The Full Answer
"Working" for a bone marrow lesion generally means measurable reduction in pain and functional scores, and in some studies, improvement in the lesion's appearance on follow-up MRI. It does not mean regenerating lost cartilage or reversing osteoarthritis itself — the target is the bone marrow, not the joint surface.
What the Current Evidence Shows
Multiple clinical series (Sánchez et al., Hernigou et al.) report meaningful pain and function improvement with intraosseous PRP or bone marrow concentrate, and a 2021 systematic review found the approach safe with real short-term benefit. That said, evidence is mixed: at least one comparative study found intraosseous injection added no measurable patient-reported benefit over intra-articular injection alone, which is a legitimate limitation rather than a reason to dismiss the technique outright.
Who May Benefit
Patients with a symptomatic, MRI-confirmed bone marrow lesion who want to manage pain and potentially delay surgery, especially when an intra-articular injection alone hasn't fully addressed their symptoms.
When Surgery May Be More Appropriate
If pain and function don't improve after an adequately dosed trial of orthobiologic treatment, or if imaging shows the joint has progressed to advanced, bone-on-bone disease, surgical options should be revisited.
Dr. Tortland's Perspective
Dr. Tortland treats this as still-emerging evidence worth taking seriously, not a settled cure — he tells patients what the data does and doesn't show, and emphasizes that outcomes depend heavily on getting the cell/platelet dose right, not just performing the injection.