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Paul Tortland, DORegenerative Orthopedics
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Non-surgical orthopedics · Glastonbury, CT · New England

 Bone on Bone Knee Arthritis in Glastonbury, CT

Told your knee is bone on bone? Dr. Tortland in Glastonbury, CT offers MFAT, BMA and PRP options, starting with an ultrasound guided test injection.

Written and clinically reviewed by

Paul D. Tortland, DO, FAOASM, CAQSM, RMSK

Dr. Paul Tortland, DO is a non-surgical orthopedic & sports medicine physician specializing in regenerative orthopedics and surgical alternative treatment. He is dual board certified in Sports Medicine & Osteopathic Manipulative Medicine (OMM) and Regenerative Medicine, Fellowship-trained in Sports Medicine. He became the first physician in the world to earn board certification in Regenerative Medicine in 2015. Diplomate, American Board of Regenerative Medicine (ABRM), 2015. Registered in Musculoskeletal Ultrasound (RMSK).

Last clinically reviewed

October 2026

Condition

Bone on bone knee arthritis

Bone on bone knee arthritis still has treatment options beyond replacement. In Dr. Tortland's experience, many patients have had good results from MFAT or BMA stem cell treatments, with PRP and strengthening added when they fit. He starts with an ultrasound guided test injection to see how much relief a longer term treatment may give.

  • What it is: "bone on bone" describes advanced arthritis on an X-ray or MRI, where little cartilage cushion appears to remain. It describes an image, not how your knee feels or works.
  • Who it fits: patients too young for a replacement, and older patients who want to avoid invasive surgery. A significant portion of Dr. Tortland's patients are bone on bone.
  • What is different here: a diagnostic injection of numbing agent under live ultrasound, and at least 50 to 60 percent relief, before he recommends MFAT or BMA, made from your own bone marrow or fat the same day.

An X-ray shows bone and the gap between the bones, and a narrow gap is read as lost cartilage. In Dr. Tortland's experience, the label is sometimes applied to knees whose imaging tells a different story once he reviews the images himself and looks at the joint on live ultrasound. Long term wear is the most common cause, and past meniscus or ligament injuries, joint alignment, family history and body weight can also play a part. Typical symptoms are pain with walking or stairs, stiffness after rest, swelling and a grinding feeling.

Patients travel from across New England to our Glastonbury, CT office, and patients who live far away can start with a telehealth consultation. A recent MRI is required for telehealth.

Exploring alternatives to knee replacement? Review the guide to alternatives to knee replacement, compare PRP, BMA and MFAT, or read about knee osteoarthritis in general.

Explore related conditions: Browse the Knee condition hub for related diagnoses and treatment options.

Anatomical illustration of the knee joint showing the thigh bone, kneecap and shin bone
Anatomical illustration of the knee joint showing the thigh bone, kneecap and shin bone

CARE OPTIONS

Treatment options for bone on bone knee arthritis

Dr. Tortland's treatment options: Evaluation starts with your imaging and ends with a test injection, so the plan reflects how your knee responds and not only how it looks.

  • BMA (bone marrow aspirate) or MFAT (microfragmented adipose tissue): your own bone marrow or fat, concentrated the same day and placed in the knee. In Dr. Tortland's experience, many end-stage arthritis patients have had good results, primarily with MFAT or BMA. Benefit usually takes about 3 to 6 months.
  • PRP: a concentrate of your own platelets, used in earlier arthritis or added alongside a cell treatment. Benefit usually shows in about 6 to 16 weeks.
  • Strengthening and load management: targeted exercise and activity changes alongside every plan.

You can also compare them side by side in PRP vs BMA vs MFAT for knee arthritis.

How the evaluation works:

  1. Imaging review: he reviews your X-rays and MRI himself. Contact us to book, and records go through our secure messaging system.
  2. Exam and live ultrasound, in the same visit.
  3. Diagnostic injection: numbing agent is placed in the knee under ultrasound guidance. It wears off within hours, so it is a test, not a treatment.
  4. Measuring relief: he looks for at least 50 to 60 percent relief. In his experience, even temporary relief is a good indicator of the percentage of relief to expect from a longer term procedure.
  5. Plan: if relief is strong, he discusses MFAT or BMA along with strengthening and, in some knees, PRP.

What to expect from the evidence: Research in advanced arthritis is still limited. Results vary, and no treatment regrows a worn out knee or guarantees an outcome.

Cost, HSA and FSA: Dr. Tortland's practice is out of network and direct pay. The initial evaluation and diagnostic workup is $500 in the office or $300 by telehealth, and PRP starts at $1,800. HSA and FSA funds may apply.

Compare all of your options: Dr. Tortland recommends that every patient with bone on bone arthritis also get two to three surgical opinions, whatever treatment they choose, so you can weigh every path. He refers you to a trusted orthopedic surgeon when replacement is the better fit.

Comparison

Compare your treatment options

Common care options for this condition, who each suits, and what to know
OptionBest forWhat to know
BMA or MFAT after a test injectionEnd-stage or advanced arthritis when the ultrasound guided test injection gives at least 50 to 60 percent relief.BMA uses your own bone marrow and MFAT your own fat, both concentrated the same day. Benefit usually takes about 3 to 6 months. Results vary, and research in advanced arthritis is limited.
PRP and strengtheningEarlier arthritis, or added alongside a cell treatment. Strengthening goes with every plan.PRP is made from your own blood and usually shows benefit in about 6 to 16 weeks. Results vary, and PRP does not restore lost cartilage.
Surgical opinionsA second view alongside your treatment plan, so you can compare every option.Dr. Tortland recommends two to three surgical opinions for every bone on bone patient. Replacement is the better fit for some knees, and he refers you to a trusted surgeon in that case.

Common questions

Questions about bone on bone knee arthritis

What are the treatment options for a bone on bone knee?

Dr. Tortland's main options are MFAT or BMA stem cell treatments, with PRP and strengthening added when they fit. He chooses based on your imaging and how your knee responds to an ultrasound guided test injection. Many of his patients are bone on bone, and many are too young for, or do not want, a replacement.

Can MFAT or BMA help a bone on bone knee?

In Dr. Tortland's experience, many end-stage arthritis patients have had good results, primarily with MFAT or BMA stem cell treatments, and he screens with a test injection first. Research in advanced arthritis is limited, results vary, and no treatment regrows cartilage or guarantees an outcome.

What is the test injection, and how much relief do I need?

It is a numbing agent injected into the knee under ultrasound guidance. Dr. Tortland wants at least 50 to 60 percent relief. In his experience, even temporary relief is a good indicator of the relief to expect from a longer term procedure. The numbing agent wears off within hours, so it is a test, not a treatment.

Does bone on bone mean I need a knee replacement?

Not automatically. In Dr. Tortland's experience the answer depends on your imaging and how your knee responds to a test injection. He recommends two to three surgical opinions for every bone on bone patient so you can compare all of your options, and he refers you to a trusted surgeon when replacement is the better fit.

Not sure which treatment fits your condition?

Patients travel from across New England to see Dr. Tortland in Glastonbury, CT. He reviews your imaging and history, examines you with ultrasound, and recommends the most appropriate non-surgical path forward, and he tells you plainly when a surgeon is the better choice.

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