Knee Pain & Osteoarthritis · Non-Surgical Care · Glastonbury, CT
The most treated joint in this practice, evaluated with the same evidence-first approach used since 2007 — starting with live ultrasound diagnosis and treatment matched to the joint you actually have not the one an X-ray report describes.
Quick answer
Knee pain and osteoarthritis are most often treated without surgery: activity modification and targeted strengthening first, then, when conservative care isn't enough, ultrasound-guided orthobiologic injections such as PRP, BMA, or MFAT. Candidacy depends on how much cartilage remains and what live ultrasound actually shows — not age or X-ray severity alone. Surgery remains the right answer for end-stage, bone-on-bone arthritis and mechanical problems like a fully torn ligament or displaced meniscus.
Most common conditions
Osteoarthritis, meniscus tears, patellar tendinopathy
Diagnosis method
Live, dynamic ultrasound examination
Non-surgical options
PRP, BMA, MFAT, intraosseous injection, prolotherapy
Return to activity
Usually within days; depends on treatment
First results
Weeks 4 to 16, depending on treatment
Who treats you
Dr. Tortland personally, every visit
When surgery is right
Bone-on-bone arthritis or mechanical instability
Insurance
Not covered; but HSA / FSA applicable
Definition
And why the right diagnosis matters more than the treatment you pick.
Knee pain has many different sources — cartilage wear, a meniscus tear, patellar tendon irritation, an inflamed bursa, or a bone marrow lesion underneath otherwise intact cartilage. Two patients with an identical-looking X-ray can have very different problems underneath. Confirming which structure is actually failing on live ultrasound, rather than assuming from imaging alone, is the starting point for any treatment plan.
Not every knee that hurts needs an injection, and not every injection is appropriate for every knee. Whether conservative care, PRP, a cellular treatment like BMA or MFAT, or a referral for surgery is the right next step depends on how much cartilage remains, what's actually causing the pain, and the patient's own goals.
Indications
The knee conditions seen most often in this practice, treated without surgery whenever the evidence and the ultrasound findings support it.
Step by step
01
Every knee evaluation starts with a dynamic ultrasound examination of the joint, tendons, and surrounding structures so the actual pain generator is identified — not assumed from an X-ray or MRI report alone.
02
X-ray and, when indicated, MRI are reviewed alongside the ultrasound findings to confirm how much cartilage and joint space remain and to rule out anything that wouldn't respond to injection treatment.
03
Based on the diagnosis and severity, the right non-surgical option is selected — PRP for mild to moderate arthritis and tendinopathy, BMA or MFAT for more advanced cases, or a referral to a trusted surgeon when the joint is beyond what injection treatment can help.
04
When PRP, BMA, or MFAT is the right next step, it's prepared in an on-site laboratory the same visit and customized to the patient's age, injury, and baseline platelet or cell count never a preset commercial kit. Dr. Tortland's process derivessignificantly higher concentration than most standard commercial kits produce.
05
The injection is placed under live ultrasound guidance into the exact structure at fault inside the knee — the joint capsule, a specific tendon, or, for select bone marrow lesions, directly into the bone itself.
06
You leave with a written loading schedule specific to your knee and the treatment given. Expect two to five days of soreness after an injection — that response is part of the treatment working. No anti-inflammatories for two weeks.
07
Follow-up at six to ten weeks with repeat ultrasound, and imaging when appropriate, to compare the joint's appearance and your symptoms against baseline and decide on next steps.
Candidacy
Comparison
Frequently asked
Sources
01
Mulvaney SW, Tortland PD, Shiple B, Curtis K. Regenerative medicine options for chronic musculoskeletal conditions: a review of the literature. Endurance and Sports Medicine. 2018.
02
Dai WL, et al. Efficacy of platelet-rich plasma versus hyaluronic acid in knee osteoarthritis: meta-analysis of randomized controlled trials.
03
Filardo G, et al. Platelet-rich plasma intra-articular injections for cartilage degeneration and osteoarthritis: evidence and indications.
04
Hernigou P, et al. Subchondral bone or intra-articular injection of bone marrow concentrate mesenchymal stem cells in bilateral knee osteoarthritis: what better postpones knee arthroplasty at fifteen years? Int Orthop. 2021;45:391-399.
05
Bennell KL, et al. Effect of intra-articular platelet-rich plasma on knee pain and cartilage volume: randomized clinical trial.
06
Pintore A, et al. Comparative clinical outcomes of BMAC and adipose-derived stromal cell injections in knee osteoarthritis. J Orthop Surg Res. 2023.
This page is written for patient education and does not constitute medical advice or establish a physician-patient relationship. Treatment decisions require an in-person examination. Orthobiologic procedures are not FDA-approved drug therapies; they are performed as autologous same-day procedures under the practice of medicine. Dr. Tortland reports no financial interest in the products or devices described on this page.
Candidacy is determined on ultrasound, not over the phone. Bring your imaging and get an honest answer about your knee in one visit.