What goes into orthobiologic care made from body material?

What does PRP put into my joint?

PRP means platelet-rich plasma, your blood with extra tiny pieces that form clots. A machine spins the blood to separate that portion for use.

Concentrated PRP uses the same blood draw and spinning step. The final portion can hold varying levels of platelets and white cells.

A written treatment name won't tell you those amounts. It's reasonable to ask which preparation method the clinic uses.

What is a bmac injection made from?

BMAC uses marrow taken from the pelvis and spun down; its full name is bone marrow aspirate concentrate. The prepared portion then goes into the aching joint.

This procedure asks more of you than a blood draw. Local anaesthetic is used, and sedation is sometimes used too.

For soreness, QC Kinetix offers biologic therapies, meaning your exam comes first and medical providers prepare either blood or marrow. The clinic can explain why it suggests one material for you.

Which choices involve more preparation?

A fat-based procedure first removes a small amount from under your skin. Donor tissue arrives prepared, so nothing is taken from your body.

Marrow and fat leave another sore area where material was removed. A blood draw doesn't involve that extra healing.

The useful questions are what goes into your joint and why. You'll also want to know what must be removed from your body.

Sources

1. FDA states verbatim of stem cell products, stromal vascular fraction (adipose-derived cells), umbilical cord blood, Wharton's jelly, amniotic fluid and exosome products: 'None of these products have been approved for the treatment of any orthopedic condition, such as osteoarthritis, tendonitis, disc disease, tennis elbow, back pain, hip pain, knee pain, neck pain, or shoulder pain.' The only FDA-approved stem cell products in the United States are blood-forming (hematopoietic progenitor) cells derived from umbilical cord blood, approved only for disorders of blood production, and there are currently NO FDA-approved exosome products.

   U.S. Food and Drug Administration — Consumer Alert on Regenerative Medicine Products Including Stem Cells and Exosomes. FDA (Center for Biologics Evaluation and Research), 2020.

2. FDA's July 2020 final guidance 'Regulatory Considerations for Human Cells, Tissues, and Cellular and Tissue-Based Products: Minimal Manipulation and Homologous Use' is the document that decides whether a given orthobiologic can be used without a licence: an HCT/P may be regulated solely under section 361 only if it is minimally manipulated AND intended for homologous use, among other criteria; otherwise it is a drug or biological product requiring an approved licence or an active investigational new drug application.

   U.S. Food and Drug Administration — Regulatory Considerations for Human Cells, Tissues, and Cellular and Tissue-Based Products: Minimal Manipulation and Homologous Use - Guidance for Industry and Food and Drug Administration Staff. FDA Guidance Document, 2020.

3. A randomized controlled trial compared a SINGLE ultrasound-guided injection of leukocyte-rich PRP (n=30) with micro-fragmented adipose tissue (n=28) in KL 1-4 knee OA. Both groups improved clinically meaningfully from baseline, and there was no significant difference in the primary outcome (KOOS-Pain at 6 months: 80.38 vs 81.61; P=.67) or in any other score - despite MFAT requiring a lipoaspiration procedure and PRP requiring only a blood draw.

   Baria M, et al. — Platelet-Rich Plasma Versus Microfragmented Adipose Tissue for Knee Osteoarthritis: A Randomized Controlled Trial.. Orthopaedic Journal of Sports Medicine, 2022. DOI: 10.1177/23259671221120678.

4. A phase III double-blind placebo-controlled trial of a SINGLE injection of culture-expanded autologous adipose-derived MSCs in 261 patients with KL grade 3 knee OA found significantly better VAS pain (25.2 vs 15.5 mm improvement; P=.004) and total WOMAC (21.7 vs 14.3; P=.002) at 6 months versus placebo, with no serious treatment-related adverse events - but MRI showed NO significant difference in cartilage-defect change between groups. Culture-expanded cells of this kind are a drug in the United States and are not available outside a trial.

   Kim KI, et al. — Clinical Efficacy and Safety of the Intra-articular Injection of Autologous Adipose-Derived Mesenchymal Stem Cells for Knee Osteoarthritis: A Phase III, Randomized, Double-Blind, Placebo-Controlled Trial.. American Journal of Sports Medicine, 2023. DOI: 10.1177/03635465231179223.

5. The ADIPOA2 phase 2b trial randomised 135 patients with mild-to-moderate knee OA to low-dose (2 million) or high-dose (10 million) culture-expanded autologous adipose-derived stromal cells or saline placebo. At 6 months 47.3% of ADSC patients were OARSI/OMERACT strict responders versus 54.8% on placebo (relative risk 0.86; P=.46), and no secondary outcome differed significantly. A single injection of expanded adipose stromal cells did NOT improve pain or function versus saline.

   Pers YM, et al. — Effect of intra-articular adipose-derived mesenchymal stromal cell versus placebo injection on pain and function in patients with knee osteoarthritis: the ADIPOA2 phase 2b randomised clinical trial.. Annals of the Rheumatic Diseases, 2025. DOI: 10.1016/j.ard.2025.07.026.

6. A meta-analysis of 27 Level I studies (1,042 PRP, 226 BMAC, 1,128 HA patients) found significantly better post-injection WOMAC, VAS and subjective IKDC scores for BOTH PRP and BMAC compared with hyaluronic acid - and NO significant difference between PRP and BMAC on any outcome score. This is the clearest published statement that the two most-marketed orthobiologics perform the same as each other in the knee.

   Belk JW, et al. — Patients With Knee Osteoarthritis Who Receive Platelet-Rich Plasma or Bone Marrow Aspirate Concentrate Injections Have Better Outcomes Than Patients Who Receive Hyaluronic Acid: Systematic Review and Meta-analysis.. Arthroscopy, 2023. DOI: 10.1016/j.arthro.2023.03.001.

7. The companion ESSKA-ORBIT consensus on cell-based therapy (77 experts, 22 countries, 27 statements) found only 5 of 27 statements reached recommendation level A or B; 22 were rated C or D. It concluded that cell-based therapy shows clinical benefit in pain and function up to 12 months for KL grades 1-3 with some benefit in selected KL 4, but that because of limited high-quality studies and NO clear superiority over other injectables it should be considered a SECOND-LINE option, after other non-operative treatment fails.

   de Girolamo L, et al. — The use of injectable orthobiologics for knee osteoarthritis: A formal ESSKA-ORBIT consensus. Part 2-Cell-based therapy.. Knee Surgery, Sports Traumatology, Arthroscopy, 2025. DOI: 10.1002/ksa.70001.

8. FDA's patient and consumer notice on regenerative medicine states that it has received reports of BLINDNESS, TUMOUR FORMATION, neurological events, bacterial infections including life-threatening blood infections, unwanted immune reactions, and cells migrating and forming unintended tissue, following the use of unapproved regenerative medicine products - a list that explicitly includes stromal vascular fraction, amniotic fluid, Wharton's jelly, ortho-biologics and exosomes. It also warns that a product's presence on clinicaltrials.gov, or a firm's registration with FDA, does NOT mean the product is legally marketed.

   U.S. Food and Drug Administration — Important Patient and Consumer Information About Regenerative Medicine Therapies. FDA (Center for Biologics Evaluation and Research), 2021.

9. A multicenter single-blind RCT randomised 200 patients 1:1:1 to a single injection of saline, hyaluronic acid or amniotic suspension allograft. ASA produced significant KOOS and VAS improvements maintained through 12 months with a 63.2% OMERACT-OARSI responder rate, no radiographic differences, and no concerning immunoglobulin or anti-HLA responses. Adverse events with ASA were comparable to HA, while NO treatment-emergent adverse events were reported in the saline group.

   Gomoll AH, et al. — Safety and Efficacy of an Amniotic Suspension Allograft Injection Over 12 Months in a Single-Blinded, Randomized Controlled Trial for Symptomatic Osteoarthritis of the Knee.. Arthroscopy, 2021. DOI: 10.1016/j.arthro.2021.02.044.

10. The largest head-to-head trial of cell-based orthobiologics to date randomised 480 patients with KL II-IV knee OA across four arms: autologous bone marrow aspirate concentrate, autologous adipose stromal vascular fraction, allogeneic umbilical cord tissue-derived MSCs, and a corticosteroid injection control. At 12 months NONE of the three orthobiologic injections was superior to another or to the corticosteroid control on either co-primary endpoint (VAS pain, KOOS pain), and none of the four groups showed a significant change in MRI osteoarthritis score from baseline. No procedure-related serious adverse events were reported.

    Mautner K, et al. — Cell-based versus corticosteroid injections for knee pain in osteoarthritis: a randomized phase 3 trial.. Nature Medicine, 2023. DOI: 10.1038/s41591-023-02632-w.