Quick answer
Alternatives to knee replacement include rehabilitation, load management and ultrasound-guided PRP, BMA or MFAT. Dr. Tortland measures your baseline platelet count and prepares a high-concentration PRP, aiming for 20 billion or more platelets per knee. For advanced and bone on bone arthritis, BMA and MFAT are the options he uses most, and he starts with an ultrasound-guided test injection to see how much relief a longer-term treatment may give.
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
PRP about 4 to 12 weeks; BMA or MFAT about 3 to 6 months
Who treats you
Dr. Tortland personally, every visit
When surgery is right
Mechanical instability, or when other options have not given enough relief
Payment
Out of network and direct pay; HSA / FSA applicable
Indications
Knee conditions that may respond
The knee conditions seen most often in this practice, treated without surgery whenever the evidence and the ultrasound findings support it.
Knee osteoarthritisMeniscus tearPatellar tendinopathyChondromalacia patellaPartial ACL or MCL tearIT band syndromeBaker's cystBone marrow lesionPatellofemoral pain syndromePost-arthroscopy painQuadriceps tendinopathyPes anserine bursitisPrepatellar bursitisOsteochondral defectEarly degenerative joint changesPost-injury swelling and instability
Comparison
Alternatives compared with knee replacement
Option
What it does
Duration of benefit
Effect on tissue
OptionCortisone injection
What it doesSuppresses inflammation and pain
Duration of benefitWeeks to a few months
Effect on tissueCan weaken tendon and cartilage with repetition
OptionHyaluronic acid
What it doesAdds lubrication to the joint
Duration of benefitMonths, variable
Effect on tissueNo repair effect on cartilage
OptionPRP
What it doesDelivers growth factors that stimulate repair
Duration of benefitOften 6 to 12 months in patients who respond
Effect on tissueAims to improve tissue quality
OptionCellular orthobiologics
What it doesDelivers cells plus signaling proteins
Duration of benefitOften longer in advanced joints
Effect on tissueStronger biologic signal for degenerated joints
OptionSurgery
What it doesRemoves or replaces structure
Duration of benefitLong-term, definitive for the right case
Effect on tissueStructural change with recovery cost
| Option | What it does | Duration of benefit | Effect on tissue |
|---|---|---|---|
| Cortisone injection | Suppresses inflammation and pain | Weeks to a few months | Can weaken tendon and cartilage with repetition |
| Hyaluronic acid | Adds lubrication to the joint | Months, variable | No repair effect on cartilage |
| PRP | Delivers growth factors that stimulate repair | Varies; some responders notice benefit for many months | Aims to improve tissue quality |
| Cellular orthobiologics | Delivers cells plus signaling proteins | Varies; considered for more advanced joints | Stronger biologic signal for degenerated joints |
| Knee replacement | Removes or replaces the joint surfaces | Long-term, definitive for the right case | Structural change with recovery cost |
Go deeper: side-by-side guides
Knee arthritis options: PRP vs BMA vs MFAT
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Knee arthritis injections: PRP vs gel vs cortisone
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Frequently asked
Knee replacement questions
Can PRP prevent or delay knee replacement?
PRP cannot be promised to prevent or delay knee replacement, and it does not regrow lost cartilage. For some patients with knee osteoarthritis, results include improved pain or function, but trial results are mixed: a 2025 meta-analysis of 18 randomized trials found clinically meaningful gains, with the clearest benefit from higher platelet concentration, while one large trial of a low-concentration commercial product found no benefit over saline at 12 months. Dr. Tortland measures your baseline platelet count and prepares a high-concentration PRP, aiming for 20 billion or more platelets for one knee.
How does arthritis severity affect non-surgical knee options?
PRP works best when cartilage and joint space remain. For more advanced knee osteoarthritis, including bone on bone, cellular treatments such as BMA or MFAT deliver cells as well as growth factors. A 2026 systematic review of 21 randomized trials found bone marrow aspirate concentrate generally improved pain and function but was not consistently better than comparison treatments. Symptoms, function, alignment, stability and imaging all matter when choosing among your options.
What is the difference between PRP, BMA and MFAT?
PRP is prepared from concentrated platelets in blood, BMA is processed bone marrow aspirate, and MFAT is processed adipose tissue. They differ in composition, preparation, evidence, risks and cost. None is automatically better, and none is appropriate for every patient.
Should I try physical therapy before an injection?
Rehabilitation, progressive strengthening, activity adjustment and load management are often important parts of knee care, and may be recommended alone or alongside another treatment. Dr. Tortland starts with a live ultrasound exam so the plan reflects the structure that is actually painful rather than a fixed sequence.
When is knee replacement the better option?
When pain and loss of function remain substantial despite appropriate care, and examination and imaging show advanced joint damage or mechanical instability, replacement may be worth discussing alongside your other options. An orthopedic surgeon can review expected benefits, risks, recovery and alternatives, and Dr. Tortland refers you when surgery is the better fit. In his experience, getting 2 to 3 surgical opinions is a sensible step for anyone who is bone on bone.
How long does knee treatment take to work?
Most patients notice change 4 to 12 weeks after PRP, depending on the area treated. Tendon problems such as patellar tendinopathy tend to respond toward the earlier end and large joints toward the later end. BMA and MFAT usually take 3 to 6 months. Improvement can continue for up to a year.
Is all knee PRP the same?
No. Dr. Tortland measures your baseline platelet count, draws extra blood, and prepares a high-concentration PRP, aiming for 20 billion or more platelets for one knee, tailored to your knee, age and count.
Does insurance cover knee treatment, and what does it cost?
Dr. Tortland's practice is out of network and direct pay, so we do not bill your insurance. We provide an itemized superbill and claim form so you can request reimbursement from your plan, and HSA and FSA funds can be used. The initial evaluation is $500 in the office, which includes a diagnostic ultrasound he performs himself in the same visit, or $300 by telehealth. Treatment pricing is provided in writing as a Good Faith Estimate, pending a full diagnostic workup, if a treatment is recommended by Dr. Tortland. For BMA and MFAT, pricing is tailored to each patient's treatment protocol. Treatments should not be a cookie-cutter, one-size-fits-all scenario.
Who performs my knee injection?
Dr. Tortland performs every knee evaluation and injection himself under live ultrasound guidance. He has treated knee osteoarthritis and tendon injury since 2007 and was the first physician in the world certified in regenerative medicine.