A comprehensive guide to how your body’s own biology is reshaping the future of joint, tendon, and musculoskeletal care.

A New Era in Orthopedic Medicine

For decades, patients facing joint pain, tendon injuries, and degenerative musculoskeletal conditions had a limited set of choices: rest and physical therapy, anti-inflammatory medications, cortisone injections, or eventual surgery. Today, a fundamentally different approach is reshaping the landscape of orthopedic care — one that harnesses the body’s own extraordinary capacity to heal itself.

It all began at the Centeno-Schultz Clinic, a small, two-physician practice in Colorado. These innovators were the first in the world to inject stem cells derived from bone marrow to treat orthopedic conditions. Everybody doctor using stem cells in this capacity learned from somebody who learned from somebody who learned from somebody who learned from these two pioneers. Drs. Centeno and Schultz founded Regenexx in 2005, began publishing and built a world-class laboratory; they became the pre-eminent publishers of regenerative orthobiologics studies. Regenexx, as of 2026, has affiliated physicians in over 100 locations worldwide and remains the most trusted and published name in the field. Advanced PainCare and BioHealth Institute is proud to be a Regenexx affiliated office.

Regenerative medicine — and specifically Platelet-Rich Plasma (PRP) therapy and stem cell therapy — represents one of the most exciting frontiers in modern orthopedics. Rather than simply masking pain or surgically replacing damaged structures, these treatments aim to catalyze genuine biological repair at the cellular level. The concept is elegant: use concentrated healing agents derived from the patient’s own blood or tissue to stimulate the regeneration of cartilage, tendons, ligaments, and other structures that traditionally heal poorly on their own. This not only prevents or postpones surgery, but it also dramatically reduces the cost of care. Both direct treatment costs and indirect expenses such as those associated with lost time at work, cost of surgical complications, and cost of post-op care are reduced.  In fact, Regenexx has a Corporate Program that is serves as a benefit to health plans among self-insured business. Increasingly, businesses are impressed with the value of the regenerative orthopedic therapies to their employees and the associated cost savings.

Interest in these therapies has grown dramatically over the past decade, driven by professional athletes who have publicly credited PRP and stem cell injections with accelerating their recovery from otherwise career-threatening injuries, as well as by an aging population seeking alternatives to joint replacement surgery. But beyond the headlines, there is a growing and serious body of clinical research exploring when these treatments work, for whom, and why.

This guide is designed to give you a thorough, honest, and up-to-date understanding of both PRP and stem cell therapy for orthopedic conditions — how they work, what conditions they may benefit, what the treatment experience involves, and what the current science supports.

Platelet-Rich Plasma

What Is PRP Therapy and How Does It Work?

Platelet-Rich Plasma, commonly referred to as PRP, is a treatment derived directly from the patient’s own blood. The process begins with a simple blood draw — typically 30 to 60 milliliters, roughly the same amount used in routine lab work. That blood is then placed in a centrifuge, a machine that spins at high speed to separate its components by density.

Blood is composed of several distinct fractions: red blood cells, white blood cells, plasma (the liquid component), and platelets. Platelets are tiny, disc-shaped cell fragments best known for their role in clotting, but they are also extraordinary repositories of growth factors — proteins that signal the body to repair damaged tissue. When the centrifuge separates the blood, the result is a concentrated solution in which the platelet count may be three to twenty higher than in normal circulating blood, depending on the sophistication of the lab equipment and technician.

The Role of Growth Factors

The therapeutic power of PRP comes from the growth factors stored within platelets. When platelets are activated — either naturally at a wound site or artificially through processing — they release these factors in a coordinated cascade. Key growth factors found in PRP include Platelet-Derived Growth Factor (PDGF), which stimulates cell growth and tissue repair; Transforming Growth Factor-Beta (TGF-β), which plays a role in cartilage matrix synthesis; Vascular Endothelial Growth Factor (VEGF), which promotes the formation of new blood vessels to supply healing tissue; and Insulin-Like Growth Factor (IGF-1), which supports cell survival and proliferation.

Together, these signaling proteins create a biological environment that tells local cells — whether in a tendon, ligament, or joint — to divide, migrate, and build new matrix. In tissues that naturally receive poor blood supply (and therefore poor healing signals), such as cartilage and tendons, this concentrated influx of growth factors can be especially meaningful.

“PRP does not introduce anything foreign into the body. It is a concentrated version of the patient’s own healing biology, delivered precisely where repair is needed most.”

How Is PRP Administered?

Once prepared, PRP is injected directly into the target area — a knee joint, a torn tendon, a degenerative hip, or other affected structure — typically under ultrasound or fluoroscopic guidance to ensure precise placement. The entire process, from blood draw to injection, usually takes about an hour and is performed in an outpatient clinical setting. No general anesthesia is required, and most patients can drive themselves home.

Some mild soreness or swelling at the injection site is common in the days following treatment, as the concentrated platelets trigger an initial inflammatory response — which is, paradoxically, a sign that the “healing cascade” has been activated. Patients are generally advised to avoid anti-inflammatory medications like ibuprofen and steroids during this period, as they can blunt this intended response.

Common Orthopedic Uses for PRP

• Knee osteoarthritis (particularly mild to moderate)
• Knee meniscus tears
• Lateral epicondylitis (tennis elbow) and medial epicondylitis (golfer’s elbow)
• Rotator cuff tendinopathy and partial tears
• Patellar tendinopathy (jumper’s knee)
• Plantar fasciitis and Achilles tendinopathy
• Hip osteoarthritis and gluteal tendinitis
• Ligament sprains and partial tears ( knee and ankle ligaments)
• Spinal issues

Bone Marrow Derived Stem Cell Therapy: Regeneration at a Deeper Level

Stem cells taken from bone marrow operate on a more ambitious biological premise than PRP. While PRP delivers growth factors to stimulate the body’s existing cells, stem cell therapy introduces progenitor cells — cells with the remarkable capacity to differentiate into multiple specialized cell types — directly into damaged or degenerated tissue. In orthopedic applications, the goal is for these cells to participate in and direct rebuilding structures like cartilage, bone, tendon, and ligament.

It’s important to clarify what “stem cell therapy” means in the orthopedic context, because the term is sometimes used loosely and can cause confusion. The stem cells used in legitimate orthopedic regenerative medicine are typically mesenchymal stem cells (MSCs) — adult stem cells that can be isolated from several sources within the patient’s own body. This is distinct from embryonic stem cell research, which involves entirely different cell sources and ethical considerations, and is not relevant to the orthopedic applications discussed here.

Where Do Stem Cells Come From?

In most orthopedic applications, MSCs are harvested from two primary sources: bone marrow and adipose (fat) tissue. Each approach has its own procedural nuances and theoretical advantages.

Bone Marrow Aspirate Concentrate (BMAC) is obtained by drawing bone marrow — typically from the posterior iliac crest of the pelvis — using a specialized needle and local anesthesia. The marrow is then processed in a centrifuge to concentrate the stem cells and growth factors it contains. BMAC is considered by many clinicians to be a gold standard source of MSCs for orthopedic use, as bone marrow is naturally rich in stem cells and biologically active factors that support musculoskeletal healing.

Adipose-derived stem cells are harvested via a minimally invasive lipoaspirate procedure — essentially a small, targeted liposuction. Fat tissue contains a high concentration of MSCs, often more abundant than bone marrow per volume harvested. Once collected, the fat is processed to isolate what is called the Stromal Vascular Fraction (SVF), a rich mixture of stem cells, growth factors, and supportive cells.

What Stem Cells Do in Orthopedic Tissue

When injected into a damaged joint or tissue, MSCs do not simply transform into new cartilage cells and replace lost tissue in a simple one-to-one fashion. The biological reality is more nuanced and, if anything, more interesting. Research suggests that MSCs exert much of their therapeutic effect through paracrine signaling — releasing bioactive molecules that modulate the local environment, reduce chronic inflammation, recruit the body’s own repair cells, and create conditions more favorable to tissue regeneration.

MSCs also have immunomodulatory properties, meaning they can help calm the dysregulated inflammatory environment that characterizes conditions like osteoarthritis — a chronic state of low-grade joint inflammation that impairs the body’s natural attempts at self-repair. By addressing this inflammatory milieu, stem cell therapy may slow the progression of degeneration even in cases where frank regeneration of cartilage is limited.

Common Orthopedic Uses for Stem Cell Therapy

• Moderate to advanced knee osteoarthritis
• Hip osteoarthritis, including avascular necrosis (early to mid-stage)
• Shoulder osteoarthritis and rotator cuff pathology
• Spinal disc degeneration and facet arthritis
• Partial or full-thickness tendon tears
• Cartilage defects (focal chondral lesions)
• Non-union fractures or slow-healing bone injuries
• Ankle arthritis

Orthopedic Conditions That May Benefit

Osteoarthritis of the Knee, Hip, and Shoulder

Osteoarthritis (OA) is the most common joint disease worldwide, characterized by the gradual breakdown of articular cartilage, the smooth tissue that cushions the ends of bones within a joint. Cartilage has extremely limited regenerative capacity — it lacks its own blood supply and contains few resident stem cells — which is why OA has traditionally been viewed as an inevitably progressive condition manageable only through pain control and, ultimately, joint replacement.

Both PRP and stem cell therapies have shown promise in altering this trajectory, particularly in earlier stages of disease. Multiple randomized controlled trials have found that PRP injections produce greater and more durable improvements in pain and function than hyaluronic acid or corticosteroid injections in knee OA. Stem cell injections, particularly BMAC, have shown potential for both symptom relief and, in some studies, evidence of cartilage preservation or modest regeneration on MRI.

The latest research by Dr. Hernigou, a pioneer in the use of bone marrow derived stem cells in joint degeneration and the Medical Director of Clinical Research at Regenexx indicates that injecting the stem cells directly into bone beneath the cartilage gives better results than injecting the cells into the joint alone. His date shows that with intraosseous (into the bone) injections, 85% of patients can avoid total knee replacement for up to 10 years.  At a Regenexx office, this is standard care.

Tendon and Ligament Injuries

Tendons and ligaments are notoriously slow healers. Like cartilage, they receive limited blood supply, and when injured — whether through acute trauma or cumulative overuse — they tend to repair with inferior scar tissue rather than true regeneration of the original structured collagen. This is why conditions like chronic tennis elbow, rotator cuff tendinopathy, patellar tendinopathy, and Achilles tendinopathy often persist for months or years despite conventional treatment.

PRP has become one of the most studied regenerative interventions for tendinopathy, and the evidence — while still evolving — is arguably strongest in this category. The growth factors in PRP appear to stimulate tendon cell activity and collagen synthesis in ways that may facilitate more complete healing of the tendon matrix. For chronic lateral epicondylitis (tennis elbow) in particular, multiple studies have shown PRP to be superior to corticosteroid injection for long-term outcomes, with effects that improve over weeks to months as the tissue remodels.

Rotator Cuff Pathology

The rotator cuff — a group of four muscles and their tendons that stabilize and move the shoulder — is one of the most commonly injured structures in the body. Partial-thickness tears, in particular, occupy a frustrating clinical middle ground: too significant to simply ignore, yet often not severe enough to warrant surgical repair. PRP and, in selected cases, stem cell therapy offer a potential bridge — providing biological stimulus to encourage partial tears to heal without surgery, or to optimize outcomes when surgery is ultimately performed. Keep in mind, that rotator cuff tears retracted over 1cm are not treatable by today’s regenerative orthobiologics. Surgery still has a place here, especially when strength and range of motion of the shoulder are compromised.

Spinal Conditions

Intervertebral disc degeneration is a significant and growing source of back and neck pain. The disc, like cartilage, is an avascular structure with minimal self-repair capacity. Early research into intradiscal PRP and stem cell injections is exploring whether regenerative therapies can restore disc height, improve disc hydration, and reduce pain — potentially delaying or avoiding the need for spinal fusion surgery. This application remains more experimental than joint-based uses, but early results are encouraging in carefully selected patients.

PRP vs. Stem Cell Therapy: Which Is Right for You?

PRP and stem cell therapy are often discussed together as “regenerative medicine,” but they are distinct treatments with different mechanisms, procedural complexity, cost profiles, and appropriate indications. Understanding the differences helps set realistic expectations and guides intelligent shared decision-making with your physician.

Option A
Platelet-Rich Plasma (PRP)

Derived from a simple blood draw. Less invasive, shorter procedure, lower cost. Best suited for tendinopathies, mild-to-moderate OA, and acute tissue injuries. Typically 1–3 injections. Results develop gradually over 6–12 weeks as tissue remodels.

Option B
Stem Cell Therapy (BMAC / SVF)

Requires harvest from bone marrow or fat — a more involved procedure under local anesthesia. Higher biological complexity and cost. Best suited for moderate-to-advanced OA, larger structural defects, and cases where PRP alone may be insufficient. Often used as a single, higher-potency treatment.

In practice, these therapies are sometimes used in combination — PRP may be added to a stem cell injection to provide an enriched growth factor environment that supports the introduced cells. Many clinicians also use PRP as an initial treatment, reserving stem cell therapy for patients who do not achieve adequate response or who present with more advanced pathology from the outset.

Cost is a practical consideration. Neither PRP nor stem cell therapy is typically covered by health insurance in the United States. Insurers make their coverage determinations based on their bottom line, not necessarily what’s best for the patient. PRP injections may range from several hundred to several thousand dollars per treatment, while stem cell procedures are substantially more expensive. Transparent communication about costs — and about the realistic likelihood of benefit — is an essential part of ethical practice in this space. Most practice offer payment and financing options so that you can invest in your health with reasonable monthly payments.

What to Expect Before, During, and After Treatment

Before Treatment

A thorough evaluation is the essential starting point. Your orthopedic provider should review your full medical history, examine the affected area, and review relevant imaging — typically X-rays and often MRI — to characterize the extent and nature of the pathology. This evaluation determines not only whether you are a candidate for regenerative therapy, but which type is most appropriate, and how the injection should be targeted.

In the weeks before treatment, you will typically be asked to stop taking non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen, as well as certain supplements like fish oil and vitamin E, which can affect platelet function. Corticosteroid injections to the target area should generally be avoided for a month prior. These steps are taken to optimize the biological activity of the PRP or stem cells.

The Day of Treatment

For a PRP procedure, the clinical visit typically takes 45 to 90 minutes. Blood is drawn, spun in the centrifuge, and the resulting PRP is prepared and loaded into a syringe. The injection is usually performed with ultrasound or fluoroscopic guidance — real-time imaging that allows the clinician to visualize the needle tip and confirm accurate placement within the target tissue. The injection itself takes only a moment.

For a BMAC stem cell procedure, the visit is longer —around three hours. The harvest from the iliac crest is performed under local anesthesia, the marrow aspirate is processed, and the resulting concentrate is then injected into the target site. There is some procedural soreness at the harvest site for several days.

Recovery and Timeline

Recovery from regenerative injections is generally manageable and does not require the downtime associated with surgery. However, patients should understand that these are not instant-relief treatments. The biological process of tissue repair and remodeling takes time — typically weeks to months. Most patients begin to notice meaningful improvement between six and twelve weeks after treatment, with maximum benefit sometimes not fully apparent until four to six months post-injection.

Activity modification is typically recommended in the early weeks following treatment — avoiding high-impact loading of the treated area while the repair process is underway. Physical therapy is often recommended in parallel, both to protect the treated tissue and to optimize functional recovery as it heals. Anti-inflammatory medications should generally be avoided for several weeks after treatment for the same reason they are paused before it.

The Conversation to Have With Your Provider

If you are considering PRP or stem cell therapy, the most important step is a thorough consultation with a physician who specializes in regenerative medicine. Key questions to ask include:

• What specific protocol will be used, and what does the evidence show for this protocol in my condition?
• How many treatments are anticipated?
• What outcomes are realistic for someone with my degree of disease?
• Is image guidance used in every injection?
• Will you be using IO (intraosseous) injections for advanced arthritis of the knee or hip?
• Will a MD or DO be performing my procedure or will it be a physician extender?
• How concentrated will my platelets be? (Offices using a beside centrifuges cannot concentrate platelets or stem cells like a Regenexx facility can.)

A provider who engages thoughtfully with these questions, acknowledges the limits of what regenerative therapy can achieve, and places your long-term wellbeing ahead of any particular treatment modality is the partner you want in navigating this decision.

Regenerative orthopedics represents a genuinely exciting evolution in how we care for musculoskeletal conditions. PRP and stem cell therapy are not miracle treatments, but they are real, biologically grounded interventions with a growing evidence base and a strong safety profile when administered by trained specialists. For the right patient, at the right stage of disease, with realistic expectations, they offer something that conventional medicine has long struggled to provide: the possibility of meaningful biological healing, rather than just symptomatic management.

As the science continues to mature — with better-characterized preparations, more precise delivery techniques, and larger clinical trials — the role of regenerative therapies in orthopedic medicine will only become clearer and more refined. This is a field worth watching, and for many patients, one worth exploring carefully with the guidance of a knowledgeable specialist.

Medical Disclaimer: The information provided in this article is intended for general education purposes only and does not constitute medical advice. PRP and stem cell therapies may not be appropriate for every patient or every condition. Outcomes vary based on individual health status, disease severity, and other factors. Always consult with a qualified, board-certified physician before making any decisions about medical treatment. This content does not establish a physician-patient relationship.