The short answer
Microfragmented adipose therapy (MFat) takes a small sample of your own fat, washes it with saline in a closed system, and injects the microfragmented tissue into an affected joint. Dr. Gruner uses the FDA-cleared Lipogems system to do this. Completed in under an hour, it is designed for patients in the “treatment gap” — those for whom conservative care has stopped working but who are not ready for major surgery.
Medically reviewed by Marc Gruner, DO, MBA, RMSK
Sports medicine physician, Mayo Clinic fellowship. Last reviewed June 2026
Orthobiologic Lipogems for Knee Arthritis — Dr. Marc Gruner
How it works
Microfragmented adipose tissue — often shortened to MFat — is your own fat, harvested from the belly or flanks under local anesthesia and gently processed rather than chemically altered. Dr. Gruner performs this using Lipogems, an FDA-cleared closed system that uses only saline to wash away blood, oil, and debris while preserving the supportive structure of your own tissue, which is then injected into the affected joint.
Many patients arrive in what is often called the “treatment gap”: conservative options such as physical therapy, corticosteroids, and viscosupplementation are no longer giving relief, but they are not ready for major, invasive surgery. Patients can spend years in that gap. Microfragmented adipose therapy is one of the options built for exactly this situation — an in-office procedure, usually under an hour, using your own tissue, with minimal downtime.
Because it uses your own tissue there is minimal risk of rejection, and multiple areas can be treated in a single session. Dr. Gruner will be candid about whether your joint is a reasonable candidate — advanced, bone-on-bone arthritis is generally better served by other options.
Why patients choose it
- FDA-cleared for orthopedic use
- Uses your own tissue — minimal risk of rejection or infection
- Minimally invasive, in-office, typically under one hour
- Only saline is used to wash away blood, oil, and debris
- Multiple treatment sites may be treated in a single session
- Minimal downtime and minimal pain medication afterward
Watch: Microfragmented Adipose
Adipose & Bone Marrow Orthobiologic Treatments — Dr. Marc Gruner
Sports Medicine Physician — Dr. Marc Gruner
How to prepare for your procedure
Following these steps gives your treatment the best chance to work. If anything here conflicts with another physician’s instructions, call the office before changing anything.
- 1.
Stop anti-inflammatories 2 weeks before — and 4 weeks after
Stop NSAIDs such as ibuprofen, naproxen, and similar anti-inflammatories two weeks before your procedure and for four weeks afterward. Orthobiologics work by triggering your body's own healing response, and anti-inflammatories blunt exactly that process. Do not stop prescribed aspirin, blood thinners, or any other prescription medication without checking with Dr. Gruner or the prescribing physician first.
- 2.
Have physical therapy scheduled
Make sure physical therapy is lined up before your procedure — rehabilitation is what converts the biology into lasting function. If you have Medicare, we'll get you set up on a remote monitoring platform so your progress is tracked between visits.
- 3.
Complete your outcome measures beforehand
You'll receive short outcome-measure surveys by email before your visit. Please complete them ahead of time — they establish your baseline so we can objectively measure how much you improve.
- 4.
Arrive 1 hour before your procedure
Plan to arrive a full hour ahead. That gives us time to check you in, complete the preparation, draw and process your sample, and get you positioned without anything feeling rushed.
- 5.
Bring athletic attire
Bring workout clothes. You'll spend a short time exercising on a bike before your blood draw — this mobilizes your platelets so we can collect the highest concentration possible for your treatment.
What to expect at your visit
- 1.
A focused conversation
Dr. Gruner reviews your history, prior imaging, and goals — what you want to get back to doing.
- 2.
Point-of-care ultrasound
When useful, a diagnostic musculoskeletal ultrasound evaluates the injury in real time, with no radiation.
- 3.
A clear, individualized plan
You leave understanding the diagnosis, the non-surgical options, and the expected timeline — in plain language.
Before and after your procedure
- How do I prepare for a Lipogems (microfragmented fat) procedure?
- Hold NSAIDs and, when advised, blood thinners beforehand, hydrate, and arrange a ride home since a small area of fat is harvested under local anesthesia. Wear comfortable clothing. Dr. Gruner reviews specific pre-procedure steps with you.
- What is recovery like after Lipogems?
- The procedure takes under an hour with minimal downtime. Expect mild soreness at both the harvest site (belly/flank) and the treated joint for a few days. Avoid anti-inflammatory medications for several weeks, modify activity briefly, and follow Dr. Gruner's graded return-to-activity plan.
Rehabilitation protocols
What to expect week by week after your procedure. Your plan is individualized; follow these alongside your physical therapist.
Shoulder — Ultrasound-Guided Lipogems / PRP Protocol
Week 1
Protect, reduce pain and swelling
- Sling for 7 days; begin weaning after day 3
- No lifting > 5 lbs; avoid overhead activity 2 weeks
- Don't sleep on the procedure side
- Begin gentle active ROM (pendulums) 4×/day
Week 2
Begin active range of motion
- No lifting > 10 lbs; avoid overhead activity
- Continue AROM and PROM
- Begin isometrics and thoracic mobility
- Stop any exercise if pain > 4/10
Weeks 3–6
Shoulder strengthening
- May lift 10–20 lbs; avoid eccentrics
- Continue active ROM
- Progressive strengthening
Weeks 6–12
Return to sport
- Activities as tolerated
- Begin eccentric training/loading
- Sport-specific exercises
Do not use NSAIDs (ibuprofen, Aleve, aspirin) for 4 weeks, and avoid ice for the first week — both blunt the healing response. Acetaminophen (Tylenol) is fine for discomfort. Care is tailored to you; use these guidelines with your physical therapist.
Knee & Hip Joint — Ultrasound-Guided PRP / Adipose / BMAC Injection Protocol
Day 1–2
Protect the joint
- Weight-bear as tolerated; crutches as needed
- Keep bandage dry; no submerging for 72 hours
- Gentle ROM as tolerated; monitor wound
Day 3–7
Begin gentle loading
- Avoid excessive joint loading
- Start low-grade closed-chain program
- Light squats/lunges (bodyweight); optional BFR
Day 8–14
Add resistance
- Avoid impact and heavy lifting to the joint
- Light open-chain exercises; add resistance as tolerated
- May begin swimming and low-resistance biking
Day 14–28
Functional progression
- Avoid impact activities
- Progress functional program; light agility and proprioception
- Resume light aerobic activity (walking)
Beyond 28 days
Long-term prevention
- Establish a long-term home exercise program
- Correct biomechanical issues that contributed to the injury
Do not use NSAIDs (ibuprofen, Aleve, aspirin) for 4 weeks, and avoid ice for the first week — both blunt the healing response. Acetaminophen (Tylenol) is fine for discomfort. Care is tailored to you; use these guidelines with your physical therapist.
Hip (Gluteal Tendon) — Ultrasound-Guided Lipogems / PRP Protocol
Week 1
Protect the tendon
- No weight-bearing 4 days, then toe-touch; wean off crutches by end of week 1
- Gentle hip-flexion ROM from day 4, 4×/day
- Optional BFR from day 4
Week 2
Pain-free ROM
- Progress weight-bearing with crutches
- Begin isometrics, straight-leg raises, clamshells
- Core stability; pool once wound healed
Weeks 3–6
Build strength
- Progress hip-abductor strengthening
- May begin stationary bike
Weeks 6–12
Return to sport
- Sport-specific exercises; balance and higher-impact activity
- Soft-tissue work (no foam rolling until week 6)
Do not use NSAIDs (ibuprofen, Aleve, aspirin) for 4 weeks, and avoid ice for the first week — both blunt the healing response. Acetaminophen (Tylenol) is fine for discomfort. Care is tailored to you; use these guidelines with your physical therapist.
Hip (Hamstring Tendon) — Ultrasound-Guided Lipogems / PRP / Tenex Protocol
Week 1
Protect the tendon
- No weight-bearing 4 days, toe-touch with crutches to day 7
- Gentle hip-flexion ROM; use a seat cushion for comfort
Week 2
Range of motion
- Wean off crutches; no eccentric strengthening
- Begin isometrics, straight-leg raises, heel slides
- Core stability; pool once wound healed
Weeks 3–6
Build strength
- No eccentrics yet; progressive strengthening
- Gentle hamstring stretching; knee-flexion and hip-extension strengthening
- Balance exercises
Weeks 6–12
Return to sport
- Activities as tolerated
- Sport-specific exercises
Do not use NSAIDs (ibuprofen, Aleve, aspirin) for 4 weeks, and avoid ice for the first week — both blunt the healing response. Acetaminophen (Tylenol) is fine for discomfort. Care is tailored to you; use these guidelines with your physical therapist.
Clinical evidence
Selected peer-reviewed research supporting these approaches.
Frequently asked questions
- What is microfragmented adipose tissue (MFat), and is it the same as Lipogems?
- Microfragmented adipose tissue is your own fat, gently washed and broken into small fragments so it can be injected into a joint. Lipogems is the FDA-cleared system Dr. Gruner uses to process the tissue — so “Lipogems” is the technology, while microfragmented adipose therapy is the treatment itself.
- How is microfragmented fat different from PRP?
- Both use your own tissue. PRP concentrates growth factors from your blood; microfragmented adipose provides structural cushioning plus a supportive cellular environment from your own fat. Dr. Gruner recommends whichever fits your joint and goals — sometimes in combination.
- How long does the procedure take?
- The full procedure — harvest, processing, and injection — is typically completed in under an hour in the office, with minimal recovery and minimal pain medication needed afterward.
- Am I a candidate for microfragmented adipose therapy?
- It is generally considered for patients whose conservative treatment has stopped working but who are not ready for major surgery. Advanced, bone-on-bone arthritis is usually better served by other options. A diagnostic exam and imaging determine whether it is appropriate for you.