Bone marrow aspirate concentrate (BMAC - Stem Cells) is bone marrow drawn from a patient's own pelvis, concentrated in a centrifuge, and injected into an injured joint or tendon the same day. It is the treatment most often marketed as a "stem cell injection." That description is not wrong, but it is incomplete in a way that matters, and this page sets out what is actually in the syringe.
What is actually in a bone marrow stem cell injection
Concentrated bone marrow is a mixture. It contains mesenchymal stem cells — but they are a small fraction of the total. Alongside them are nucleated cells, platelets, and a broad set of growth factors and signalling proteins:
- Platelet-Derived Growth Factor (PDGF)
- Fibroblast Growth Factor (FGF)
- Vascular Endothelial Growth Factor (VEGF)
- Transforming Growth Factor Beta (TGF-β)
- Insulin-like Growth Factor 1 and 2 (IGF-1, IGF-2)
- Epidermal Growth Factor (EGF)
- Interleukin-8 (IL-8)
Current understanding is that whatever benefit BMAC - Stem Cells provides comes from that mixture acting on the local environment, not from stem cells differentiating into new cartilage. No injection available today has been shown to regrow a joint surface. A clinic telling you otherwise is describing a result the literature does not support.
How the bone marrow stem cells are harvested
The harvest is done in the office under local anesthetic. The source is the posterior iliac crest — the back of the pelvis — which is where marrow is most accessible and most cellular. The harvest site is closed with a single bandage. Bone marrow regenerates, so the procedure can be repeated over time when that is appropriate.
Once drawn, the aspirate is concentrated in the office. That step takes about twenty minutes, and the injection follows on the same visit. Nothing is banked, shipped, cultured or expanded.
Why technique changes what you get
This is the part almost no clinic will discuss, and it is the part that determines whether the injection contains what it is supposed to.
Bone marrow sits in a vascular space. Draw a large volume from one spot and the later part of that draw is increasingly peripheral blood rather than marrow — the aspirate is diluted and the cell count falls. Experimental data shows that drawing smaller volumes from multiple depths recovers substantially more cells than one large draw.
Our technique uses draws of 10 cc or less at multiple depths from a single harvest site, specifically to maximise the cell count available for a same-day procedure. Dr. Buford published on this with Matthew Murphy, PhD and Jessica Terrazas, BS in Techniques in Regional Anesthesia and Pain Management in 2015; the technique has been peer reviewed and separately validated. See the research and publications page.
If you are comparing providers, "how much volume do you draw, and from how many depths" is the single most informative question you can ask about a stem cell injection.
How BMAC - Stem Cells works, step by step
- Consultation. Patient undergoes orthopedic evaluation and treatment planning.
- Bone marrow aspiration. Bone marrow is harvested from the posterior iliac crest under local anesthesia.
- Concentration. Bone marrow is processed in the office to concentrate the stem cells, platelets and growth factors.
- Injection. The concentrated bone marrow stem cell preparation is precisely injected into the injured area using image guidance.
- Recovery. Patients follow post-procedure instructions and return for follow-up evaluations.
What bone marrow stem cell therapy is used for
Degenerative joint disease
- Knee osteoarthritis
- Hip osteoarthritis
- Shoulder osteoarthritis
- Ankle osteoarthritis
- Elbow and wrist osteoarthritis
- Symptomatic articular cartilage injury
Tendon problems — chronic tendinopathy and partial-thickness tears
- Rotator cuff and biceps tendon
- Tennis elbow and golfer's elbow
- Gluteus medius, hamstring and piriformis-related pain
- Patellar and quadriceps tendinitis
- Peroneal and tibialis posterior tendinitis
- Achilles tendinopathy
- Plantar fasciitis
Ligament injury
- Ulnar collateral ligament injury of the elbow
- Medial collateral ligament injury of the knee
Fracture care
- Delayed union and nonunion
BMAC - Stem Cells or PRP?
Bone marrow concentrate is a larger procedure than PRP, involves a marrow harvest, and is a considerably larger investment. It is not simply "the stronger option" to be chosen when a patient can afford it.
For a great many problems — and for knee osteoarthritis in particular, where the randomized evidence for PRP is deepest — PRP is the appropriate first step and the honest recommendation. BMAC - Stem Cells is considered when the tissue problem, the imaging and the prior response point that way.
You should expect to be told which of the two is indicated for your problem, and why, before you are quoted a figure for either.
Injections are performed under ultrasound guidance
Injections are placed under direct ultrasound guidance rather than by surface landmarks. The needle is visible on screen throughout, and the joint or tendon being treated is identified before anything is injected.
This matters more than it sounds. A blind injection relies on the anatomy being where the textbook says it is. Ultrasound shows where it actually is in the patient on the table that day, confirms the needle has reached the intended structure, and shows the injectate spreading where it was meant to go. When the treatment is a single dose of the patient's own concentrated biology, placing it accurately is not a refinement — it is the procedure.
Ultrasound also adds diagnostic information during the visit itself. Tendons can be examined dynamically, in motion and under load, which a static scan cannot show.
What happens after the injection
Depending on the area treated, crutches or upper-body immobilization may not be needed at all. When they are used, it is usually for about two days. Soreness can last up to 48 hours before it starts to settle.
Most patients have some soreness afterwards that decreases fairly quickly. Plan on avoiding significant physical activity or sport for about a week.
Do not take aspirin, ibuprofen, naproxen or other NSAIDs after the procedure. Anti-inflammatory medication blocks the inflammatory phase that the treatment is deliberately trying to start, so taking it works directly against the injection you just paid for. Acetaminophen (Tylenol) and other pain medicines that do not block inflammation are fine. If you take an NSAID or a blood thinner regularly for another condition, raise it before the procedure rather than after — it changes the plan.
Follow-up is scheduled rather than left to the patient to arrange. Progress is reviewed at intervals so the response can be judged against what was expected, and the plan adjusted if it is not tracking.
Your investment
Worth being direct about, because most sites are not: in the United States, most insurance plans, Medicare and Medicaid do not currently cover orthobiologic treatment. This is an investment you make in your own health rather than a benefit you claim, and you should expect a clear number rather than a vague one.
Bone marrow aspirate concentrate (a stem cell injection)
Nationally, the range is $5,000 to $13,000 for a single joint. Treating a second joint, or adding intra-osseous delivery into the bone, can take that as high as $19,900.
What the figure for an individual patient reflects:
- How many joints or sites are treated in one visit
- Which structure is involved — a joint, a tendon, or both
- The complexity of the treatment being planned
- Whether imaging or a diagnostic step is needed first to confirm the source of pain
What you are quoted includes the follow-up care that normally goes with the procedure. It is not a deposit against a series of further visits.
Every patient leaves the consultation with a clear understanding of the risks, the benefits and the potential investment before making any decision. Nobody is asked to commit to treatment at the visit.
CareCredit is available for patients who prefer to spread the investment over time. Interest rates are typically lower than regular credit card rates, and we offer financing plans up to twelve months in length. Our clinical specialists handle these questions directly, and it is worth speaking to them before you rule a treatment out — there are usually more options than are obvious from the outside.
To discuss the investment for your own treatment, call (877) 777-8883.
What we do not offer, and why
This field has a marketing problem, so rather than just listing exclusions it is worth stating the standard being applied.
We do not use any product that lacks a clear FDA regulatory pathway for use in humans and clear human clinical outcomes data showing that it is safe and that it works for the indication being treated. Both halves, not either one. That single sentence accounts for most of what is on the market and not on the menu here.
Amniotic fluid, Wharton's jelly, exosomes and regenerative protein arrays
These are marketed heavily, often as “stem cell” injections, and patients are frequently quoted a great deal of money for them. None of them is used here. There are two reasons, and the second matters more than the first.
The regulatory reason. The FDA regulates these products as biologic drugs. None of them currently holds an approved orthopedic indication. That is a description of their regulatory status rather than a matter of opinion, and it holds whatever a clinic's marketing says about it.
The evidence reason, which is the more significant one. Treatment here is based on evidence, and there is no published literature for any of these injectable allograft options in orthopedics showing that any of them works better than PRP or bone marrow concentrate. Not equivalent-but-cheaper, not better-in-a-subgroup — the comparison that would justify using them has not been made in their favour. PRP and bone marrow concentrate, by contrast, have a substantial published human literature behind them.
So even setting the regulatory question aside entirely, there is no evidence-based argument for choosing one of these over a treatment prepared from your own tissue.
Adipose (fat) based treatments, also called microfat
Texas Orthobiologics does not currently offer adipose-based orthobiologics. That is a practice decision, and it is worth separating from the regulatory picture, because the two kinds of adipose treatment are not in the same position.
Adipose preparations produced with a device carrying FDA clearance or approval are regulatory compliant. An adipose-based biologic is often called microfat, after the way clinicians in the United States must process the tissue. It is a legitimate orthobiologic option and some clinicians have success with it.
Treatments based on stromal vascular fraction — SVF — are not currently regulatory compliant. This is now settled, and it is worth being specific about how it got there, because clinics still advertise these injections.
In 2024 a federal appeals court held that SVF is a drug under federal law, and that it does not qualify for the same-surgical-procedure exception that same-day fat procedures had relied on. The Supreme Court declined to review that decision in 2025. On 28 August 2026 the district court entered a permanent injunction on remand in United States v. California Stem Cell Treatment Center, Inc., which also names Cell Surgical Network Corporation. That is not a warning letter or an opinion — it is a standing federal court order.
The practical meaning for a patient is simple. An SVF injection is an unapproved drug unless it goes through the drug approval pathway, whatever the clinic offering it advertises about same-day processing or minimal manipulation. That argument has been made, and it lost.
Every injection here is made from your own tissue
Every biologic injection performed at Texas Orthobiologics is autologous — prepared from the patient's own blood or bone marrow on the day of treatment.
That is deliberately a statement about injections rather than a blanket position on donor tissue. Donor cartilage used as a structural graft in cartilage transplantation surgery is a different proposition entirely: it is regulated under an established pathway, it is implanted rather than injected, and it carries decades of published human outcomes data. It meets the standard above. An injectable donor cell product does not.
A biologic is one option, not the only one
A consultation here is not a pre-decided route to an injection. Some presentations of joint and tendon problems respond well to an orthobiologic. Some do better with an operation. Some need physical therapy, a change in loading, or time, and would get neither benefit nor harm from a syringe.
Dr. Buford performs the injections personally, and performs shoulder and knee surgery. He does not perform hip, elbow, hand and wrist, foot and ankle, or spine surgery — so where an operation in one of those regions is the better answer, you will be told plainly and referred, with your imaging and workup handed over personally rather than left to you to arrange. That also means the recommendation here is not shaped by what happens to be on offer. If a biologic is unlikely to help your particular problem, you will be told that at the visit rather than after a course of treatment.
Request an appointment or call (877) 777-8883.
Common questions
What is bone marrow aspirate concentrate?
Bone marrow aspirate concentrate (BMAC - Stem Cells) is bone marrow drawn from a patient's own posterior iliac crest, concentrated in a centrifuge, and injected into an injured joint or tendon on the same visit. It contains mesenchymal stem cells along with nucleated cells, platelets and a broad set of growth factors.
Do you offer stem cell therapy in Dallas?
Yes. The stem cell treatment offered here is BMAC - Stem Cells: bone marrow aspirate concentrate drawn from your own pelvis, concentrated in the office, and injected the same day under ultrasound guidance. It is autologous, meaning every cell comes from your own body. Donor, amniotic, umbilical cord and exosome products are not used here. Call (877) 777-8883.
Are stem cell injections FDA approved?
No stem cell injection is FDA approved as a drug for orthopedic conditions. Same-day autologous procedures such as BMAC - Stem Cells are performed under the FDA's exception for minimally manipulated tissue used within the same surgical procedure, which is why nothing here is cultured, expanded, banked or shipped. Amniotic fluid, umbilical cord and exosome products are considered unapproved drugs by the FDA.
Is BMAC - Stem Cells a stem cell treatment?
Yes. BMAC - Stem Cells is what most clinics mean by a stem cell injection, though the label is incomplete. Mesenchymal stem cells are a small fraction of concentrated bone marrow. Current understanding is that any benefit comes from the whole mixture of cells, platelets and growth factors, not from stem cells rebuilding tissue directly.
How is the bone marrow taken?
From the posterior iliac crest — the back of the pelvis — in the office under local anesthetic. The harvest site is covered with a single bandage. Bone marrow regenerates, so the procedure can be repeated over time when appropriate.
How long does the BMAC - Stem Cells procedure take?
It is a single office visit. The concentrating step takes about twenty minutes after the marrow is drawn, and the injection is performed the same day under ultrasound guidance.
Does BMAC - Stem Cells regrow cartilage?
No injection available today has been shown to regrow a joint surface, BMAC - Stem Cells included. Any provider promising regrown cartilage is describing a result the published literature does not support.
How much does stem cell therapy (BMAC - Stem Cells) cost?
It is self-pay — not covered by most insurance, Medicare or Medicaid. Nationally, bone marrow concentrate runs $5,000 to $13,000 for a single joint, and as much as $19,900 for two joints or when intra-osseous delivery into the bone is added. Texas Orthobiologics fully explains any investment before you decide whether the potential outcome is worth it. For patients who qualify, Cherry and CareCredit offer 0% interest for three months up to low-interest plans for twelve months. Call (877) 777-8883.
Do you use fat-derived or donor stem cells?
No. Every biologic injection performed here is autologous — prepared from your own blood or bone marrow on the day of treatment. Adipose (microfat), amniotic fluid, Wharton's jelly and exosome products are not used, because none of them has both a clear FDA pathway and human outcomes data showing it works better than PRP or bone marrow concentrate. Donor cartilage used as a structural graft in cartilage transplantation surgery is different, and Dr. Buford does perform those procedures.
I have a cartilage defect in my knee. Is an injection the right treatment?
Not necessarily, and it is worth separating the two. A discrete full-thickness cartilage defect is a structural problem, and no injection has been shown to regrow a joint surface. Dr. Buford performs cartilage restoration surgery - MACI, osteochondral allograft transplantation and the CartiHeal Agili-C implant - for exactly that presentation. Diffuse wear across the joint is a different problem, and that is where an orthobiologic injection is one of the reasonable things to discuss.
Why does bone marrow harvest technique matter?
Drawing a large volume from one depth increasingly dilutes the aspirate with peripheral blood and lowers cell yield. Experimental data shows smaller volumes drawn from multiple depths recover more cells. Our technique uses draws of 10 cc or less at multiple depths, published by Dr. Buford and colleagues in 2015 and separately validated.
Related
- Cartilage restoration — MACI, allograft, Agili-C
- Platelet-rich plasma (PRP)
- What orthobiologics are
- Research and publications
- PRP and orthobiologics for the knee
- PRP and orthobiologics for the shoulder
- PRP and orthobiologics for the hip
- PRP and orthobiologics for the elbow
- PRP and orthobiologics for the wrist
- PRP and orthobiologics for the foot and ankle
- PRP for low back pain
