after the injection of platelet-rich plasma. In vitro and in vivo results showed that platelet-rich plasma and ADSCs can reduce myofibroblasts and fibrosis, which can be used as a treatment option for Dupuytren’s disease [59, 60].

4.8 Intravenous expanded MSC therapy in immune-mediated disease

Apart from their effects on musculoskeletal tissues, systemic delivery of expanded MSCs using an intravenous delivery route has also been considered for immune-mediated and inflammatory disorders. MSCs have been shown to have various effects on immune cells, including suppression of pro-inflammatory cytokines such as TNF-α and IL-6, suppression of antigen-presenting cell maturation, B cell effects, and generation of immune tolerance. All these effects are mediated by MSCs and have been shown to change the immune environment from one that is inflammatory to one that is tolerogenic. The delivery of adipose-derived mesenchymal stem cells (AD-MSCs) using a systemic delivery route is considered promising because adipose tissue is rich in MSCs and can be used for repeated delivery without the risk of allo-sensitization, which is associated with allogeneic cell delivery [61].

The systemic administration of MSCs in rheumatoid arthritis patients has shown positive results in clinical trials and systematic evidence synthesis, indicating that MSC therapy is safe for use in rheumatoid arthritis patients. The positive effects of MSC therapy on rheumatoid arthritis patients include the reduction of composite disease activity, improvement in inflammation biomarkers, and enhancement in patient-reported outcomes. However, it is evident that various MSC sources, different cell administration regimens, and diverse outcome measures were utilized in multiple studies. The meta-analysis and reviews of literature on MSC therapy revealed that, although various studies on MSC therapy had heterogeneous findings, the trend of the studies indicated that further research on MSC therapy as adjunctive/rescue therapy in rheumatoid arthritis patients is needed, especially for those with refractory rheumatoid arthritis [62–64].

Moreover, systemic MSC therapy has also been investigated in other autoimmune rheumatologic disorders, such as systemic lupus erythematosus, and early-phase clinical trials have demonstrated symptomatic relief and modulation of disease activity after the IV infusion of MSC. Again, this demonstrates the overall applicability of immune modulation using MSC therapy [65].

Inclusion body myositis (IBM) is a difficult type of autoimmune degenerative myopathy with steadily progressive weakness, chronic inflammatory features, and a lack of response to conventional immunosuppressive treatment modalities. There are no disease-modifying therapies available for IBM presently, and treatment is generally considered to be symptomatic in nature. In this context of treatment resistance in IBM, MSC-based immune modulation has been considered a new paradigm for the treatment of IBM [66]. A case report on the use of a first-in-human intravenous autologous AD-MSCs treatment for IBM has been published, providing an early clinical rationale for this new type of immune modulation for this treatment-resistant type of IBM (Figure 9) [67, 68].

Figure 9.

Pre- and post-IV stem cell therapy images of the arms show restoration of muscle bulk at 9 months post-treatment.

The ongoing studies of adipose-derived regenerative cell and MSC therapies for IBM continue to assess the safety and potential efficacy of these therapies, and the interest in systemic cell therapies for immune modulation for the treatment of unmet medical needs continues to grow [69].

5. Safety of MSC therapy

The safety of autologous adipose-derived expanded mesenchymal stem cells (AD-MSCs) has been evaluated through various clinical trials involving both local and systemic administration of these cells. The data indicate that there is a positive safety profile for autologous adipose-derived expanded MSCs in short- and mid-term use, following the isolation and expansion of these cells under appropriate laboratory and regulatory conditions [61].

The local administration of autologous AD-MSCs resulted in mild and transient adverse effects, such as pain, edema, and local inflammatory reactions after the administration of these cells. Severe complications, such as infection, tissue formation, and tumour development, have not been observed, even after long-term follow-up of the subjects through imaging techniques [51]. In addition, autologous adipose-derived expanded MSCs do not have a risk of rejection due to their autologous nature.

The intravenous administration of AD-MSCs has been used to treat various immune-related and inflammatory conditions. The safety of these cells has been established through the systematic evaluation of clinical trials, and no significant adverse effects have been observed after the administration of these cells. Although these cells are sequestered in the pulmonary microvasculature after intravenous administration, this phenomenon has not been associated with significant clinical consequences in humans [70].

Even though the long-term safety of these cells has not been established, various systematic reviews and meta-analyses have not indicated increased risks of malignancy, genetic instability, or disease progression after the administration of these cells under Good Manufacturing Practice conditions [71].

6. Evidence base and future directions

Autologous AD-MSCs-based therapy has increasingly been accepted as a disease-modifying intervention in regenerative medicine and orthobiologics for early-stage disease. There is high-level clinical evidence available to support the efficacy of AD-MSC-based intra-articular intervention in knee OA, with significant improvements in pain and functional outcomes demonstrated under highly controlled conditions with minimal placebo effect [72]. These findings have been consistently shown in contemporary systematic reviews of level I randomized controlled trials, where clinical benefits have been consistently demonstrated while highlighting the need for standardisation [73].

Clinical results of AD-MSCs-based therapy have shown a close association with the intrinsic quality of the MSCs and biological factors associated with the patient’s response. Clinical translation of MSC-based therapy has demonstrated a direct association between the therapeutic response and the stemness and senescence profile of MSCs used for therapy, highlighting the significance of optimised MSC characterisation in joint-preserving strategies [74]. Improved platforms for cell expansion, delivery systems, and optimisation of the cell microenvironment have demonstrated enhanced cell viability and retention.

AD-MSC therapy has also shown clinical efficacy in the treatment of tendinopathy, with sustained symptomatic relief and MRI evidence of repair in rotator cuff tendinopathy after the intra-tendinous injection of autologous MSCs [75].

Osteochondral pathology is another area of pathology that possesses limited potential for spontaneous repair. Case reports of MSC therapy in osteochondral lesions of the ankle have shown symptomatic relief, with MRI evidence of repair, which could represent an emerging treatment strategy for these difficult lesions [25].

Similarly, fibrocartilaginous labral pathology has also demonstrated complete resolution of significant labral tears and paralabral cysts following scaffold-assisted MSC therapy, providing a joint-preserving therapeutic option to surgery [33].

Outside of the knee and shoulder, MSC therapy has also been evaluated in other joints. In the setting of hip OA, early studies and narrative reviews have demonstrated symptomatic and safety benefits of MSC therapy, and comparative studies are needed to determine the optimal therapeutic approach [76].

Furthermore, systemic delivery of MSCs has also opened up the scope of using MSCs for autoimmune and inflammatory disorders. A recent meta-analysis of randomised controlled trials has demonstrated that mesenchymal stromal cell transplantation is beneficial for a range of autoimmune and rheumatic diseases without a significant increase in serious adverse effects [77]. Simultaneously, mechanistic studies have also demonstrated the immunomodulatory effects of MSCs and their contribution to tissue homeostasis and repair, as well as the challenges that need to be overcome for clinical applicability [78].

7. Conclusions

Autologous adipose-derived expanded mesenchymal stem cell (MSC) therapy is an emerging form of biological therapy for the treatment of several musculoskeletal and immune-related diseases. However, the existing literature suggests that the therapeutic effect of expanded MSC therapy is more related to paracrine and immunomodulatory effects rather than the engraftment of the cells themselves.

The therapeutic effect of the expanded MSC therapy has been suggested to be valuable for the treatment of musculoskeletal diseases, including cartilage degeneration, subchondral bone pathology, osteochondral lesions, tendon and ligament defects, meniscal and labral pathology, and fracture healing. The therapeutic effect of the expanded MSC therapy may be more significant for diseases where the therapy is initiated in the early stages of the disease process, when there has been minimal structural damage to the affected tissues. The therapeutic effect of three-dimensional biomaterial scaffolds may be significant for the retention of the expanded MSCs in the tissues, although the literature on the comparative effect is not well developed.

The therapeutic effect of the expanded MSC therapy has been suggested to be valuable for the treatment of several systemic diseases, including the administration of stem cells for the treatment of various inflammatory and autoimmune diseases, such as immunomodulation, which is the therapeutic effect of the therapy.

Acknowledgments

We would like to sincerely thank our patients for allowing us to share their clinical history for academic and research purposes. We would also like to thank the radiologists for their expertise in the imaging process. We would like to thank the plastic surgeons for their assistance in the process of adipose tissue collection. We would like to thank the biologic laboratory for their expertise in the process. We would like to thank the nursing staff of Ormiston Specialist Center for their dedication and continued commitment to providing the best care to our patients.

This book chapter has been edited with the assistance of GPT-4 and Grammarly for polishing the language and grammar correction. All content, intellectual contributions, visual materials, and final interpretations remain the responsibility of the author, who has thoroughly assessed and approved the final version of the manuscript.

Abbreviations

ACL

Anterior cruciate ligament

 ADSC

Adipose-derived stem cell

 AD-MSC

Adipose-derived mesenchymal stem cell

 BMO

Bone marrow oedema

 DMEM

Dulbecco’s Modified Eagle Medium

 ECM

Extracellular matrix

 GMP

Good Manufacturing Practice

 IBM

Inclusion body myositis

 MSC

Mesenchymal stem cell

 MRI

Magnetic resonance imaging

 OA

Osteoarthritis

 PRP

Platelet-rich plasma

 SVF

Stromal vascular fraction

 2D culture

Two-dimensional monolayer cell expansion

 3D scaffold

Three-dimensional collagen–hyaluronic acid hydrogel matrix used for cell delivery

 DDD

degenerative disc disease

Conflict of Interest

The authors declare no conflicts of interest.

Thanks

The author would like to express his sincere and heartfelt thanks to his wife, Zahraa Jasim, for her constant support in the practice of regenerative medicine, especially stem cell therapy.

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Written By

Hassan Mubark

Submitted: 05 February 2026 Reviewed: 13 February 2026 Published: 07 April 2026

© 2026 The Author(s). Licensee IntechOpen. This content is distributed under the terms of the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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