Ryan P. Coughlin, M. D. , F. R. C. S. C. , Alexander Oldweiler, B. S

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Adipose-Derived Stem Cell Transplant Technique for Degenerative Joint Disease Ryan P. Coughlin, M.D., F.R.C.S.C., Alexander Oldweiler, B.S., Dayne T. Mickelson, M.D., Claude T. Moorman, M.D. Arthroscopy Techniques Volume 6, Issue 5, Pages e1761-e1766 (October 2017) DOI: 10.1016/j.eats.2017.06.048 Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 1 (A) Patient is positioned supine with the abdomen and flanks freely exposed. The patient is prepped and draped using an extremity drape with a cut-out section for the abdominal harvest site. (B) An arthroscopy is performed on the right knee while the tumescent solution acts to emulsify the subcutaneous fat for subsequent lipoaspiration. Arthroscopy Techniques 2017 6, e1761-e1766DOI: (10.1016/j.eats.2017.06.048) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 2 (A) Lipoaspiration is being performed using the Vaclok syringe that creates a negative suction seal. (B) Vaclok syringe showing a yellow lipoaspirate obtained from the first liposuction attempt. (C) Vaclok syringe showing a more hemorrhagic lipoaspirate from later liposuction attempts, indicating less adipose tissue yield. (D) Successive lipoaspirates are combined into a single 60-mL holding syringe using the luerlock connector. Arthroscopy Techniques 2017 6, e1761-e1766DOI: (10.1016/j.eats.2017.06.048) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 3 (A) Cylinder containing the steel spheres used for mechanical processing of the lipoaspirate. The top hose attached to the orange filter is connected to a bag of normal saline. The bottom hose attached to the gray filter is connected to a waste bag. The cylinder containing normal saline and the lipoaspirate is ready for processing. (B) After processing is complete, the blood and oily impurities have been washed away, leaving a layer of mesenchymal stem cells (MSCs) at the top and saline solution below. (C) The MSCs are being injected using a spinal into the medial compartment under arthroscopic visualization. A full-thickness cartilage defect is seen on the medial femoral condyle (MFC). The knee had been drained of all fluid before injection. (D) An abdominal binder is applied for 48 hours to help minimize swelling and ecchymosis. Arthroscopy Techniques 2017 6, e1761-e1766DOI: (10.1016/j.eats.2017.06.048) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions