Regenerative medicine has changed the way we approach many orthopedic injuries. Instead of simply masking pain with medication or removing damaged tissue surgically, orthobiologic treatments use substances derived from the patient’s own body with the goal of supporting healing and improving the biological environment surrounding an injury.
Two of the most commonly discussed treatments are Platelet Rich Plasma (PRP) and what patients often refer to as stem cell therapy. Although these treatments are frequently grouped together, they are not the same thing, and choosing between them should depend on the tissue being treated, the severity of the injury, and the underlying diagnosis.
At Compass Pain and Wellness, we don’t start by asking whether a patient needs PRP or cellular therapy. We start by asking a more important question: What tissue is actually injured, and what is the most appropriate biologic for treating it?
What Is Platelet Rich Plasma?
Platelet Rich Plasma, or PRP, is produced from a patient’s own blood. A blood sample is drawn and processed to concentrate platelets and other components of plasma before the resulting preparation is precisely injected into the targeted tissue.
Platelets are best known for their role in blood clotting, but they also contain numerous growth factors and signaling molecules involved in inflammation, tissue repair, and healing. PRP concentrates these components and delivers them directly to an injured area.
PRP has been studied across a growing range of musculoskeletal conditions. In knee osteoarthritis, for example, the American Academy of Orthopaedic Surgeons states that PRP may reduce pain and improve function, although the strength of its recommendation remains limited because PRP preparations and study results vary considerably.[1]
Depending on the diagnosis, PRP may be considered for conditions involving:
- Tendons and tendon attachments
- Ligaments
- Mild to moderate osteoarthritis
- Selected meniscal injuries
- Rotator cuff and other shoulder pathology
- Tennis or golfer’s elbow
- Patellar and quadriceps tendinopathy
- Achilles tendinopathy
- Plantar fascia injuries
- Selected spinal and sacroiliac conditions
The important distinction is that PRP is not simply an injection for pain. The objective is to place the appropriate PRP preparation precisely into the tissue believed to be contributing to the patient’s condition.
What Patients Call “Stem Cell Therapy”
The term stem cell therapy is often used loosely in regenerative medicine.
One autologous procedure used in orthobiologic practice is bone marrow aspirate concentrate, or BMAC. Bone marrow is typically aspirated from the patient’s pelvis and processed to create a concentrated preparation containing a mixture of platelets, growth factors, cytokines, hematopoietic cells, progenitor cells, and a relatively small population of mesenchymal stromal/stem cells.[2]
That distinction matters. BMAC should not be thought of as a syringe filled exclusively with stem cells. Its potential biological effects are thought to involve interactions among numerous cellular and signaling components.
BMAC has been particularly studied for orthopedic conditions such as knee osteoarthritis. A 2024 systematic review of eight randomized controlled trials involving 937 patients found that patients receiving BMAC experienced significant improvement from baseline, with some pain outcomes favoring BMAC over hyaluronic acid at six and twelve months.[3] However, researchers continue to emphasize that the optimal indications for BMAC remain incompletely defined.[2]
When Do We Use PRP?
For many orthopedic injuries, PRP is our first-line orthobiologic.
This is particularly true when the primary problem involves a tendon, ligament, or relatively focal soft-tissue injury. PRP allows us to deliver concentrated autologous platelets and their associated signaling molecules directly to the injured structure without requiring a bone marrow harvest.
The decision is not based simply on where it hurts. A patient with knee pain, for example, might have patellar tendinopathy, ligament injury, meniscal pathology, osteoarthritis, or a combination of several problems. Each represents a different biological and mechanical problem.
That is why the diagnosis comes first.
When Might We Consider BMAC?
BMAC is generally a more involved procedure than PRP because it requires harvesting bone marrow before preparing and injecting the concentrate.
In our practice, it may be considered when we are treating more substantial degenerative or structural pathology, particularly when the clinical picture suggests that PRP alone may not be the most appropriate orthobiologic option.
Examples may include selected patients with:
- Moderate to advanced joint degeneration
- More substantial cartilage damage
- Complex knee pathology involving multiple structures
- Selected osteochondral injuries
- Certain more significant tendon or ligament injuries
- Conditions that have failed more conservative orthobiologic treatment
Importantly, “more powerful” does not automatically mean “more appropriate.” A relatively isolated tendon injury does not necessarily require BMAC simply because it is a more involved procedure. Conversely, a severely degenerative joint may require a different strategy than a small focal tendon injury.
The objective is to match the treatment to the pathology.
PRP vs. BMAC: It Isn’t a Competition
Patients frequently ask which treatment is better: PRP or BMAC.
The better question is: Better for what?
A hammer isn’t better than a screwdriver. Each is useful when applied to the right problem.
The same principle applies to orthobiologics. PRP can be an excellent option for certain tendon, ligament, and joint conditions. BMAC may make more sense for selected patients with more substantial degenerative or structural pathology. In other cases, neither treatment may be appropriate.
And sometimes the most effective treatment strategy involves more than one component.
A patient with knee osteoarthritis, for example, may have cartilage degeneration inside the joint while simultaneously having an injured meniscus, weakened ligamentous structures, altered joint mechanics, and muscular dysfunction. Simply injecting one substance into the center of the knee does not necessarily address every component contributing to that patient’s symptoms.
The Injection Is Only as Good as the Diagnosis
This is one of the most important principles in regenerative medicine.
The biologic itself is only part of the treatment.
Where it is placed matters. What concentration is used matters. The tissue being targeted matters. The patient’s underlying diagnosis matters. And the physician’s ability to identify and precisely reach that structure matters.
At Compass, regenerative procedures are performed using advanced image guidance, including diagnostic ultrasound and fluoroscopy when appropriate. This allows us to identify individual tendons, ligaments, joints, nerves, and other anatomical structures and place treatment where it is actually intended to go.
The goal isn’t simply to perform a “PRP injection” or a “stem cell injection.”
The goal is to identify the injured structures, understand how those structures function together, and develop a treatment strategy around the patient’s specific pathology.
There Is No Universal “Best” Regenerative Treatment
Regenerative medicine works best when it is practiced as medicine, not as a product.
PRP isn’t automatically better because it is simpler. BMAC isn’t automatically better because it is more involved. And neither should be recommended simply because a patient has pain in a particular joint.
At Compass Pain and Wellness, we use examination, advanced imaging, diagnostic ultrasound, and other testing when appropriate to determine what is actually generating a patient’s symptoms. From there, we can determine whether PRP, autologous cellular therapy, another treatment, or a combination of approaches makes the most sense.
The right biologic. The right diagnosis. The right location.
That’s the difference between simply injecting a regenerative product and practicing regenerative medicine.
A Note About “Stem Cells”
The term “stem cell therapy” is widely used by patients and throughout the regenerative medicine industry, but it can be misleading. BMAC is a complex autologous bone-marrow preparation containing many cellular and signaling components, only a small proportion of which are mesenchymal stromal/stem cells.
Patients should also understand that the FDA states that stem cell products are not FDA-approved for orthopedic conditions such as osteoarthritis, tendonitis, disc disease, or back, knee, hip, shoulder, or neck pain. Patients should be particularly cautious of clinics marketing off-the-shelf umbilical cord, Wharton’s jelly, amniotic, exosome, or other products as FDA-approved “stem cell” treatments for orthopedic conditions.[4]
References
[1] American Academy of Orthopaedic Surgeons. Management of Osteoarthritis of the Knee (Non-Arthroplasty): Platelet-Rich Plasma. AAOS Clinical Practice Guideline. PRP may reduce pain and improve function in symptomatic knee osteoarthritis; strength of recommendation: limited.
[2] Management of knee osteoarthritis using bone marrow aspirate concentrate: a systematic review. British Medical Bulletin. 2025;153(1).
[3] Han JH, et al. Bone Marrow Aspirate Concentrate Injections for the Treatment of Knee Osteoarthritis: A Systematic Review of Randomized Controlled Trials. Orthopaedic Journal of Sports Medicine. 2024.
[4] U.S. Food and Drug Administration. Consumer Alert on Regenerative Medicine Products Including Stem Cells and Exosomes.
