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.
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.
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, depending on how many joints are treated and the complexity of the treatment.
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 and exosome products
These are considered unapproved drugs by the FDA and are not approved for any treatment indication. That is a description of their current regulatory status, not a matter of opinion, and it holds whatever the clinic marketing says.
Separately, and just as importantly, there is a significant lack of published human outcomes data for these products in orthopedics — a marked contrast with PRP and bone marrow concentrate, where the human literature is substantial. So both halves of the standard fail, and they are not used here.
Every biologic injection performed at Texas Orthobiologics is autologous — prepared from the patient's own tissue on the day of treatment.
That is deliberately a statement about injections, not 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.
Adipose (fat) based treatments, also called microfat
An adipose-based biologic is known as microfat because of how clinicians in the United States must process the tissue. It is a different orthobiologic treatment option, and some clinicians have success with it. At Texas Orthobiologics we do not currently offer adipose or microfat based treatments.
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.
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 depending on how many joints are treated and the complexity of the treatment. 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
