The knee is the joint with the strongest evidence behind orthobiologic treatment, and the one we treat most. At Texas Orthobiologics in Dallas, knee pain is treated with ultrasound-guided platelet-rich plasma (PRP) or bone marrow aspirate concentrate (BMAC), chosen after an orthopedic examination rather than offered as a default. Both are prepared from the patient's own tissue in the office and injected the same day by a board-certified orthopedic surgeon.
New to this field? What orthobiologics are covers the terminology, what the evidence supports, and what no injection can do — worth ten minutes before you compare clinics.
Knee problems treated with orthobiologics
- Knee osteoarthritis — the most common reason patients come in, and the indication with the most published randomized evidence
- Patellofemoral arthritis — arthritis behind the kneecap
- Symptomatic articular cartilage injury
- Meniscal tears, particularly degenerative tears in a knee that also has arthritis
- Medial collateral ligament (MCL) injury
- Patellar and quadriceps tendinitis — including jumper's knee
- Pes anserine and other bursal pain around the knee
Related reading on specific diagnoses: knee osteoarthritis, meniscal tears, patellar tendinitis, patellofemoral arthritis.
PRP for the knee
Platelet-rich plasma is a patient's own blood, spun down so that the platelets are concentrated into a small volume of plasma and everything unwanted is discarded. Platelets are best known for clotting, but they also carry a large reservoir of the growth factors and signalling proteins the body uses to recruit cells to an injury and start repair. PRP delivers a concentrated dose of that signal directly to the tissue that needs it.
Knee osteoarthritis is where PRP has been examined most rigorously. More than thirty Level 1 studies have now compared PRP against corticosteroid injection and against hyaluronic acid injection in the arthritic knee. That is an unusually deep evidence base for an orthobiologic and it is the reason the knee is the most straightforward conversation in this clinic.
Platelet concentration is worth asking any provider about. Blood carries roughly 200,000 platelets per microliter; current evidence suggests PRP should approach or exceed 1,000,000 per microliter, about a five-fold concentration. Preparations that fall short of that are sold under the same three letters.
Bone marrow concentrate — "stem cell" injection for the knee
This is the treatment most often searched for as a knee stem cell injection, and it is worth being precise about what it is, because the marketing around it is not.
Bone marrow aspirate concentrate (BMAC, sometimes BMC) is bone marrow drawn from the patient's own posterior iliac crest — the back of the pelvis — in the office under local anesthetic, then concentrated in a centrifuge and injected the same day. The concentrating process takes about twenty minutes. The harvest site needs a single bandage.
Being honest about the phrase "stem cell"
Bone marrow concentrate does contain mesenchymal stem cells, but they are a small fraction of what is in the syringe. The preparation is a rich mixture of nucleated cells, platelets, growth factors and signalling proteins, and the current understanding is that the benefit comes from that mixture rather than from stem cells rebuilding cartilage directly. Anyone promising you regrown cartilage from an injection is describing something that has not been shown.
We say this plainly because the alternative — letting patients believe they are buying new cartilage — is how this field earned its reputation.
Why the harvest technique matters
How the marrow is drawn changes what you get. Drawing large volumes from a single depth dilutes the aspirate with peripheral blood and lowers the cell yield. Experimental data shows that taking smaller volumes from multiple depths increases the number of cells recovered. Our technique uses draws of 10 cc or less at multiple depths to maximise yield in a same-day procedure.
That is not an in-house opinion. Dr. Buford published on this with Matthew Murphy, PhD and Jessica Terrazas, BS in Techniques in Regional Anesthesia and Pain Management in 2015, and the technique has been peer reviewed and separately validated. The research and publications page lists the work.
Bone marrow concentrate has the longest human follow-up of any orthobiologic
Bone marrow aspirate concentrate is the only orthobiologic injection for the knee with controlled human outcomes measured in decades rather than months. Most injection studies report at six months or a year. The question a patient actually has — will this delay or prevent a knee replacement — takes fifteen years to answer, and one group has answered it.
The fifteen-year randomized data
Philippe Hernigou and colleagues in Paris studied 60 patients who had osteoarthritis in both knees to a similar degree. Each patient had bone marrow drawn once, and the concentrate was split between the two knees. One knee was randomized to receive it into the subchondral bone — the bone immediately beneath the worn cartilage — and the other received it into the joint space, the ordinary intra-articular injection. Every patient served as their own control.
At a mean of fifteen years, 20 percent of the knees treated into the bone had gone on to knee replacement, compared with 70 percent of the knees injected into the joint. Among the patients who had needed no further surgery on either side, every one preferred the knee that had been treated into the bone. (International Orthopaedics 2021;45:391–399. PMID 32617651.)
Two things that study does not say, and both matter. The comparison was against another bone marrow injection — not against a placebo, and not against doing nothing — so it establishes which route works better rather than the size of the benefit against the natural course of the disease. And it was one group at one centre in Paris. Nobody has yet reproduced fifteen-year numbers anywhere else.
What that means for treatment here
Knee treatment here can deliver bone marrow concentrate by both routes in the same session — into the bone and into the joint. The intra-osseous portion is placed into the subchondral bone under ultrasound guidance, in the office, and takes about fifteen minutes. It is done under local anesthetic, with a sedative as well if you would prefer one. The whole visit, from the bone marrow aspiration to the injection, runs about seventy-five minutes. There is no brace and there are no crutches afterwards — you put full weight on the knee straight away.
That is a different delivery from the study above, and the difference is worth stating plainly. Hernigou's group placed the concentrate surgically, in an operating room, under anesthesia. The target is the same — the bone immediately beneath the worn cartilage — but here it is reached with a needle under ultrasound rather than in surgery.
The combination itself has not been tested with fifteen-year outcomes — no published study has followed it that long. What can be said is narrower, and worth saying plainly: the route into the bone is the one carrying the long-term evidence, and in the trial above the intra-articular knee received roughly half a dose, because a single aspirate was divided between two knees. All PRP is not the same, and the same is true of bone marrow concentrate. The dose, and where it is placed, are the variables — not the label on the syringe.
PRP or bone marrow concentrate — how the choice is made
There is no formula, and any clinic that gives you one is selling rather than diagnosing. The factors that actually drive the decision:
- What the tissue problem is. A tendon problem and an arthritic joint are different targets.
- How advanced the arthritis is on imaging and on examination.
- What has already been tried, and how the knee responded.
- The investment. Bone marrow concentrate is a significantly larger procedure and a significantly larger investment. For many knees, PRP is the appropriate first step and the honest recommendation.
It is common to be advised to start with PRP. It is also common, in a knee with more advanced change, to be told that neither injection is likely to give a result worth the investment — and to have that said before you commit to one.
Hyaluronic acid is a different kind of injection
Hyaluronic acid is not an orthobiologic. It does not come from your body and it does not contain living cells. It is a gel, similar to a substance already present in healthy joint fluid, and it is injected to improve how the joint moves and feels. The treatment is often called viscosupplementation.
For some patients with earlier-stage knee arthritis, it is a reasonable alternative to a biologic injection — and worth discussing before anything else is considered. The clearest evidence comes from a randomized trial by Robert Leighton and colleagues, published in Osteoarthritis and Cartilage in 2014, which compared a single injection of a high-molecular-weight, cross-linked hyaluronic acid against a cortisone injection in 442 patients. The two performed similarly at twelve weeks. By twenty-six weeks — about six months — the cortisone group's improvement had faded while the hyaluronic acid group's had held.
The stage of arthritis matters more than most patients are told
Hyaluronic acid is often described as ineffective, and the large reviews behind that claim mixed together patients at every stage of disease. When Matthew Nicholls and colleagues separated them in 2019, the picture changed: across sixteen trials of patients with mild to moderate arthritis, hyaluronic acid outperformed a placebo injection at both three months and six months. Across four trials of patients with bone-on-bone arthritis, it did not — at either point. That study was funded by a company that makes these products, which is worth knowing, but the pattern it describes is consistent with what we see: this is a treatment for a knee that still has cartilage left to protect.
Does adding it to PRP work better?
It is a fair question and we get asked it. The best available evidence does not show that adding viscosupplementation to PRP improves on a single high-dose PRP injection, and the most-cited paper claiming otherwise was retracted in 2026. A 2025 review of nine randomized trials found the small differences that did reach statistical significance were too small for a patient to notice. If better-designed trials change that, our protocol will follow the evidence.
More detail, including which patients we consider it for, is on hyaluronic acid injections.
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 space or the specific tendon 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.
High-dose PRP
Nationally, the range for a high-dose, single-injection PRP treatment is $1,500 to $3,500.
Lower-dose PRP often requires multiple injections, and clinical outcomes are often not as good. That is why Texas Orthobiologics specializes in the higher-dose PRP protocols — one well-concentrated treatment placed accurately under ultrasound, rather than a series of weaker ones. It is also why the platelet concentration question above is worth putting to any provider you are comparing.
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.
The figure for your own treatment is given plainly at the consultation — the investment for injecting one knee with PRP is a single number, not a range, once we know what we are treating.
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.
The knee is also where surgery still wins sometimes
Dr. Buford is a board-certified orthopedic surgeon who continues to operate, and knee arthroscopy remains the right answer for some of the knees that walk through the door — a mechanically locking meniscal tear being the clearest example. For advanced arthritis that has passed the point where a biologic can help, the appropriate referral is made rather than a treatment sold.
Some knees respond to a biologic. Some do better with an operation. Having both available is what makes the recommendation trustworthy.
Request an appointment or call (877) 777-8883.
How Orthobiologics for the Knee Are Performed
- Orthopedic Evaluation. Assess symptoms, imaging studies, knee function, and previous treatments.
- Diagnosis. Identify cartilage injuries, arthritis, ligament injuries, tendon disorders, or other knee conditions.
- Biologic Preparation. Prepare PRP or bone marrow concentrate in the office on the day of treatment.
- Guided Injection. Inject orthobiologic treatment into the affected knee using sterile technique and imaging guidance when appropriate.
- Recovery and Rehabilitation. Follow activity modification, rehabilitation exercises, and scheduled follow-up care.
Common questions
How much does a PRP knee injection cost in Dallas?
Nationally, the range for a high-dose single-injection PRP treatment is $1,500 to $3,500. Most insurance plans, Medicare and Medicaid do not cover it, so it is an investment in your own health. The investment for injecting one knee with PRP is given as a single figure at the consultation, and includes the follow-up care that normally accompanies the procedure. Call (877) 777-8883.
How much does a knee stem cell injection cost?
Bone marrow aspirate concentrate — a stem cell injection — ranges nationally from $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. It is not covered by most insurance. CareCredit is available, with interest rates typically lower than regular credit card rates and financing plans up to twelve months in length. Every patient leaves the consultation with a clear understanding of the risks, the benefits and the potential investment before deciding. Call (877) 777-8883.
Is PRP or a stem cell injection better for knee arthritis?
Neither is universally better. Knee osteoarthritis has the deepest evidence base for PRP, with more than thirty Level 1 studies behind it. Bone marrow concentrate is a larger procedure and a larger investment. The choice depends on the tissue problem, how advanced the arthritis is, what has already been tried, and what the treatment asks of you. For many knees, PRP is the appropriate first step.
Do stem cell injections regrow knee cartilage?
No. Bone marrow concentrate contains mesenchymal stem cells, but they are a small fraction of the preparation, and current understanding is that any benefit comes from the overall mixture of cells, platelets and growth factors rather than from stem cells rebuilding cartilage. Any clinic promising regrown cartilage from an injection is describing something that has not been demonstrated.
Where is the bone marrow taken from?
The posterior iliac crest, at the back of the pelvis. It is done in the office under local anesthetic and the harvest site is covered with a single bandage. Bone marrow regenerates, so the procedure can be repeated over time if appropriate.
Does a PRP knee injection hurt?
Most patients have some soreness afterwards that decreases fairly quickly. Plan on avoiding significant physical activity or sport for about a week.
Can PRP help a meniscal tear?
It can be appropriate for degenerative meniscal tears, particularly in a knee that also has arthritis. A mechanically locking tear is a different problem and may be better treated arthroscopically. That distinction is made at the examination.
Can I take ibuprofen after a knee injection?
No. NSAIDs block the inflammatory phase the injection is intended to start. Use acetaminophen (Tylenol) instead, and tell the office beforehand if you take an NSAID or blood thinner regularly.
Related
- Cartilage restoration — MACI, allograft, Agili-C
- Platelet-rich plasma (PRP)
- Bone marrow aspirate concentrate (BMAC)
- Knee osteoarthritis
- 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
