Where to See Dr. Tortland in Connecticut
Dr. Paul Tortland, DO provides comprehensive orthopedic evaluations for patients at his Glastonbury, CT office. The practice sees patients from Glastonbury, Hartford, West Hartford, Farmington, Simsbury, South Windsor, and other Connecticut and New England communities.
📍 59 Sycamore Street, Suite 301, Glastonbury, CT 06033 — Get directions
📞 (860) 430-2821
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Direct answer: Bone marrow aspirate concentrate (BMAC) is a same-day, in-office procedure that uses a small amount of your own bone marrow, drawn from the back of the pelvis, concentrated, and injected under image guidance into an arthritic joint or damaged tissue. Many patients with knee osteoarthritis report less pain and better function afterward. However, BMAC has not been shown to regrow cartilage, and the best-designed trials have not shown it to outperform other injections.
What BMAC Is, and Why "Stem Cell" Is Only Part of the Story
Bone marrow contains a mix of cells: a small population of mesenchymal stromal cells (often called "stem cells"), along with platelets, white blood cells, and signaling proteins. BMAC concentrates that whole mix into a small injectable volume. Only a small fraction of the concentrated cells are mesenchymal stromal cells, which is why many physicians describe BMAC as a cellular orthobiologic rather than a "stem cell treatment."
Current thinking is that most of BMAC's effect comes from signaling. The concentrate influences inflammation and the chemical environment inside a joint. It does not work by new cells turning into new cartilage. That distinction matters for setting realistic expectations.
Because the cells come from you and are processed and returned during the same visit, BMAC belongs to a different category from the commercial donor-tissue products sold as "stem cells." Our article on real vs. commercial stem cell products explains that difference in detail.
How the Procedure Works
- Evaluation comes first. Every new patient's initial visit is scheduled for at least an hour and includes a live musculoskeletal ultrasound exam, so candidacy is decided on examination and imaging, not over the phone.
- Harvest. Marrow is drawn from the back of the pelvis (the posterior iliac crest) after the area is numbed with local anesthetic.
- Processing. The marrow is concentrated on site during the same visit.
- Injection. Dr. Tortland personally delivers the concentrate under image guidance to the specific joint or tissue being treated.
- Time. Plan on 2 to 3 hours for the entire visit.
For arthritis, a cellular procedure is often followed by a PRP procedure roughly 4 to 6 weeks later as part of the overall treatment plan.
Who May Be a Candidate
BMAC is most often considered for:
- Mild to moderate osteoarthritis of the knee, hip, or shoulder, where meaningful joint space and cartilage remain
- Patients who have already tried physical therapy, activity changes, and weight management where relevant
- Patients whose response to PRP was limited or short-lived
- Patients hoping to delay or avoid joint replacement who understand the limits described below
- Selected degenerative tendon problems and partial ligament injuries
In our practice, patients referred for BMAC often have already tried a round of PRP or a corticosteroid injection that gave some relief but not enough to last, which is a pattern we see regularly. BMAC is generally a poor fit for end-stage, bone-on-bone arthritis with deformity, joints with mechanical instability, and completely torn or retracted tendons. Some medical conditions and medications also affect whether a marrow harvest is appropriate; these are reviewed during the evaluation.
What the Current Evidence Shows
The research on BMAC is promising for symptom relief but humbling on the question of whether it beats other options:
- Systematic review (Keeling et al., 2021). Across 8 studies and 299 knees, nearly all patient-reported outcomes improved from baseline at short- to mid-term follow-up. However, the comparative studies did not show BMAC to be superior to PRP, microfragmented adipose tissue, or placebo.
- Placebo-controlled trial (Shapiro et al., 2017). Twenty-five patients with arthritis in both knees received BMAC in one knee and saline in the other. Pain improved substantially in both knees, and the difference between them was not statistically significant. This is a reminder of how powerful the placebo response is in knee pain research.
- Large randomized trial (Mautner et al., 2023). In a multicenter trial of 480 patients, none of three cell-based injections (BMAC, adipose-derived stromal vascular fraction, or donor umbilical cord cells) was superior to the others or to a corticosteroid injection at one year, and none changed cartilage appearance on MRI.
- Updated review (Migliorini et al., 2025). BMAC improved function in clinical trials, but conflicting results mean its superiority over other orthobiologic options cannot yet be established.
Taken together, the honest summary is this: BMAC appears safe and can meaningfully reduce pain for many patients, but it has not been proven better than simpler or less expensive injections, and it does not rebuild cartilage.
When Non-Surgical Care May Be Appropriate
For patients with mild to moderate arthritis whose main goals are less pain, better function, and staying active, a non-surgical plan is often a reasonable first path. That plan usually combines exercise-based rehabilitation, activity modification, and, when the evaluation supports it, an orthobiologic such as PRP or BMAC. The choice between options depends on the diagnosis, the imaging findings, prior treatment response, and cost, and it is made together with the patient.
When Surgery May Be More Appropriate
Surgery is usually the better answer for advanced, bone-on-bone arthritis with deformity, for joints that are mechanically unstable, for large or retracted tendon tears, and for patients whose pain and loss of function remain severe despite a genuine trial of non-surgical care. In those situations, Dr. Tortland says so directly and refers patients to trusted orthopedic surgeons.
What BMAC Does Not Do
- It does not regrow or replace lost cartilage, and it does not reverse structural joint damage seen on X-ray or MRI.
- It is not a substitute for surgery when surgery is genuinely the better option.
- It has not been proven superior to PRP, other cell-based injections, or, in some trials, placebo or corticosteroid.
- It does not guarantee results. Benefit varies from patient to patient and is not necessarily permanent.
- It is not appropriate for every patient or every stage of arthritis, which is why a thorough evaluation comes first.
Dr. Tortland's Perspective
My approach is the same for every patient: validate that the pain is real, investigate the actual cause with a careful exam and diagnostic ultrasound, and only then talk about regenerating. BMAC is a tool I use for the right patient, often someone with moderate arthritis who wants to stay active and has not gotten enough from simpler care. I also tell patients plainly what the research shows, including the trials where BMAC did not beat other injections. I would rather a patient make this decision with accurate expectations, and when surgery is the better path, I will say so.
Related Questions
- BMAC vs. PRP: how do they differ?
- What is MFAT, and how does it compare to BMAC?
- Can any injection regrow cartilage?
- What should I ask before choosing a provider?
Next Step
If you are considering BMAC, start with an evaluation, not a procedure. Learn more on the Cellular Orthobiologics page, or schedule a consultation for an unrushed exam, a live ultrasound assessment, and a clear discussion of every option, surgical and non-surgical.
