Orthobiologics are substances taken from the body — cells, blood components, tissue and the growth factors they carry — that are concentrated and placed back into an injured joint, tendon or ligament to support repair. The best known are platelet-rich plasma (PRP) and bone marrow aspirate concentrate (BMAC). At Texas Orthobiologics in Dallas, both are prepared in the office from the patient's own tissue during the same visit and placed under ultrasound guidance by a board-certified orthopedic surgeon.
The category also includes surgery. Dr. Buford performs cartilage restoration and transplantation — MACI, osteochondral allograft transplantation and the CartiHeal Agili-C implant — alongside the injections. That combination is unusual, and it is the reason the recommendation here can go either way.
This page is the plain-English version of the whole category: what the word covers, what is genuinely in it, what the evidence supports, and which of these treatments we offer — along with which ones we deliberately do not, and why. If you already know which treatment you are researching, the PRP page and the bone marrow concentrate page go into procedural detail.
Orthobiologics, regenerative medicine, stem cell therapy: what the words mean
These three terms get used interchangeably in clinic marketing, and they do not mean the same thing. Sorting them out is the fastest way to read any orthobiologics website critically, including this one.
Orthobiologics is the narrowest and most useful of the three. It names the substances — the biologic material itself, applied to orthopedic problems. PRP is an orthobiologic. Concentrated bone marrow is an orthobiologic. It is the term orthopedic surgeons use with each other.
Regenerative medicine is the broader field these substances belong to, and it extends well beyond orthopedics into cardiology, wound care and much else. When a clinic uses this phrase about a knee, it is usually describing an orthobiologic. Our regenerative medicine page is the plain-English version of this one — what can be done for each joint, what it costs, and how to tell a legitimate treatment from a marketed one.
"Stem cell therapy" is where the language gets loosest, and it is worth being blunt. Concentrated bone marrow does contain mesenchymal stem cells, so the phrase is not fabricated — but those cells are a small fraction of what is in the syringe. Most of the biological activity comes from growth factors, signalling proteins and other cell populations. A clinic advertising "stem cell injections" is, in almost every case in the United States, describing concentrated bone marrow or a fat preparation, not a purified population of stem cells. The bone marrow concentrate page sets out what is actually in it.
The six categories of orthobiologics
Nearly everything in this field falls into one of six groups. Three are offered here: PRP, bone marrow concentrate, and cartilage restoration and transplantation surgery. Three are not, and the standard behind those decisions is stated further down the page.
1. Platelet-rich plasma (PRP) — offered
The patient's own blood, drawn at the visit and spun down so the platelets are concentrated into a small volume of plasma. Platelets carry a large reservoir of the growth factors the body uses to recruit cells to an injury and begin repair. Concentration is the variable that separates preparations: blood normally carries about 200,000 platelets per microliter, and current evidence suggests PRP should approach or exceed 1,000,000 platelets per microliter — roughly a five-fold concentration. A preparation that does not reach that is a different product wearing the same name, which is why it is a fair question to put to any provider.
Autologous, prepared in under ten minutes in the office, injected the same visit. Full detail on the PRP page →
2. Bone marrow aspirate concentrate (BMAC) — offered
Bone marrow drawn from the posterior iliac crest — the back of the pelvis — under local anesthetic in the office, then concentrated for about twenty minutes and injected. Marrow contains mesenchymal stem cells along with a broad mix of growth factors and progenitor cells, and it is the preparation usually meant when a clinic says "stem cell injection."
Technique matters here as much as concentration does with PRP. Drawing in small aliquots of ten cubic centimetres or less, from several depths, yields substantially more cells than pulling one large volume from one spot — a point published in the peer-reviewed literature and independently validated since. Full detail on the bone marrow concentrate page →
3. Adipose (fat) based treatments, also called microfat — not offered here
An adipose-based biologic is known as microfat because of how clinicians in the United States must process the tissue. Fat is harvested from the abdomen or flank, processed, and injected. 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. If microfat is what you are researching specifically, you will want a practice that performs it.
4. Amniotic fluid and Wharton's jelly — not offered here
Donor material recovered after elective cesarean delivery, processed and sold as an injectable. Wharton's jelly is the connective tissue from inside the umbilical cord and is marketed in the same category.
These products are considered unapproved drugs by the FDA and are not approved for any treatment indication. That is a description of their current regulatory status rather than an opinion about them. Separately, there is a significant lack of published human outcomes data for them in orthopedics, particularly set against PRP and bone marrow concentrate. Both points matter, for the reason given under the standard we apply further down.
5. Exosome products — not offered here
Exosomes are vesicles released by cells that carry signalling molecules between them, and the underlying science is real and interesting. The regulatory position is the same as above: exosome products are considered unapproved drugs by the FDA and are not approved for any treatment indication. The published human outcomes data in orthopedics is likewise thin. Clinics in this market advertise them anyway.
6. Cartilage restoration and transplantation — offered
The one group on this list that is surgery rather than an office injection, and the one most likely to be missing from the conversation elsewhere — because a clinic that only injects cannot offer it, and cannot tell you when it is the better answer.
Dr. Buford performs three cartilage restoration procedures: MACI, osteochondral allograft transplantation, and the CartiHeal Agili-C implant. All three resurface a discrete cartilage defect in a joint that is otherwise structurally sound — not widespread arthritis. All three have an established FDA regulatory pathway, which is why they are here when several better-marketed alternatives are not.
Cartilage restoration in Dallas, TX → — what each procedure is, how the choice between them is made, the approvals and the trial data behind them, and how cartilage surgery relates to the injections on the rest of this site.
The standard we apply
Rather than just listing what is not on the menu, here is the test being applied to everything on it.
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 categories four and five above. Amniotic fluid, Wharton's jelly and exosome products are considered unapproved drugs by the FDA and are not approved for any treatment indication, and the published human outcomes data in orthopedics is thin next to what exists for PRP and bone marrow concentrate. Both halves fail, so they are not used here.
It cuts the other way too, which is the part worth noticing. The three cartilage procedures above reach the bar by three different routes, and the distinctions are real:
- MACI is FDA-approved, for a specific written indication.
- CartiHeal Agili-C holds an FDA Premarket Approval — the most demanding device pathway there is — supported by a randomised controlled trial against the previous standard of care.
- Osteochondral allograft is human tissue for transplantation under 21 CFR Part 1271, with decades of published outcomes behind it.
All three clear the bar, so all three are offered — including the one that uses donor tissue. Full detail on the cartilage restoration page →
The standard is not "autologous only" and it is not "injections only." It is evidence and regulatory pathway, applied the same way to everything. You can hold any provider to it, including this one.
Three questions that sort the field fast
Patients researching this field are asked to evaluate claims that normally require a clinical education to evaluate. These three questions do most of the work, and you are entitled to ask them of anyone:
- "Is what you are injecting taken from my own body, today?" Autologous treatment removes the donor-tissue questions entirely. If the answer involves a vial that arrived by courier, ask what is in it, what its FDA status is, and what human outcomes data exists for it.
- "What platelet concentration does your PRP reach?" A provider running a high-dose protocol will know the number. A provider who has not thought about it will not.
- "If an injection is not the right answer, what else can you offer me?" An injection-only clinic has one answer to every question. A surgeon can tell you when surgery is the better option — and perform it.
Who performs the injection
Every orthobiologic injection at Texas Orthobiologics is performed by Don Buford, M.D., a board-certified orthopedic surgeon. That matters for two reasons that have nothing to do with marketing.
The first is diagnosis. A biologic injection only helps if the thing being injected is the thing causing the pain. Deciding that is an orthopedic problem before it is an injection problem, and it is the part of the visit where an imaging study gets read against an examination rather than in place of one.
The second is that the recommendation can go either way. Dr. Buford still operates. Some joints and tendons respond well to a biologic. Some do better with an operation, and some need neither. Being able to offer both means the answer is not decided by what is available.
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, tendon or ligament 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 orthobiologics are used for
Orthobiologics have been studied across most of orthopedics. The strongest body of randomized evidence is in knee osteoarthritis, where more than thirty Level 1 studies have compared PRP against corticosteroid injection and against hyaluronic acid injection. Beyond the knee, PRP and bone marrow concentrate have been used and studied for effectively every joint, tendon and ligament problem in the specialty.
Broadly, three kinds of problem:
- Degenerative joint disease — osteoarthritis of the knee, hip, shoulder, ankle, elbow and wrist, and symptomatic articular cartilage injury.
- Chronic tendon problems — tendinopathy and partial-thickness tears: rotator cuff, tennis and golfer's elbow, gluteal and hamstring tendons, patellar and quadriceps tendons, peroneal and posterior tibial tendons, Achilles tendinopathy, plantar fasciitis.
- Ligament injury — including ulnar collateral ligament injury at the elbow and medial collateral ligament injury at the knee.
By body region
Each region has its own page covering what is treated there, what ultrasound can reach, and what recovery looks like:
- Knee — osteoarthritis, cartilage injury, patellar tendinitis, MCL injury
- Shoulder — rotator cuff tendinopathy and partial tears, biceps tendon, glenohumeral arthritis
- Hip — osteoarthritis, gluteal tendinopathy, deep gluteal and hamstring pain
- Elbow — tennis elbow, golfer's elbow, UCL injury
- Hand and wrist — arthritis and ligament injury
- Foot and ankle — plantar fasciitis, Achilles tendinopathy, ankle arthritis
- Low back — what ultrasound can and cannot reach in the spine, stated plainly
What the evidence supports, and what it does not
The claim you will see most often in this market is that an injection regrows cartilage or reverses arthritis. It is worth stating the position clearly: no injection 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.
What the better studies do 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. In knee osteoarthritis specifically, that is the comparison the Level 1 literature has repeatedly made against the injections it would otherwise be weighed against.
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 joint, not a way of turning the clock back on one. Anyone promising the second thing is selling something.
Who is a reasonable candidate
Orthobiologics are usually considered when rest, activity modification, medication and physical therapy have not given enough relief, and when the problem is identifiable on examination and imaging. Beyond that, the honest answer is that candidacy is decided at the visit rather than from a list.
The presentations that tend to do well share features: the source of pain can be pinned down, the structure involved is one ultrasound can reach, the joint has cartilage left in it, and the patient is able to follow a loading plan afterwards. The presentations that tend to do poorly are the mirror image — diffuse pain with no clear anatomic source, or a joint far enough along that a mechanical problem is driving the symptoms.
That second group is the reason a consultation here is not a pre-decided route to an injection.
What happens after the injection
Most patients have some soreness that settles fairly quickly, and plan on avoiding significant physical activity or sport for about a week. Depending on the area treated, crutches or a sling may not be needed at all; when they are used it is usually for about two days.
Do not take aspirin, ibuprofen, naproxen or other anti-inflammatory medication afterwards. These block the inflammatory phase the treatment is deliberately trying to start, so taking them works directly against the injection. Acetaminophen (Tylenol) is 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, so the response can be judged against what was expected. Recovery detail specific to each treatment is on the PRP and bone marrow concentrate pages.
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.
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.
A biologic is one option, not the only one
A consultation here is not a pre-decided route to an injection. Some presentations of a painful joint or tendon 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 both the injections and the surgery, so the recommendation 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 are orthobiologics?
Orthobiologics are biologic substances - cells, blood components, tissue and the growth factors they carry - concentrated and placed into an injured joint, tendon or ligament to support repair. The two used at Texas Orthobiologics are platelet-rich plasma (PRP) and bone marrow aspirate concentrate (BMAC), both taken from the patient's own body during the same visit.
What is the difference between orthobiologics and regenerative medicine?
Orthobiologics names the substances themselves, applied to orthopedic problems. Regenerative medicine is the broader field those substances belong to, which extends well beyond orthopedics. When a clinic uses the phrase regenerative medicine about a knee or a shoulder, it is almost always describing an orthobiologic.
Which orthobiologics does Texas Orthobiologics offer?
Three: platelet-rich plasma (PRP) injection, bone marrow aspirate concentrate (BMAC), and cartilage restoration surgery - MACI, osteochondral allograft transplantation and the CartiHeal Agili-C implant. The two injections are autologous - taken from the patient's own body on the day of treatment - prepared in the office and placed under ultrasound guidance by a board-certified orthopedic surgeon. Adipose or microfat based treatments are not offered, and neither are amniotic fluid, Wharton's jelly or exosome products.
Do you offer adipose or microfat treatments?
No. 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 two treatments offered here are platelet-rich plasma and bone marrow aspirate concentrate.
Why do you not offer amniotic fluid, Wharton's jelly or exosome products?
Amniotic fluid, Wharton's jelly and exosome products are all considered unapproved drugs by the FDA and are not approved for any treatment indication. In addition, there is a significant lack of published human outcomes data for them in orthopedics, especially compared with PRP and BMAC. We therefore 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 a particular indication. Every biologic injection performed here is prepared from the patient's own tissue on the day of treatment. That is a statement about injections rather than a blanket position on donor tissue - donor cartilage used as a structural graft in cartilage transplantation surgery has an established regulatory pathway and decades of published outcomes data, so it meets the same standard.
Do you perform cartilage transplantation or cartilage restoration?
Yes. Dr. Buford performs three cartilage restoration procedures: MACI (matrix-associated autologous chondrocyte implantation), osteochondral allograft transplantation, and the CartiHeal Agili-C implant. These are operations rather than office injections, and all three are for a discrete cartilage defect in a joint that is otherwise structurally sound rather than for widespread arthritis. The decision rests on imaging, the size and location of the defect, whether there is bone loss underneath, and the condition of the rest of the joint. All three have an established FDA regulatory pathway. Full detail, including the approvals and the trial data, is on the cartilage restoration page.
Do orthobiologics regrow cartilage or reverse arthritis?
No. No injection has been shown to regrow a joint surface - not PRP, not bone marrow concentrate, and not any 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.
What conditions do orthobiologics treat?
Osteoarthritis of the knee, hip, shoulder, ankle, elbow and wrist; symptomatic articular cartilage injury; chronic tendon problems including rotator cuff tendinopathy, tennis and golfer's elbow, gluteal and hamstring tendinopathy, patellar tendinitis, Achilles tendinopathy and plantar fasciitis; and ligament injuries including elbow UCL and knee MCL injury.
How much do orthobiologics cost?
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. Most insurance plans, Medicare and Medicaid do not currently cover orthobiologic treatment in the United States. Every patient leaves the consultation with a clear understanding of the risks, the benefits and the potential investment before making any decision, and CareCredit is available, with interest rates typically lower than regular credit card rates and financing plans up to twelve months in length.
Who performs the injection?
Every orthobiologic injection at Texas Orthobiologics is performed by Don Buford, M.D., a board-certified orthopedic surgeon, under direct ultrasound guidance. That matters because deciding whether to inject, and what to inject, is an orthopedic diagnostic problem before it is an injection problem.
Are orthobiologic injections done under ultrasound guidance?
Yes. Every injection and aspiration is placed under direct ultrasound guidance rather than by surface landmarks, with the needle visible on screen throughout. Ultrasound also allows tendons to be examined dynamically, in motion and under load, which a static scan cannot show.
How long does recovery take after an orthobiologic injection?
Most patients have soreness that settles fairly quickly, and plan on avoiding significant physical activity or sport for about a week. Anti-inflammatory medication such as ibuprofen or naproxen should be avoided afterwards because it blocks the inflammatory phase the treatment is deliberately trying to start; acetaminophen is fine. Progress is reviewed at scheduled intervals rather than left to the patient to arrange.
Related
- Platelet-rich plasma (PRP) injections
- Bone marrow aspirate concentrate (BMAC)
- Cartilage restoration — MACI, allograft, Agili-C
- Orthopedic regenerative medicine
- Orthobiologic research
- Don Buford, MD — board-certified orthopedic surgeon
- 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
