PRP vs BMAC for Cartilage Growth?

𝗧𝗵𝗲 𝗲𝘃𝗶𝗱𝗲𝗻𝗰𝗲 𝘀𝘂𝗴𝗴𝗲𝘀𝘁𝘀 𝗣𝗥𝗣 𝗮𝗻𝗱 𝗕𝗠𝗔𝗖 𝗱𝗼𝗻’𝘁 𝗿𝗲𝗴𝗿𝗼𝘄 𝗰𝗮𝗿𝘁𝗶𝗹𝗮𝗴𝗲, 𝘀𝗼 𝘄𝗵𝘆 𝗱𝗼 𝗽𝗮𝘁𝗶𝗲𝗻𝘁𝘀 𝘁𝗵𝗶𝗻𝗸 𝘁𝗵𝗲𝘆 𝘄𝗶𝗹𝗹?

There’s no question PRP and BMAC can deliver value. Studies consistently show pain relief, improved function, and in some cases slowing of degeneration. For the right patient, those gains matter.

But here’s the problem: patients hear “𝘀𝘁𝗲𝗺 𝗰𝗲𝗹𝗹𝘀” or “𝗴𝗿𝗼𝘄𝘁𝗵 𝗳𝗮𝗰𝘁𝗼𝗿𝘀” and expect regeneration.....damaged cartilage restored good as new. The moniker "Regenerative Medicine" found it's way to patients ears long before we had tools capable of true regeneration. And once that bell was rung, it can’t be unrung.

Layer on the fact that 𝗺𝗼𝘀𝘁 𝗼𝗳 𝘁𝗵𝗲𝘀𝗲 𝗽𝗿𝗼𝗰𝗲𝗱𝘂𝗿𝗲𝘀 𝗮𝗿𝗲 𝗰𝗮𝘀𝗵-𝗽𝗮𝘆. When someone is writing a check out-of-pocket, expectations naturally climb higher.

The evidence tells us something more modest:

𝙋𝙍𝙋: Meta-analyses show symptomatic improvement vs HA, but no consistent MRI cartilage regeneration (Dai 2017; Sax 2022).

𝘽𝙈𝘼𝘾: Systematic reviews highlight pain relief and functional gains, but no reproducible structural repair (Chahla 2016; Shapiro 2019).

Yes, a few small studies have reported MRI or arthroscopic signs of cartilage improvement, but aren't these exceptions, often without controls, and don't seem to shift the weight of evidence in meta-analyses.

Part of the confusion lies in how we use the word "Regenerative". In clinical and research settings, it can mean anything from modulating inflammation to slowing degeneration; valuable outcomes in themselves. But patients hear regenerative and think new tissue. That’s the expectation gap.

So the tension is clear:

𝘛𝘩𝘦 𝘵𝘩𝘦𝘳𝘢𝘱𝘪𝘦𝘴 𝘩𝘦𝘭𝘱, 𝘣𝘶𝘵 𝘯𝘰𝘵 𝘭𝘪𝘬𝘦𝘭𝘺 𝘣𝘺 𝘳𝘦𝘨𝘳𝘰𝘸𝘪𝘯𝘨 𝘤𝘢𝘳𝘵𝘪𝘭𝘢𝘨𝘦.

𝘗𝘢𝘵𝘪𝘦𝘯𝘵𝘴 𝘱𝘢𝘺 𝘤𝘢𝘴𝘩 𝘢𝘯𝘥 𝘦𝘹𝘱𝘦𝘤𝘵 𝘮𝘰𝘳𝘦.

𝘗𝘩𝘺𝘴𝘪𝘤𝘪𝘢𝘯𝘴 𝘢𝘳𝘦 𝘭𝘦𝘧𝘵 𝘣𝘳𝘪𝘥𝘨𝘪𝘯𝘨 𝘵𝘩𝘢𝘵 𝘦𝘹𝘱𝘦𝘤𝘵𝘢𝘵𝘪𝘰𝘯 𝘨𝘢𝘱 𝘪𝘯 𝘵𝘩𝘦 𝘦𝘹𝘢𝘮 𝘳𝘰𝘰𝘮.

From where I sit, the real question is:

How do you present the value of PRP or BMAC without feeding the “new cartilage” narrative?

Do we retire the word regenerative, or simply accept that patients will hear it that way and focus harder on expectation management?

Further reading: Dai 2017 (Arthroscopy), Sax 2022 (J Arthroplasty), Chahla 2016 (OJSM), Shapiro 2019 (Cartilage).