Beyond the Cortisone Shot: What Orthobiologics Can Do for Your Joints

By Ryan Bentley, MD, PhD, DC

Let me paint a picture you have probably lived. You have been dealing with knee pain, shoulder pain, hip pain, whatever it is, for months. Maybe years. You finally get in to see the doctor. They take a look, maybe order some imaging, and fifteen minutes later you are walking out with a cortisone injection and a follow-up in six weeks.

For the first couple of weeks, it feels like a miracle. The pain is gone. You are moving again. You start to think maybe this whole thing is behind you. And then, almost on cue, it comes back. Same spot. Same pain. Sometimes worse. Because the cortisone did exactly what it was designed to do; it suppressed the inflammation. It did not repair the tissue that was generating the pain in the first place.

Now, I am not going to sit here and tell you cortisone is the villain. It has its place. When a joint is acutely inflamed and you need to function, cortisone buys time. But that is all it does. It buys time. And here is the part that most patients are never told; it may actually be making the underlying problem worse.

I am not saying cortisone should never be used. If a patient comes to me with a joint that is beyond the point of regeneration and heading toward a joint replacement, I will absolutely use cortisone to manage pain while we plan for surgery. That is a perfectly appropriate use. But if we are trying to do anything regenerative — if the goal is to preserve cartilage, stimulate healing, or rebuild tissue — cortisone works against us. It suppresses the very inflammatory cascade that orthobiologic therapies depend on to initiate repair.

At some point, most patients land on the same question: Is there anything that actually helps the joint heal instead of just turning down the volume on the pain? The answer is yes. And at Vitalis-Health, orthobiologics are now a core part of how we approach joint and musculoskeletal care.

Your Body Already Knows How to Heal

This is the part that surprises most people, and honestly, it is one of the most fascinating things I get to talk about.

Your body produces roughly 100 billion platelets every single day. Not once in a while. Every day. Those platelets carry growth factors, signaling proteins, and repair molecules that are part of a healing system more sophisticated than anything a pharmaceutical company has ever built.

But platelets do more than signal. Each one carries five to eight mitochondria — the energy-producing structures inside your cells. In a single blood draw, we can concentrate billions of mitochondria available to be transferred to damaged cells at the treatment site. Platelets also release extracellular vesicles, including exosomes — tiny packages of genetic information and repair instructions that communicate directly with the cells around them. This is not a simple injection. It is a biological delivery system, and your body was designed to run it long before we figured out how to put it to work.

So the system is not broken. The problem is that when a joint or tendon has been degenerating slowly over months or years, the body’s natural repair response is often not loud enough to keep up with the damage. That is the idea behind orthobiologics. We take what your body already produces, concentrate it, and deliver it precisely where the tissue needs it most. We are not introducing anything foreign. We are turning up the volume on a process your body was already designed to run.

Platelet-Rich Plasma (PRP)

Platelet-rich plasma, or PRP, starts with a simple blood draw. We process your blood through a centrifuge to concentrate the platelets and their growth factors — including PDGF, TGF-beta, VEGF, and IGF-1 — then inject that concentrated solution directly into the injured tissue under ultrasound guidance. The result is a concentrated repair signal delivered exactly where your body needs it.

PRP is most commonly used for tendinopathy, early to moderate osteoarthritis, plantar fasciitis, tennis elbow, ligament injuries, and a range of musculoskeletal conditions where the tissue is damaged but structurally intact. When the structure is still there but the biology needs a push, PRP is often the right starting point.

Why Our PRP Is Different

For the better part of six years, I largely set PRP aside. I did not find it consistently effective, and I was not confident recommending it when the results felt like a coin flip. Looking back, the answer was staring me in the face. The issue was never PRP as a concept. The issue was the technology I was using to prepare it.

The system we use now is a dual-spin, supraphysiologic concentration system that achieves over 90% platelet recovery and gives us precise control over the final product. Many single-spin systems recover far fewer platelets and produce only two to three times baseline concentration. That is a meaningfully different product. And when a patient is investing real money and real hope into a treatment, the difference between a therapeutic dose and a subtherapeutic one matters a great deal.

Not All PRP Is the Same: Leukocyte-Poor vs. Leukocyte-Rich

Here is something most patients have never been told: not all PRP should contain the same cells. The white blood cells included in or excluded from the preparation change how the injection behaves once it reaches the tissue.

Leukocyte-poor PRP minimizes white blood cell content, particularly neutrophils. This is the safest formulation and the one we default to when treating joints, especially in patients with autoimmune conditions. In autoimmune disease, the immune cells are already biased toward inflammation — adding more of them is like throwing gasoline on a fire you are trying to put out.

Monocyte-rich PRP includes a specific population of white blood cells called monocytes. When platelets activate, they release both pro- and anti-inflammatory signals. When monocytes are present, they help convert those pro-inflammatory signals into fuel for repair — shifting from an M1 to an M2 macrophage phenotype. For most joint and tendon applications, this is our preferred formulation.

Leukocyte-rich PRP includes neutrophils, which drive angiogenesis — the formation of new blood vessels. This can be beneficial in acute soft tissue injuries and in tendons that have poor blood supply. However, it carries more inflammatory risk and has to be used selectively.

Protein-Rich Plasma

Most clinics discard the platelet-poor plasma left over after concentrating the platelets. They throw it away. We do not — because that plasma contains a family of powerful proteins that play critical roles in the healing process.

Using an ultrafiltration system, we concentrate those plasma proteins while filtering out small inflammatory molecules you do not want. What remains is a concentrated solution of:

• Fibrinogen — converts to fibrin at the injection site, creating a scaffold that holds growth factors in place for sustained release over weeks rather than minutes.
• Fibronectin — helps repair cells attach to the treatment site and activates key cartilage genes.
• Albumin — one of the most potent natural antioxidants in your body, reducing oxidative stress in the degenerating joint.
• Serpins — a family of protease inhibitors that neutralize the inflammatory enzymes driving cartilage breakdown in both osteoarthritis and rheumatoid arthritis pathways.

When we combine this concentrated protein solution with PRP, the result delivers growth factors, cellular signaling, anti-inflammatory protection, and a physical scaffold all in one injection. This is protein-rich PRP, and it represents the most complete formulation we can produce from a single blood draw.

Alpha-2-Macroglobulin (A2M)

Alpha-2-macroglobulin is a large protein concentrated from your own blood that traps and permanently neutralizes those destructive enzymes. It has a “bait region” that attracts the proteases — when the enzyme bites the bait, A2M forms a cage-like structure around it, locking it down for good.

This is why the order of operations matters. In a joint with active cartilage destruction, A2M is often the first step. We neutralize the destructive environment. Then, two to four weeks later, we deliver PRP into a joint that can actually use the repair signal. Construction starts after the demolition has stopped. That sequence gives the repair its best chance to hold.

Bone Marrow Aspirate Concentrate (BMAC)

BMAC takes the concept of orthobiologics into a different category. Rather than concentrating platelets and proteins from your blood, we harvest a small amount of bone marrow from the back of your pelvis under local anesthesia in the office.

Bone marrow contains mesenchymal stem cells — the precursor cells responsible for generating cartilage, connective tissue, and bone. It also carries a rich profile of growth factors and signaling molecules tied to structural repair. We always concentrate the aspirate; raw bone marrow has a very small percentage of stem cells per cc, and the clinical power comes from concentrating the entire cellular and molecular payload into a potent biological solution.

One feature of bone marrow stem cells is that they express a surface marker called CD106 (VCAM-1), which lets them interact directly with the inflammatory immune cells in an arthritic joint — helping regulate the inflammatory environment they land in.

When do we reach for BMAC? Moderate to advanced arthritis. Cartilage defects. Partial tendon tears. Bone marrow edema. Avascular necrosis before the bone has collapsed. BMAC is where we often turn when the damage is more advanced and the goal is cellular reinforcement rather than a growth factor signal alone.

Adipose-Derived Therapies (Fat)

Fat is one of the most misunderstood biologics in this space. Most people hear “fat injection” and picture something cosmetic. That is not what we are doing — not even close.

Adipose tissue is one of the most stem-cell-dense tissues in your body. Studies report it contains far more mesenchymal stem cells per volume than bone marrow — by some estimates hundreds of times more. And critically: fat is tissue, not fluid. When you inject bone marrow concentrate, it disperses with joint movement. When you inject processed fat, it maintains physical presence at the site — providing both regenerative signaling and structural support.

We process harvested fat into two forms:

• Microfat — retains the connective tissue scaffold, pericyte network, and stromal vascular fraction. Provides both structure and regenerative signaling. Preferred when a joint has lost volume or a tendon tear needs to be physically bridged.
• Nanofat — processed further to remove all intact fat cells while preserving stem cells and exosomes. Maximum regenerative signal in minimal volume. Preferred for small joints and combination protocols.

Combination Therapy and Why It Matters

This is where the different tools start to work together. Consider a partial rotator cuff tear with a gap where the tissue has pulled apart. PRP can help here on its own — when protein-rich PRP activates, its fibrinogen converts to fibrin and forms a scaffold that holds growth factors in place. But when the gap is larger, a fluid may not provide enough bulk. In that situation, we may add microfat, because fat is living tissue that can physically fill the space and deliver a dense population of stem cells.

Preparing the Soil Before Planting the Seeds

This is where our approach separates from most orthobiologic practices. You would not plant seeds in depleted, dehydrated soil and expect a harvest. The same principle applies to your body. If we inject a concentrated biologic into a patient who is sleeping poorly, chronically dehydrated, running on processed food, systemically inflamed, and taking medications that suppress the very healing cascade the injection needs to work — we have set that treatment up to underperform before we even uncapped the needle.

How well you sleep, how well you eat, how you manage stress, your metabolic health, your inflammatory status — all of it influences the environment that biologic lands in. Consider hydration alone. Well-hydrated connective tissue is supple and resilient, more like a fresh, well-marbled steak. Chronically dehydrated tissue is closer to beef jerky — dry and brittle and far less able to repair itself.

Some of what patients are taking — including things they consider healthy — can interfere with platelet function or suppress the inflammatory cascade the injection depends on. Others support the healing process and need to be timed correctly relative to the procedure. The details are different for every patient, and they all matter. This level of preparation is what separates an orthobiologic injection that delivers results from one that underperforms.

What Orthobiologics Are Not

They are not a cure for structural failure. A joint that has lost nearly all of its cartilage is a different situation than one showing early to moderate degeneration. Orthobiologics can be meaningful in the second scenario. In the first, surgery may genuinely be the right answer, and if it is, I will tell you that directly.

They are not fast. Most patients begin noticing improvement between four and eight weeks. The full biological response often takes three to six months, and for some treatments, peak benefit can take over a year. This is tissue remodeling, not symptom suppression. Patients who understand the timeline consistently have better outcomes.

They are not guaranteed. I do not promise outcomes the evidence does not support. What I can tell you is that for appropriately selected patients, with proper preparation and precise delivery, these therapies have helped many of the people I have cared for.

The Consultation: Where It All Comes Together

Everything I have described — the different biologics, the formulations, the combinations, the sequencing — exists as a toolkit. The question that actually matters is which tool, or which combination, is right for you. And that is not something an article can answer. It requires a conversation.

At your consultation, we review your imaging, your labs, your history, and your goals. We examine the joint. We assess where you are on the spectrum from early dysfunction to advanced structural change. And then we build a plan that matches the biology to the problem and the person.

All of our injections are performed under musculoskeletal ultrasound guidance. Image guidance improves injection accuracy from roughly 60% to over 95%. When you are working with concentrated biological materials, delivering them to the right anatomical location is one of the most important factors in whether the treatment works. We do not inject blind, because an inaccurate injection is a missed injection.

The Vitalis-Health Approach

What makes our program different is that we do not look at your knee, your shoulder, or your hip in isolation. We look at you. Your metabolic health, your inflammatory status, your nutritional foundation, and the specific biology of your joint all factor into the plan. Precise dosing, control over the cellular formulation, the protein-rich proteins most clinics discard, thoughtful combination and sequencing, patient optimization, and ultrasound-guided delivery — these are not add-ons for us. They are the standard.

We use the same principle here that guides everything we do at Vitalis-Health: health, not disease. The goal is always to understand the whole picture rather than chase the symptom that brought you through the door.

The body was designed with a remarkable capacity for self-repair. Every platelet, every stem cell, every protective protein circulating in your blood is evidence of a system built to heal. Orthobiologics do not replace that capacity. They concentrate it, focus it, and deliver it where it is needed most.

Common Questions About Orthobiologics

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References

1. Li YF, Xing HH, Wei CK, et al. Platelet-Rich Plasma Is More Effective Than Hyaluronic Acid Injections for Osteoarthritis of the Knee: A Meta-Analysis Based on Randomized, Double-blinded, Controlled Clinical Trials. Arthroscopy. Published online July 16, 2025. doi:10.1016/j.arthro.2025.06.033

2. Szwedowski D, Mobasheri A, Moniuszko A, Zabrzyński J, Jeka S. Intra-Articular Injection of Platelet-Rich Plasma Is More Effective than Hyaluronic Acid or Steroid Injection in the Treatment of Mild to Moderate Knee Osteoarthritis: A Prospective, Randomized, Triple-Parallel Clinical Trial. Biomedicines. 2022;10(5):991. doi:10.3390/biomedicines10050991

3. McAlindon TE, LaValley MP, Harvey WF, et al. Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis: A Randomized Clinical Trial. JAMA. 2017;317(19):1967-1975.

4. Bharadwaj UU, Lynch JA, Joseph GB, et al. Intra-articular Knee Injections and Progression of Knee Osteoarthritis: Data from the Osteoarthritis Initiative. Radiology. 2025;315(2):e233081. doi:10.1148/radiol.233081