New at Aeon · In affiliation with RMIC
Regenerative Matrix Therapy™
A non-surgical, single-visit procedure that uses a small sample of your own fat tissue to treat moderate-to-severe joint arthritis. For people who've been told it's surgery or nothing, who haven't responded to PRP, or who want to stay active without a replacement.
Why we're excited
One of a small number of RMIC-affiliated clinics in Canada.
Regenerative medicine has had a frustrating gap: PRP works well for mild and moderate arthritis, but once a joint is bone-on-bone the options narrow to injections that wear off or a replacement. Regenerative Matrix Therapy™ is built for exactly that gap, and Aeon Health is among the first clinics in the country to offer it under the RMIC protocol.
Moderate-to-severe, "bone-on-bone" osteoarthritis, the knees most other injections struggle with. In the only randomized head-to-head with PRP, advanced knees were about twice as likely to improve meaningfully.
Used to delay or, for some patients, avoid surgery. It doesn't burn any bridges: a replacement remains an option afterwards.
Fat tissue carries a broader mix of cells and structural matrix than blood-derived PRP, which is why it's the next step when PRP, hyaluronic acid or cortisone have stopped helping.
What it is
Your own tissue, concentrated and placed where it's needed.
Fat (adipose) tissue is far more than padding. It contains adipose-derived mesenchymal stem cells, blood-vessel cells, fibroblasts and immune cells, held in a supportive structural matrix. RMIC's Precision Adipose Modulation™ protocol collects a small sample, purifies and concentrates those components without enzymes or culturing, and places them into the damaged joint. In the research literature this class of treatment is called micro-fragmented adipose tissue, or MFAT.
Candidacy consultation
History, examination and review of your X-rays or MRI. Dr. Chawla confirms you're a good candidate, explains realistic expectations for your grade of arthritis, and gives you the full cost.
Procedure day
One clinic visit, under local anaesthetic. A small fat sample is collected from the abdomen or flank, processed on site, and placed into the joint under ultrasound guidance. No operating room, no general anaesthetic. You walk out the same day.
Recovery plan
Expect mild soreness or swelling at the harvest and injection sites for a few days. Most people return to daily activities within days; high-impact exercise waits about two weeks. You leave with a personalised plan.
Results
Some patients notice improvement within a few weeks. The full effect builds over three to six months as the tissue settles and inflammation subsides, and benefits may last more than a year. Outcomes are tracked at follow-up.
Who it's for
Candidacy is assessed one person at a time.
A good fit if you have
- Moderate-to-severe knee, hip or shoulder osteoarthritis (KL 3–4)
- Pain that has stopped responding to PRP, hyaluronic acid or cortisone
- A recommendation for joint replacement you'd like to delay or avoid
- Chronic tendon or ligament injury: rotator cuff, Achilles, patellar, tennis elbow
- SI joint or low-back pain, plantar fasciitis, post-traumatic joint pain
- An active life you want to keep, without implants or long-term medication
Honest limits
- It will not regrow a joint. Areas of full-thickness cartilage loss did not improve on MRI in the studies.
- Results vary, and the most severe or badly mal-aligned (bow-legged) knees respond less predictably.
- Long-term superiority over PRP has not yet been proven in large trials; the advantage appears in advanced knees in the first 6–12 months.
- It is private-pay and not covered by MSP.
Where it fits
A stepped approach to an arthritic joint.
There is no single answer for osteoarthritis. The right option depends on how advanced the joint is on imaging, what you've already tried, and what you want to get back to. This is the framework we use; your plan is set at your consultation.
| Mild OAKL 1–2 | Moderate OAKL 2–3 | Severe OAKL 3–4 · bone-on-bone | |
|---|---|---|---|
| First lineFor everyone | Conservative therapy. Physiotherapy and a progressive strengthening program, massage, activity modification, weight management, bracing or footwear changes, and simple analgesics. This is the foundation at every grade, and it continues alongside anything below. | ||
| Second line | Injection therapy. PRP or hyaluronic acid; steroid in selected cases.* Regenerative Matrix Therapy™ if the joint is progressing. | Injection therapy. PRP, hyaluronic acid or Regenerative Matrix Therapy™; steroid in selected cases.* | Regenerative Matrix Therapy™ vs joint replacement. A non-surgical option built for this grade, weighed against surgery, with an honest conversation about both. |
| Third line | Reassess. Repeat course if it helped; Regenerative Matrix Therapy™ if the joint has advanced. | Regenerative Matrix Therapy™ if PRP has stopped helping; surgical opinion if the joint is progressing. | PRP. As an adjunct, or where Regenerative Matrix Therapy™ and surgery aren't chosen. Expect a smaller, shorter response at this grade. |
* A note on steroid injections. Cortisone has a place, but it's used carefully, for the right patient and the right condition: people seeking short-term relief rather than a long-term result, or bridging comfortably toward a planned surgery. Repeated steroid injections can accelerate cartilage loss, so we don't use them as a maintenance strategy.
Our affiliation
Regenerative Medicine Institute of Canada
RMIC is a national network of physicians delivering science-driven, minimally invasive treatments for pain and joint degeneration. It developed Regenerative Matrix Therapy™ and the Precision Adipose Modulation™ protocol behind it, and holds affiliated physicians to a consistent, personalised, physician-led standard.
Its Chief Medical Officer, Dr. Adrian Le, MD, CCFP(SEM), leads development of the treatment protocols and is President and Chair of the Canadian Board of Orthobiologics and Regenerative Medicine (CBORM), the not-for-profit standards body that accredits physicians performing these procedures.
What affiliation means for you
- The same protocol, candidacy screening and consent process as every RMIC clinic
- Performed by a physician trained in the RMIC protocol, not a technician
- Outcome tracking at follow-up, so your result is measured, not assumed
- A protocol reviewed by Health Canada with no objection
What Aeon adds
- Ultrasound-guided placement by a family physician with sports-medicine and regenerative training
- PRP, prolotherapy and IV iron under one roof, so the plan isn't limited to one tool
- A complimentary first consultation and the full price before anything is booked
The research
What the published studies actually show.
A study-by-study guide to the research on micro-fragmented adipose tissue (MFAT) for knee osteoarthritis, with a focus on moderate-to-advanced disease. Every entry links to its PubMed record so you can read the source yourself. Where a study has weaknesses, we say so.
KL grade
How advanced the arthritis looks on X-ray, from 1 (mild) to 4 (severe, "bone-on-bone").
RCT
Randomized controlled trial. Patients are assigned to treatments by chance and compared. The strongest type of evidence.
MCID
Minimal clinically important difference. The smallest change patients actually notice and care about.
At a glance
| Study | Type | Knees / grade | Compared with | Key result | PMID |
|---|---|---|---|---|---|
| Panchal et al., 2018 | Case series | 26 knees, all KL 3–4 | — | Pain −24%, function +17% at 1 yr | 30517209 |
| Borić / Hudetz et al., 2019 | Open-label trial | 32 knees, KL 3–4 | — | Pain at rest −88% at 2 yrs; MRI cartilage signal improved in many areas | 31861180 |
| Heidari et al., 2020 | Observational | 110 knees, ~80% KL 3–4 | — | Pain 70 → 30 at 1 yr; 81% responders | 32831853 |
| Borg et al., 2021 | Observational | 418 knees, mostly KL 3–4 | — | 90% of women and 60% of men responded at 2 yrs | 33727933 |
| Zaffagnini et al., 2022 | RCT | 118 patients, mixed grades | PRP | Equal overall; in KL 3–4, 75% vs 35% meaningful improvement at 6 mo | 35984721 |
| Pintore et al., 2023 | Comparative, non-randomized | 102 patients, KL 2–4 | Bone marrow concentrate | Similar results; faster early pain relief with fat | 37170296 |
| Wu et al., 2023 | RCT, multicentre | 302 patients, KL 2–3 | Hyaluronic acid | MFAT better at 2 yrs (WOMAC −53% vs −32%) | 38179213 |
| Russo et al., 2023 | Case series | 67 knees, mostly KL 1–2 | — | 80% meaningful improvement at 3 yrs | 37968496 |
Study by study
1 Panchal et al., 2018 — Severe knees, candidates for replacement
Panchal J, Malanga G, Sheinkop M. Safety and efficacy of percutaneous injection of Lipogems micro-fractured adipose tissue for osteoarthritic knees. Am J Orthop. 2018;47(11). PubMed 30517209 · DOI
In plain words. Doctors treated 26 badly arthritic knees — most of them bone-on-bone, in people already considered candidates for knee replacement — with a single MFAT injection. Over the next year, pain and knee function improved and nobody had a serious side effect.
- 17 patients (26 knees); 19 knees KL 4, 7 knees KL 3; mean age 68.
- Single ultrasound-guided injection; follow-up at 6 weeks, 6 and 12 months.
- At 12 months: pain (NPRS) 5.7 → 4.4 (−24%); Knee Society Score 74 → 82; function 65 → 76; activity (LEAS) +31%.
- Only minor pain and swelling, resolving in 48–72 hours.
Limitations. Small, single centre, no control group. One author consults for the device maker.
Why it matters for grade 3/4. Shows the treatment is safe and can help even in the most advanced knees.
2 Borić / Hudetz et al., 2019 — Pain relief and cartilage signal on MRI
Borić I, Hudetz D, Rod E, et al. A 24-month follow-up study of the effect of intra-articular injection of autologous microfragmented fat tissue on proteoglycan synthesis in patients with knee osteoarthritis. Genes. 2019;10:1051. PubMed 31861180 · DOI
In plain words. Patients with moderate-to-severe knee arthritis had one MFAT injection and special MRI scans that measure the health of cartilage. Two years later, pain had dropped dramatically, and in many parts of the knee the MRI suggested healthier cartilage.
- KL 3–4; 32 knees at 12 months, 18 knees at 24 months.
- Pain at rest 4.5 → 0.6 (−88%); pain with activity 7.7 → 3.4 (−56%).
- dGEMRIC MRI (a measure of cartilage proteoglycan): about two-thirds of the knee areas that changed improved, with average gains of +32%.
- No improvement in areas of full-thickness cartilage loss; the inner (medial) side tended to worsen in bow-legged (varus) knees.
Limitations. Small, no control group, many patients lost by 24 months. MRI is a surrogate marker, not proof of regrown cartilage.
Why it matters for grade 3/4. The only study here suggesting a possible structural effect, not just symptom relief.
3 Heidari et al., 2020 — Real-world results, mostly grade 4
Heidari N, Noorani A, Slevin M, et al. Patient-centered outcomes of microfragmented adipose tissue treatments of knee osteoarthritis: an observational, intention-to-treat study at twelve months. Stem Cells Int. 2020;2020:8881405. PubMed 32831853 · DOI
In plain words. A London clinic tracked 110 knees treated with MFAT, most with severe arthritis. After one year, average pain was cut by more than half, and about 8 in 10 people said they had less pain and better function.
- 110 knees; 62% KL 4, 18% KL 3; ages 42–94; ~8 mL single injection.
- At 12 months: pain (VAS) 70 → 30; Oxford Knee Score 25 → 33.5; quality of life improved (all p < 0.001).
- 81% responders. Grade 4 knees also improved (pain −32.5 points).
- No adverse events reported.
Limitations. No control group, about 12% missing data, single private clinic.
Why it matters for grade 3/4. Most patients had grade 4 arthritis and still improved.
4 Borg et al., 2021 — The largest study, 418 knees
Borg TM, Heidari N, Noorani A, et al. Gender-specific response in pain and function to biologic treatment of knee osteoarthritis. Stem Cells Int. 2021;2021:6648437. PubMed 33727933 · DOI
In plain words. The same London group followed 418 knees, mostly with advanced arthritis, for two years after MFAT. Most patients improved, and women responded especially well — about 9 in 10 women had less pain.
- 418 knees; median KL 3, with grade 4 the largest group.
- At 2 years, women: pain 49 → 28, Oxford score 27 → 36; responders 90% (pain) / 87% (function).
- At 2 years, men: pain 41 → 31, Oxford score 32 → 38; responders 60% / 65%.
- One serious adverse event (a knee washout) in 418 knees.
Limitations. No control group; single private clinic; the reasons for the sex difference are not proven.
Why it matters for grade 3/4. The biggest dataset in advanced knees, with results lasting two years.
5 Zaffagnini et al., 2022 — MFAT vs PRP (randomized trial)
Zaffagnini S, Andriolo L, Boffa A, et al. Microfragmented adipose tissue versus platelet-rich plasma for the treatment of knee osteoarthritis: a prospective randomized controlled trial at 2-year follow-up. Am J Sports Med. 2022;50(11):2881–2892. PubMed 35984721 · DOI
In plain words. 118 people with knee arthritis were randomly given either MFAT or PRP. Both groups improved and stayed improved for two years. Overall, the two treatments did about equally well. But in people with more advanced arthritis, MFAT gave a much stronger response in the first six months: 75% had a meaningful improvement, compared with about 35% with PRP.
- 118 patients randomized (59 MFAT, 59 PRP); follow-up 3, 6, 12 and 24 months.
- Whole group: both improved; no significant difference in the main outcomes, failures or side effects. No worsening on X-ray or MRI.
- KL 3–4 subgroup at 6 months: meaningful improvement 75.0% vs 34.6% (p = .005); IKDC +15.7 vs +8.6 (p = .041).
- KL 1–2: no difference between treatments. At 12 months the subgroup gap had narrowed (52% vs 46%, not significant).
Limitations. The severity subgroup was exploratory and small; no placebo group.
Why it matters for grade 3/4. The only randomized head-to-head with PRP, and the advantage for MFAT appeared specifically in advanced knees.
6 Pintore et al., 2023 — Fat vs bone marrow
Pintore A, Notarfrancesco D, Zara A, et al. Intra-articular injection of bone marrow aspirate concentrate (BMAC) or adipose-derived stem cells (ADSCs) for knee osteoarthritis: a prospective comparative clinical trial. J Orthop Surg Res. 2023;18:350. PubMed 37170296 · DOI
In plain words. 102 people with knee arthritis received either processed fat or bone marrow concentrate. Both worked about equally well at six months, roughly halving pain, and the fat group got relief faster in the first month. People with milder arthritis improved the most.
- 102 patients (51 per group); KL 2 ~50%, KL 3 ~37%, KL 4 ~14%.
- At 6 months overall: pain (VAS) 6.1 → 2.8; Oxford score 20.5 → 35.5.
- At 1 month: pain fell ~70% with fat vs ~49% with bone marrow.
- Pain reduction at 6 months: ~62% in KL 2, 48% in KL 3, 45% in KL 4. No complications.
Limitations. Not randomized; only 6 months; no placebo group.
Why it matters for grade 3/4. Fat performs as well as bone marrow with an easier harvest, and grade 3–4 knees still improved by nearly half.
7 Wu et al., 2023 — MFAT vs hyaluronic acid (randomized trial)
Wu CZ, Shi ZY, Wu Z, et al. Mid-term outcomes of microfragmented adipose tissue plus arthroscopic surgery for knee osteoarthritis: a randomized, active-control, multicenter clinical trial. World J Stem Cells. 2023;15(12):1063–1076. PubMed 38179213 · DOI
In plain words. In a large trial across 10 hospitals, 302 people having knee arthroscopy were randomly given either MFAT or hyaluronic acid (“gel”) injections. Two years later, the MFAT group had clearly less pain and better function, and their MRIs improved while the gel group's did not.
- 302 patients (151 per group); KL 2–3 only.
- At 24 months: WOMAC improved ~53% vs ~32% (p < .001); pain ~59% vs ~48% (p = .006); Lequesne index ~33% vs ~20%.
- MRI (WORMS) improved in the MFAT group only.
- No serious adverse events in either group.
Limitations. All patients also had arthroscopy, so the injection effect isn't isolated; no grade 4 knees; compared with HA, not PRP.
Why it matters for grade 3/4. Strong randomized evidence that MFAT outperforms a standard injection over two years, including many grade 3 knees.
8 Russo et al., 2023 — Three-year durability
Russo A, Cortina G, Condello V, et al. Autologous micro-fragmented adipose tissue injection provides significant and prolonged clinical improvement in patients with knee osteoarthritis: a case-series study. J Exp Orthop. 2023;10:116. PubMed 37968496 · DOI
In plain words. An Italian hospital followed patients for up to five years after a single MFAT injection. Improvements in pain and function held for three years, and none of the patients needed a knee replacement during the study.
- 49 patients (67 knees); KL 1 31%, KL 2 61%, KL 3 8%.
- WOMAC pain 10.7 → 4.4 at 36 months; KOOS 38 → 71.
- 80% met the meaningful-improvement threshold for function at 3 years.
- Minor swelling in 10% of knees; no serious events.
Limitations. Retrospective; no control group; only 25 knees followed to 3 years; mostly mild arthritis.
Why it matters for grade 3/4. Shows results can last several years — mainly in milder knees, so less relevant to grade 3/4.
Bottom line
Why this is a reasonable recommendation for grade 3/4 knees
- Consistent improvement in advanced knees. Four studies of mostly grade 3–4 knees (Panchal, Borić, Heidari, Borg; nearly 600 knees) all report meaningful gains in pain and function lasting one to two years.
- A signal over PRP where it matters most. In the only randomized MFAT-vs-PRP trial, patients with advanced arthritis were about twice as likely to have a meaningful early improvement with MFAT.
- Beats a standard injection in a large RCT. MFAT outperformed hyaluronic acid over two years in 302 patients.
- Possible structural benefit. MRI studies suggest improved cartilage signal and less joint damage in some patients, something growth-factor-only injections haven't shown as clearly.
- Safe. Across all studies, serious complications were very rare, and it doesn't rule out a later knee replacement.
What it can't promise: it won't regrow a knee, results vary (especially in the most severe knees), and long-term superiority over PRP has not yet been proven in large trials.
Common questions
Before your consultation.
Is this stem cell therapy?
No. Fat tissue does contain adipose-derived stem cells, but the tissue is not enzymatically processed or cultured, and we don't market it as stem cell therapy. It is a minimally manipulated preparation of your own tissue, placed back into your own joint. In the research it is called micro-fragmented adipose tissue (MFAT).
How is it different from PRP?
PRP concentrates growth factors from your blood. Regenerative Matrix Therapy™ uses fat tissue, which carries a wider mix of cells plus a structural matrix that stays in the joint. PRP remains excellent for mild and moderate arthritis and tendons, and the two are sometimes combined. The evidence for fat is strongest where PRP is weakest: advanced, bone-on-bone joints.
Does it hurt, and what is recovery like?
The harvest and injection are done under local anaesthetic in the clinic. Expect soreness and some bruising at the harvest site and swelling in the joint for a few days. Most people walk out the same day and are back to daily activities within days. Avoid high-impact exercise for about two weeks; you'll leave with a personalised plan.
How soon will I notice a difference, and how long does it last?
Some patients notice less pain within a few weeks. The full effect typically builds over three to six months. In the studies, benefits in advanced knees lasted one to two years, and up to three years in milder knees. Responses vary from person to person.
Is surgery still an option afterward?
Yes. The treatment doesn't change your anatomy or rule out a future replacement. For many patients the goal is to delay surgery; for some it may mean avoiding it.
Is it covered by MSP or extended health?
No. It is a private-pay procedure. We provide an itemised receipt; some extended health plans reimburse part of physician-performed procedures, so it's worth checking your plan.
How much does it cost?
Pricing depends on the joint and whether PRP is combined with it, and is confirmed at your candidacy consultation. There is no charge for that consultation and no obligation. A $200 deposit, credited to your treatment, secures a procedure date.
Is it approved by Health Canada?
RMIC's protocol has been reviewed by Health Canada with no objection. That is a regulatory correspondence outcome and does not constitute approval, endorsement or certification; Health Canada does not approve medical procedures or treatment protocols. The procedure is performed by physicians accredited through CBORM in accredited outpatient clinics.
Regenerative Matrix Therapy™ and Precision Adipose Modulation™ are trademarks of the Regenerative Medicine Institute of Canada. The protocol has been reviewed by Health Canada with no objection; this does not constitute approval or endorsement. All medical procedures carry some risk. Candidacy is assessed individually and results vary. Research summaries are provided for education and link to their PubMed records; they are not a guarantee of outcome.
Find out if you're a candidate
Book a complimentary candidacy consultation.
Bring your X-ray or MRI report if you have one. You'll leave with an honest answer, realistic expectations for your grade of arthritis, and the full cost.