Ultrasound-guided · Autologous tissue · Glastonbury, CT
Five procedures, each answering a different problem — platelets, cells, dextrose, ozone and fluid. Which one applies to you is decided on ultrasound, not from a brochure.
Overview
Dr. Tortland is board certified in Sports Medicine and Osteopathic Manipulative Medicine, registered in musculoskeletal ultrasound, and was the first physician in the world certified in regenerative medicine.
The procedures below are grouped by what they actually do. Orthobiologic treatments — high-concentrate PRP, BMAC and MFAT — deliver your own platelets or cells into a degenerating joint or tendon. Injection and nerve procedures — prolotherapy, prolozone and nerve hydrodissection — address instability and nerve entrapment, which are different problems requiring different targets.
None of them are offered as a package or a tier. The diagnostic ultrasound examination comes first, at a separate visit, and it determines which of these is appropriate — including the possibility that none is.
Your own platelets and cells
All three use tissue taken from your own body on the day of treatment. They differ in what they deliver, how strong a biologic signal they produce, and what they cost.
Platelet-Rich Plasma uses concentrated growth factors from your own blood to ease joint and tendon pain and support natural healing.
Blood is drawn, processed in our on-site laboratory rather than an automated bedside kit, and injected under live ultrasound into the tissue at fault. Preparation is customised to the target — leukocyte-poor for joints, leukocyte-rich for tendons — and every dose is counted on a cell counter before injection, targeting 6 to 10 times baseline platelet concentration.
Read about High-Concentrate PRP →Bone Marrow Aspirate Concentrate uses cells from your own bone marrow to support joint and tissue healing through paracrine signaling.
Marrow is aspirated from the pelvis under local anesthetic and concentrated to deliver mesenchymal signalling cells alongside platelets and growth factors. BMAC carries a stronger biologic signal than platelets alone, which is why it is reserved for more advanced joint degeneration and for cases where a prior PRP course produced only partial benefit.
Read about BMAC →Microfragmented adipose therapy uses your own fat tissue's regenerative cells to cushion joints and support long-term healing.
A small volume of fat is harvested, mechanically microfragmented without enzymes, and injected into the joint. Adipose tissue is rich in pericytes and provides a structural, cushioning scaffold in addition to a biologic signal — which makes it well suited to joints that have lost cartilage height and to patients whose marrow quality is limited by age.
Read about MFAT →Not sure whether you need platelets or cells? That question is answered on imaging and examination, not in advance. Most patients begin with the least intensive option their diagnosis supports. See how the options compare →
Stability and nerve
These treat problems that orthobiologics do not solve: a joint held loosely by lax ligaments, or a nerve trapped in the tissue around it.
Photo: prolotherapy injection, ultrasound-guided
Dextrose or ozone injections stimulate the body's own repair response in weakened ligaments and tendons to restore joint stability.
Prolotherapy uses a concentrated dextrose solution to provoke a controlled healing response in lax ligaments and chronically irritated tendon attachments. Prolozone adds medical ozone to the same principle. Both are appropriate where instability, rather than cartilage loss, is driving the pain — and both cost considerably less than an orthobiologic course.
Read about Prolotherapy and Prolozone →Photo: nerve hydrodissection on ultrasound screen
Ultrasound-guided fluid injection separates a compressed or irritated nerve from surrounding tissue to relieve pain and restore mobility.
Where a nerve is tethered in scar tissue or fascia — carpal tunnel, tarsal tunnel, an entrapped peripheral nerve — fluid is placed precisely along the nerve under ultrasound to free it mechanically. It treats a genuinely different problem from joint and tendon disease, and it is frequently the answer when a joint-directed treatment has not worked because the joint was never the source.
Read about Nerve Hydrodissection →Also performed here: diagnostic musculoskeletal ultrasound, ultrasound-guided injection of any joint or tendon, extracorporeal shockwave therapy and EMTT. Ask which applies to your case →
Find your starting point
Pick the line that sounds most like your situation.
My joint hurts and imaging shows arthritis
Where this leads →
A tendon has not healed after months of therapy
Where this leads →
I have been told I need a joint replacement
Where this leads →
My pain feels like burning, tingling or numbness
Where this leads →
My joint feels unstable rather than stiff
Where this leads →
A previous injection elsewhere did not work
Where this leads →
How the procedure is chosen
01
Every patient is examined dynamically on ultrasound before anything is injected, at a visit separate from treatment. A meaningful proportion of people arrive certain they need a joint injection and leave with a nerve diagnosis, or the reverse. Choosing the right procedure is almost entirely a question of identifying the right target — which is why the diagnostic scan is not optional here.
02
Orthobiologic outcomes track with dose. Commercial bedside kits yield roughly 2 to 3 times baseline platelet concentration and cannot control cellular composition; our on-site laboratory targets 6 to 10 times baseline and counts every preparation before it is injected. If a treatment is going to be paid for out of pocket, the dose behind it should be a known number.
03
Platelets, cells, dextrose and hydrodissection are not competing products — they answer different problems, at different costs. Most patients begin with the least intensive option that fits their diagnosis. Cellular therapy is recommended when the degree of degeneration genuinely calls for a stronger biologic signal, not as a default upgrade.
Candidacy
There is no age cut-off. What matters is the state of the tissue on imaging, your general health, and how much the pain is costing you. Bring your imaging to a consultation →
Common questions
You will not know from a website, and neither will anyone who has not scanned the joint. Candidacy is determined on diagnostic ultrasound, where the actual pain generator is identified and the degree of degeneration assessed. That examination determines whether platelets, cells, dextrose or nerve hydrodissection is appropriate — or whether none of them are and you should be seeing a surgeon.
PRP delivers platelets and growth factors but very few cells. BMAC and MFAT deliver cells in addition to signalling proteins, which produces a stronger biologic effect and costs more. PRP is usually the right starting point for mild to moderate arthritis and for tendinopathy; cellular therapy is reserved for more advanced joint degeneration or for cases where a well-dosed PRP course produced only partial benefit.
They do different things. BMAC provides a marrow-derived signalling population and is well studied in joint degeneration. MFAT adds structural cushioning as well as a biologic signal, which can matter more in joints that have lost cartilage height, and it does not depend on marrow quality — a real consideration in older patients. The choice follows the joint and the patient, not a preference.
The orthobiologic procedures are not covered by United States insurers and are paid out of pocket. Diagnostic evaluation and ultrasound examination are frequently billable to insurance. Our staff confirms exactly what applies to you before you commit to anything.
Dr. Tortland performs every injection himself under live ultrasound guidance. He performed the first PRP treatments in southern New England in 2007 and was the first physician in the world certified in regenerative medicine by the American Academy and Board of Regenerative Medicine.
You will be told so plainly. Advanced bone-on-bone arthritis with deformity, complete retracted tendon rupture, and several other presentations do not respond to these treatments, and offering them anyway would waste your money. In those cases the honest recommendation is a surgical opinion, and we will say so at the first visit.
Candidacy is determined on ultrasound, not over the phone. Bring your imaging and get an honest answer in one visit — including if the answer is no.