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Treatment of knee osteoarthritis with minimally manipulated cell therapies have gained increasing popularity. The purpose of the present study was to investigate the feasibility and safety issues of treatment of knee OA with intra-articular injection with mechanically treated cells from abdominal adipose tissue.The study was performed as a prospective cohort study with follow up after 3, 6 and 12 months. The primary endpoint was any adverse event at 3 months. Secondary endpoint was KOOS.Abdominal adipose tissue was harvested and prepared for implantation using the Lipogems system; an enzyme-free technology that works through a mild mechanical tissue cluster size reduction. Implantation of 8–16 ml of the stromal vascular fraction of abdominal adipose tissue in the knee was performed using a 21 gauge syringe.20 patients were included and 19 participated in follow up. Mean (SD) age was 49 (9), weight 89 kg (22), height 170 cm (23). One adverse event was registered as a patient complaint of cosmetically changes to the abdominal subcutaneous tissue. At 3 months KOOS Pain increased 17 (p<0.01) points, Symptoms 9 (p=0.09), ADL 13 (p=0.07), Sport 15 (p<0.01) and QOL 19 (p<0.01). And improved further at one year: KOOS Pain 18 (p<0.01) points, Symptoms 13 (p=0.03), ADL 18 (p<0.01), Sport 20 (p<0.01) and QOL 21 (p<0.01).Treatment of knee osteoarthritis with intra-articular injection with mechanically treated cells from abdominal adipose tissue. Efficiency of the treatment is promising but high quality randomised controlled trials are needed to elucidate efficiency.