Knee arthritis is the gradual loss of the smooth surface that lets the joint move without pain, together with the changes that happen in the bone underneath it and the lining around it. It is not simply wear and tear, and it is not one disease with one answer — which is why the first useful question is not "how bad is it" but "where is it, and what is actually driving the pain."
Most pages about knee arthritis describe the joint and then list treatments. This one starts somewhere more useful: the knee has three separate compartments, and which one is worn changes what the pain feels like, what shows up on an X-ray, and which treatments are worth considering.
Three compartments, three different problems
The knee is really three joints sharing one space.
- The medial compartment — the inner side. The most commonly worn, and the reason a knee that hurts on the inside and turns slightly bow-legged over the years behaves the way it does.
- The lateral compartment — the outer side. Less commonly the main problem, and it tends to travel with a different leg alignment.
- The patellofemoral compartment — where the kneecap runs in its groove on the front of the thigh bone. This one gets missed constantly, and it is worth its own section.
A knee can be badly worn in one compartment and largely intact in the others. That single fact drives a great deal of what follows — it is the difference between a knee that may do well with an injection and one that has a mechanical problem no injection will solve.
Kneecap arthritis, and why it gets missed
Patellofemoral arthritis produces a pattern people describe without ever using the word arthritis:
- Pain going down stairs more than going up
- Pain rising out of a low chair or a car seat
- An ache after sitting still for a long stretch — a film, a flight, a long meeting — that eases once you get moving
- Pain kneeling, squatting, or getting down to the floor
- Grinding or catching at the front of the knee
Walking on the flat is often comfortable, which is exactly why people delay coming in. The knee behaves normally at the thing they do most.
It is also missed because of how knees are commonly X-rayed. The two standard views of a knee show the inner and outer compartments well and the kneecap compartment poorly. A dedicated view looking down the groove that the kneecap runs in is what actually shows this — and if nobody orders it, the report can read as a relatively unimpressive knee while the patient is genuinely struggling.
Kneecap arthritis also responds differently. Loading matters more than in the other compartments — how the hip and thigh muscles control the knee changes how hard the kneecap is pressed into its groove. That makes rehabilitation genuinely disease-modifying here in a way that it is not always elsewhere, and it changes where an injection is placed and what it is being asked to do.
How the knee is examined here
The examination decides what the imaging means, not the other way around. Where the tenderness sits, whether there is fluid, how the kneecap tracks, what the alignment looks like standing rather than lying down, whether the knee is stable, and whether the hip or the back is contributing.
X-rays are taken standing. This matters more than it sounds. A knee X-rayed lying down can look far better than it is, because the joint space is not being loaded. Weight-bearing views show what the joint actually does under the patient's own body weight — and for the kneecap compartment, a dedicated view is added rather than assumed.
An MRI is usually not necessary for established arthritis. It becomes useful when the question is something other than arthritis, or when a discrete cartilage defect is suspected in a joint that is otherwise sound — because that is a genuinely different problem with a different set of options, including surgical cartilage restoration.
Ultrasound is used in the room. It shows fluid, the state of the lining, and the surrounding tendons, and it lets any injection be placed under direct vision rather than by feel. For a knee, accurate placement is not a refinement; an injection that does not reach the target is simply a different treatment.
What the evidence supports, and what it does not
No injection available today has been shown to regrow a joint surface. Not PRP, not bone marrow concentrate, not any fat, donor or exosome product currently sold in the United States. Anyone promising regrown cartilage is selling something.
What is true is more useful, and it is unusually well studied here. Knee osteoarthritis is where the randomized evidence for PRP is deepest anywhere in orthopedics — more than thirty Level 1 studies comparing PRP against corticosteroid and against hyaluronic acid injection. What those studies broadly support is meaningful reduction in pain and improvement in function, in appropriately selected patients, sustained over a period measured in months to a year or more.
Two consequences follow from taking that honestly. Selection matters more than technique — a well-placed injection into the wrong problem is still the wrong treatment. And a biologic is a way of buying good years in a knee, not a way of turning the clock back on one.
The options, all of them
Load management and rehabilitation
Unglamorous and genuinely effective, particularly for the kneecap compartment. Hip and thigh strength changes how the knee is loaded with every step. The commonest reason it "did not work" is that it was never really done.
Corticosteroid injection
Fast-acting and useful for settling a badly inflamed knee so that other things become possible. Best understood as a way of breaking a cycle rather than a treatment for the arthritis, and worth being thoughtful about repeating.
Hyaluronic acid
A viscous supplement to the joint fluid rather than a biologic. It has its place and its own evidence base — covered on the hyaluronic acid page.
Orthobiologic injection
Platelet-rich plasma for most knees, and bone marrow aspirate concentrate where the problem and the prior response point that way. Both prepared in the office from your own tissue, both placed under ultrasound guidance. PRP is the appropriate first step for a great many knees and the honest recommendation — BMAC is a larger procedure and a considerably larger investment, and is not simply "the stronger option" to be chosen by anyone who can afford it.
Surgery, when it is the right answer
Worth being direct about, because it is where an injection-only clinic cannot help you.
Arthroscopic "clean out" for arthritis alone is generally not supported. A meniscal tear found on a scan of an arthritic knee is usually part of the arthritis rather than a separate fixable problem, and removing more meniscus from a worn knee can make things worse. Arthroscopy keeps a clear role elsewhere — genuine mechanical locking, and discrete cartilage defects in a joint that is otherwise structurally sound.
For a discrete defect rather than diffuse arthritis, cartilage restoration is a real option: MACI, osteochondral allograft transplantation and the CartiHeal Agili-C implant, covered on the cartilage restoration page. Telling those two situations apart is most of the value of the consultation.
And for a knee that has genuinely reached the end of what can be preserved, joint replacement is an excellent operation. Being told that plainly is worth more than being sold three more injections.
How the choice actually gets made
Not from an X-ray grade. There is no line on a scan that rules a knee in or out.
What tends to predict a poor response to any injection is a knee whose symptoms are driven by mechanics rather than by inflammation and irritation — significant deformity, real instability, a knee that gives way. What tends to predict a good one is a knee where the pain source can be pinned down, the alignment is reasonable, and there is still joint left to work with.
Dr. Buford performs the injections, the arthroscopic surgery and the cartilage restoration procedures. That is the reason the recommendation here is not shaped by what happens to be on offer. If a biologic is unlikely to help your particular knee, you will be told so at the visit.
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. Nationally, a high-dose single-injection PRP treatment runs $1,500 to $3,500, and bone marrow aspirate concentrate runs $5,000 to $13,000, depending on how many joints are treated and the complexity of the treatment.
What you are quoted includes the follow-up care that normally goes with the procedure. CareCredit is available, with interest rates typically lower than regular credit card rates and financing plans up to twelve months in length, and every patient leaves the consultation with a clear understanding of the risks, the benefits and the potential investment before deciding anything.
To discuss the investment for your own treatment, call (877) 777-8883.
Common questions
Can PRP regrow cartilage in an arthritic knee?
No. No injection available today has been shown to regrow a joint surface, and that includes PRP, bone marrow concentrate and every fat, donor or exosome product sold in the United States. What the stronger studies support is meaningful reduction in pain and improvement in function in appropriately selected patients, sustained over months to a year or more. A biologic is a way of buying good years in a knee, not a way of turning the clock back on one.
Is PRP better than a cortisone shot for knee arthritis?
Knee osteoarthritis is where the randomized evidence for PRP is deepest anywhere in orthopedics, with more than thirty Level 1 studies comparing PRP against corticosteroid and against hyaluronic acid. Broadly, corticosteroid tends to work quickly and fade, while PRP tends to build more slowly and last longer. Cortisone still has a place, particularly for settling a badly inflamed knee so that rehabilitation can happen.
Why does my knee hurt on stairs but feel fine walking?
That pattern points at the kneecap compartment rather than the main weight-bearing part of the joint. Patellofemoral arthritis characteristically hurts going down stairs, getting out of a chair, kneeling, and after sitting still for a long period. It is commonly missed because the standard two X-ray views of a knee do not show that compartment well. A dedicated kneecap view does.
Do I need an MRI for knee arthritis?
Usually not. Established arthritis is generally diagnosed from the examination and weight-bearing X-rays. An MRI becomes useful when the question is something other than arthritis, or when a discrete cartilage defect is suspected in an otherwise sound joint, because that is a repairable problem with a different set of options.
Should I have an arthroscopy to clean out my arthritic knee?
For arthritis alone, generally no. The evidence for arthroscopic debridement in a degenerative knee is poor, and a torn meniscus found on a scan of an arthritic knee is usually part of the arthritis rather than a separate fixable problem. Arthroscopy retains a clear role in other situations, including genuine mechanical locking and discrete cartilage defects in a joint that is otherwise structurally sound.
How do I know if I am too far gone for an injection?
There is no single X-ray grade that rules a knee in or out. What tends to predict a poor response is a knee whose symptoms are driven by a mechanical problem rather than by inflammation and irritation: significant deformity, marked instability, or bone-on-bone change with a knee that gives way. Those knees are usually better served by an operation, and you should be told that plainly rather than after a course of treatment.
Does insurance cover PRP for knee arthritis?
In most cases, no. Most United States insurance plans, Medicare and Medicaid do not currently cover orthobiologic treatment for orthopedic conditions, so it is an investment you make in your own health. Nationally a high-dose single-injection PRP treatment runs $1,500 to $3,500, and bone marrow aspirate concentrate runs $5,000 to $13,000 depending on how many joints are treated and the complexity of the treatment.
Request an appointment or call (877) 777-8883.
