Knee pain is worth being specific about, because the knee is really three joints sharing one space and the answer changes depending on which one is the problem. This page routes you to the right one and is honest about which treatments belong where.
Dr. Buford is a board-certified orthopedic surgeon who performs both image-guided orthobiologic injections and knee surgery. That combination is unusual and it is the reason the advice here can go either way — an injection-only clinic has one answer available to it, and a surgical practice that does not offer biologics has another.
Start with what the knee is doing
- Aching, stiffness after sitting, pain that builds through the day, worse on stairs. Usually arthritis. Start with knee arthritis — which also covers the kneecap compartment, the one most often missed.
- Caught, locked, or gave way after a twist. Think meniscus. Start with meniscal tears, which explains why a tear found on a scan is not automatically the thing to fix.
- Pain at the front, just below the kneecap, worse jumping, running downhill or after sitting. Think patellar tendon. Start with patellar tendinitis.
- The kneecap has come out, or feels like it is about to. Start with patellar dislocation and instability.
- A single defined hole in an otherwise sound joint surface, often in a younger knee after an injury. That is a genuinely different problem from arthritis — see cartilage restoration.
What is offered here
- Orthobiologic injection. Platelet-rich plasma for most knees, bone marrow aspirate concentrate where the problem and the prior response point that way. Both prepared in the office from your own tissue and placed under ultrasound guidance. Detail, including what it costs, is on PRP and orthobiologics for the knee.
- Hyaluronic acid injection — a viscous supplement to the joint fluid rather than a biologic, with its own place and its own evidence base. See hyaluronic acid injections.
- Knee surgery where surgery is the right answer. See knee surgery in Dallas.
- Cartilage restoration for discrete cartilage defects — MACI, osteochondral allograft and the CartiHeal Agili-C implant. Very few practices in the region offer these.
- Class IV MLS laser therapy as an adjunct. See MLS laser therapy.
Why the knee is the strongest case in this whole field
If you read one thing about orthobiologics before spending money on them, make it this. The knee is where the randomised evidence for PRP is deepest anywhere in orthopedics — dozens of Level 1 studies comparing PRP against corticosteroid and against hyaluronic acid. What they broadly support is meaningful reduction in pain and improvement in function, in appropriately selected patients, sustained over months to a year or more.
Two things follow from taking that seriously. Selection matters more than technique — a perfectly placed injection into the wrong problem is still the wrong treatment. And the dose is the variable most clinics do not measure. Two syringes both labelled PRP can differ tenfold in the platelets they actually deliver, depending on the kit, the spin protocol, the starting blood volume and your own platelet count. That is the question worth putting to any practice you are comparing.
What no injection does, here or anywhere: regrow a worn joint surface. Not PRP, not bone marrow concentrate, not any fat, donor or exosome product sold in the United States today. A biologic buys good years in a knee. It does not turn the clock back on one.
Where surgery still wins
Worth stating because it is exactly where an injection-only clinic cannot help you.
- A knee that genuinely locks — a displaced meniscal fragment blocking movement is a mechanical problem, and no injection unblocks it.
- A discrete cartilage defect in a structurally sound joint — a restoration procedure, not an injection.
- Instability that is not settling with rehabilitation.
And where it does not: arthroscopic “clean out” for arthritis alone is not supported by the evidence. A degenerative meniscal tear found on the 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 it worse.
If you have already been told you need a knee replacement
Sometimes that advice is right, and you will be told so. But it is worth knowing that a knee can be badly worn in one compartment and largely intact in the others, and that the interval between “something should be done” and “a replacement is the only option left” is often longer than it is presented as being. A surgical second opinion from someone who performs both injections and surgery is a different conversation from one with a practice that only offers one of them.
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.
Common questions
I have knee pain. Which page should I read first?
If the knee aches, stiffens after sitting and hurts on stairs, read the knee arthritis page — it also covers kneecap arthritis, which is the commonly missed one. If the knee caught, locked or gave way after a twist, read the meniscal tears page. If the pain is at the front just below the kneecap and worse with jumping or running downhill, read the patellar tendinitis page.
Do you do knee replacements?
No. Knee arthroplasty is not performed at this practice. What is offered is image-guided orthobiologic injection, arthroscopic surgery where it is indicated, and cartilage restoration for discrete defects. If a replacement is genuinely the right answer for your knee, you will be told that plainly and referred rather than sold something else.
Is PRP better than a cortisone shot for the knee?
For many knees, over a longer horizon, the randomised evidence in knee osteoarthritis supports PRP over corticosteroid on pain and function. Corticosteroid still has a real role — it works quickly and can settle a badly inflamed knee so that rehabilitation becomes possible — but it carries a cumulative cost, which is why the number you can have is limited. PRP does not have that ceiling. Which is right for you depends on what is actually driving the pain.
How much does a knee injection cost?
Most insurance plans, Medicare and Medicaid do not currently cover orthobiologic treatment in the United States, so this is an investment rather than a benefit you claim. Nationally, a high-dose single-injection PRP treatment runs $1,500 to $3,500, and bone marrow aspirate concentrate $5,000 to $13,000 for a single joint, rising to as much as $19,900 for two joints or when intra-osseous delivery into the bone is added. The full breakdown, and what the figure includes, is on the orthobiologics for the knee page. Your own number is given plainly at the consultation, and nobody is asked to commit at the visit.
Can I be seen for a knee problem without a referral?
Yes. Bring any imaging you already have, ideally the images rather than the report alone. X-rays taken here are taken standing, because a knee X-rayed lying down can look considerably better than it is, and for the kneecap compartment a dedicated view is added rather than assumed.
