PRP — Best Evidence, Most Accessible
Multiple Level 1 randomised controlled trials support the use of PRP for knee OA. A 2023 meta-analysis of 18 RCTs showed PRP significantly outperforms hyaluronic acid at 6 and 12 months for pain and function. Optimal protocol: 3 injections, 4-6 weeks apart. Best results in Grade 1-3 OA.
BMAC — More Powerful, More Evidence Needed
Multiple case series and prospective studies show significant improvement in pain and function, with some evidence of cartilage regeneration on MRI. BMAC is recommended for younger patients with larger cartilage defects where more aggressive regeneration is required.
Hyaluronic Acid — Established but Modest
Viscosupplementation with hyaluronic acid has a long track record. Evidence shows modest pain reduction, particularly in Grade 2 OA. High molecular weight HA appears superior to low molecular weight preparations.
Dr. Sumit's Clinical Recommendation for 2025
For Grade 1-2 knee OA: Start with high molecular weight HA combined with PRP. For Grade 2-3 with cartilage defects in younger patients: BMAC. For Grade 4 (bone on bone): Regenerative therapy will not meaningfully help — joint replacement is the right answer.
Predictors of Good Response
- Age under 65
- BMI below 30
- Grade 1-3 arthritis (not Grade 4)
- Adequate baseline activity level
- Non-smoker
- Commitment to physiotherapy alongside treatment
🎬 Regenerative OA Therapies 2025 — Dr. Sumit Dubewar
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