Table 1 Inclusion and exclusion criteria

1. 18 < Age < 65

1. BMI \(>\) 35 kg/m²

2. Kellgren–Laurence grading: II or III

2. Immune deficiency

3. VAS Index Score \(\ge 3\)

3. Renal failure (Cr \(>\) 2 mg/dL)

4. Knee joint alignment \(<\) 30 degrees

4. Hepatitis B, C, HIV, HTLV1-2, CMV infections

5. Informed consent

5. Coagulopathy or using anticoagulant agents

6. Liver malfunction (ALT or AST \(>\) 100 IU/L)

7. Uncontrolled diabetes (HbA1c > 8.5%)

8. Heart diseases (EF < 45%)

9. Allergy to proteins or cultured substances

10. Pregnancy or lactation

11. Malignancy

12. Addiction

13. Concurrent corticosteroid therapy

14. Participating in another clinical trial

15. Unwillingness to cooperate in the study and follow-ups