Comparing Biological Therapies for the Treatment of Knee Osteoarthritis

Categories: Musculoskeletal Health Tags: BMAC, Hyaluronic Acid, Knee Osteoarthritis, MFAT, PRP, Regenerative Medicine Posted on: 11-Aug-2025

Knee osteoarthritis (OA) is a degenerative joint disease that leads to cartilage loss, pain, stiffness, and functional decline. While joint replacement remains a final option for severe cases, many patients seek less invasive solutions that can relieve symptoms and delay or prevent surgery. Regenerative and orthobiologic therapies have emerged as promising options, offering tissue-supportive and anti-inflammatory effects. This article compares four common injectable treatments, hyaluronic acid (HA), platelet-rich plasma (PRP), microfragmented adipose tissue (MFAT), and bone marrow aspirate concentrate (BMAC), in the management of knee OA.

Hyaluronic Acid: Viscosupplementation and Lubrication

HA is a synthetic or biologically derived polysaccharide that mimics the natural lubricants in synovial fluid. It is typically used in mild to moderate OA, aiming to reduce friction and provide cushioning within the joint. Some patients report moderate symptom relief for several months. However, HA has limited ability to address underlying inflammation or promote tissue repair. Multiple large meta-analyses suggest the effects are modest at best, especially when compared to regenerative therapies.

Platelet-Rich Plasma: Anti-inflammatory and Anabolic Effects

PRP is derived from the patient’s own blood and contains a concentrated mixture of platelets, growth factors, and cytokines. These bioactive molecules support cellular signaling, reduce inflammation, and stimulate the healing environment within the joint. PRP is particularly effective in early to moderate OA, with several randomized trials demonstrating superior pain relief and function compared to HA injections. Leucocyte-poor PRP tends to produce better outcomes in joint pathology, as it minimizes pro-inflammatory responses. Effects typically last 6 to 12 months, with repeat treatments sometimes needed.

Microfragmented Adipose Tissue (MFAT): Structural and Biologic Support

MFAT is processed lipoaspirate that retains the native stromal vascular fraction, a rich source of pericytes and mesenchymal progenitor cells. It serves as a biologic scaffold and delivers anti-inflammatory, immunomodulatory, and matrix-supporting elements to the damaged joint. MFAT may be particularly useful in moderate to severe OA, where tissue breakdown and chronic inflammation are more pronounced. Emerging studies show longer-lasting benefits compared to PRP and HA, especially in patients with cartilage thinning or mechanical overload. MFAT is often performed as a one-time outpatient procedure with durable results.

Bone Marrow Aspirate Concentrate (BMAC): Cellular Regeneration and Immunomodulation

BMAC contains mesenchymal stem cells, hematopoietic progenitors, cytokines, and growth factors extracted through a tiny hole in the patient’s bone. It has potent immunoregulatory effects and may help modulate the degenerative environment of the osteoarthritic knee. BMAC also promotes angiogenesis and supports cartilage matrix preservation. Clinical studies suggest that BMAC provides more substantial improvements in pain, function, and joint structure than HA or PRP, especially in advanced OA. However, outcomes can vary based on cell yield and processing technique, and BMAC requires a higher level of procedural expertise.

Choosing the Right Option Based on Severity and Goals

Early OA: PRP offers the best combination of safety, efficacy, and cost-effectiveness.
Mild to Moderate OA: MFAT or BMAC may offer longer-lasting results with fewer repeated injections.
Advanced OA: BMAC may have the greatest potential to reduce symptoms and improve function, particularly when joint replacement is not yet desired.

Integrated Rehabilitation Maximizes Outcomes

Regardless of the injectable used, results are enhanced by integrating physical therapy, strength training, weight optimization, and biomechanical correction. Regenerative therapies do not replace mechanical alignment or functional retraining but rather amplify the body’s capacity to heal.

Conclusion

Knee osteoarthritis no longer means choosing between pills and surgery. Regenerative therapies such as PRP, MFAT, and BMAC offer real, evidence-based alternatives that reduce pain and support joint health. Each option has unique advantages depending on the severity of arthritis, patient goals, and clinical findings. Want to explore the right treatment plan for your knees? Contact Us

References

Filardo, G., et al. (2015). Platelet-rich plasma intra-articular knee injections show no superiority versus viscosupplementation. The American Journal of Sports Medicine, 43(7), 1575–1582.

Cole, B. J., et al. (2021). Clinical outcomes of microfragmented adipose tissue in knee osteoarthritis: A prospective, multicenter study. The American Journal of Sports Medicine, 49(6), 1523–1531.

Shapiro, S. A., et al. (2017). A prospective, single-blind, placebo-controlled trial of bone marrow aspirate concentrate for knee osteoarthritis. The American Journal of Sports Medicine, 45(1), 82–90.

Anil, U., et al. (2021). Evidence of clinical efficacy of intra-articular biologic therapies for knee osteoarthritis: A systematic review. Cartilage, 13(1_suppl), 82S–103S.