Home / OrthoRegen™ / Subchondral BMAC
Subchondral BMAC places your own bone marrow concentrate directly into the stressed bone under the worn cartilage — not just into the joint space. For carefully selected Grade 2–3 knees, it may help delay knee replacement.
We don't start with an injection. We start by understanding your whole knee — and we will tell you honestly if replacement is the better choice.
Results from two published long-term studies of subchondral bone marrow concentrate (Hernigou et al., International Orthopaedics, 2021). These describe specific study groups — not a promise for every knee. Read what the studies show
Most people think knee arthritis is only about cartilage "wearing out". But cartilage itself has almost no nerves — it cannot feel pain. The pain comes from the tissues around it, and one of the most important is the bone just beneath it.
The subchondral bone is alive, has a rich blood and nerve supply, and takes the load when cartilage thins. Overloaded bone can become painful.
Areas of "bone swelling" seen on MRI. They are linked with more pain and faster worsening of arthritis in many patients.
Repeated overload can cause small stress injuries in the bone plate that supports the cartilage.
An inflamed lining (synovium) causes swelling, warmth and morning stiffness.
A worn meniscus or bow-legs shift more weight onto one side of the knee.
Weak thigh and hip muscles mean the knee absorbs more shock with every step.
Both tests have a role. Not every patient needs an MRI — we advise one only when it will change your treatment plan.
📲 Already have an X-ray or MRI? Send it on WhatsApp for a free review — we'll tell you if you may be eligible and whether more tests are needed.
BMAC (Bone Marrow Aspirate Concentrate) is made from your own bone marrow. It contains your own healing cells, platelets and growth factors. "Subchondral" means we place it inside the bone just under the cartilage — right where the stress and pain are — instead of only injecting into the joint fluid.
Examination, standing X-rays and MRI to locate the stressed bone areas and confirm you are a suitable candidate.
A small amount of marrow is drawn from the back of your hip bone (pelvis) under anaesthesia. No cut or stitches — just a needle puncture.
The marrow is processed in a special closed system to concentrate the healing cells. This is done right there, in the same session.
Under live X-ray (C-arm) guidance, the concentrate is placed into the lesion area in the bone below the cartilage. Part of it is usually also given into the joint.
A structured exercise programme and review visits to track pain, walking and strength.
Both studies were published by Prof. Philippe Hernigou and colleagues (France) in International Orthopaedics. We show the actual numbers so you can judge for yourself.
Study 1 · Randomised
60 patients with arthritis in both knees. One knee got BMAC into the bone under the cartilage; the other knee got the same dose into the joint only.
12 of 60 bone-treated knees needed replacement, compared with 42 of 60 joint-injected knees, over about 15 years.
Hernigou P, Bouthors C, Bastard C, et al. Int Orthop 2021;45:391–399 · PubMed 32617651 ↗
Study 2 · Randomised
140 patients who were due for replacement in both knees. One knee got a replacement; the other got subchondral BMAC.
115 of 140 BMAC-treated knees had not needed replacement at about 15 years. In the 25 knees that did, it happened on average around 10 years later. Bone lesions shrank on MRI over 2 years; larger lesions that stayed were linked with later replacement.
Hernigou P, Delambre J, Quiennec S, Poignard A. Int Orthop 2021;45:365–373 · PubMed 32322943 ↗
We decide together, based on your symptoms, examination, X-ray, MRI, general health and your goals.
Slight roughening. Occasional pain.
Exercise · lifestyleCartilage thinning, pain with activity.
SuitableClear narrowing, daily pain, stairs difficult.
SuitableBone-on-bone, pain at rest, deformity.
Knee replacementTake our free 2-minute Knee Self-Assessment. Answer simple questions about pain, stiffness, walking and stairs — and get an idea of your arthritis stage before your consultation.
A minimally invasive procedure — not a knee replacement. Details vary from person to person.
Examination, X-ray and MRI review, blood tests and fitness check. We explain all options — including replacement — and take your consent.
Sterile conditions, anaesthesia, marrow collection from the hip bone, and X-ray-guided placement into the knee. Takes about 1–1.5 hours.
Usually home the same day. Some soreness in the knee and hip is normal. You may use a walker or crutches for a short period as advised.
Guided exercises to strengthen your thigh, hip and core. Review visits to track pain, walking and function.
Low downtime is not zero downtime. Some patients need protected weight-bearing for a few weeks. We do not promise instant relief — we give you a realistic plan.
A simple phase-wise exercise framework. Tap a phase to see the exercises.
Goal: keep blood flowing, wake up the thigh muscle, gentle movement.
| Exercise | Sets × reps |
|---|---|
| Ankle pumps | 3 × 20 |
| Static quadriceps (press knee down) | 3 × 15, hold 5 sec |
| Glute squeezes | 3 × 15, hold 5 sec |
| Heel slides (comfortable range) | 2 × 10–15 |
| Straight leg raise* | 2 × 10 |
*Only if you can keep the knee fully straight while lifting.
Goal: full bending and straightening, walking pattern, hip strength.
| Exercise | Sets × reps |
|---|---|
| Short-arc quads (roll under knee) | 3 × 12 |
| Side-lying hip abduction | 3 × 12 |
| Bridges | 3 × 10 |
| Stationary cycle, no resistance (if cleared) | 10 min |
| Weight shifting with support | 2 × 10 |
Goal: start standing strength and balance once full weight is allowed.
| Exercise | Sets × reps |
|---|---|
| Mini squats (chair behind you) | 3 × 10 |
| Calf raises | 3 × 15 |
| Wall sit, shallow | 3 × 20 sec |
| Single-leg balance with support | 3 × 20 sec |
| Cycling, light resistance | 15 min |
Goal: build thigh and hip strength for stairs and longer walks.
| Exercise | Sets × reps |
|---|---|
| Sit-to-stand from chair | 3 × 12 |
| Step-ups (low step) | 3 × 10 each leg |
| Resistance band side-walks | 3 × 10 steps |
| Leg press / knee extension (light, in gym) | 3 × 12 |
| Brisk walking on flat ground | 20–30 min |
Goal: long-term knee care habits — this phase never really ends.
| Habit | How often |
|---|---|
| Strength routine (thigh, hip, core) | 3 days/week |
| Walking, cycling or swimming | Most days |
| Weight control — every kg lost reduces knee load | Ongoing |
| Avoid deep squatting / floor sitting on bad days | As needed |
| Review with Dr. Sumit | As scheduled |
More knee exercises with videos: Exercise library
Improvement is gradual and varies from person to person. Pain relief is not guaranteed.
Procedure soreness in the knee and hip settles. Follow the walking and loading advice.
We check pain, swelling, walking and how your exercises are progressing.
Strength, walking distance and daily activities usually keep improving.
Regular check-ups. Repeat imaging only when it will help a decision.
Dr. Sumit Dubewar is an orthopaedic surgeon in Secunderabad with 10+ years of experience in both regenerative orthopaedics and joint replacement — including robotic knee replacement. He holds the DABRM (Diplomate, American Board of Regenerative Medicine), one of very few orthopaedic surgeons in India with this US certification.
Because he performs both BMAC and knee replacement, your advice is not biased towards one treatment. If replacement is the better choice for your knee, you will be told so clearly.
Preserve when possible. Replace when necessary.
Fill this 1-minute form. Our team will review your details, and WhatsApp will open so you can send your MRI / X-ray for a free review by Dr. Sumit.
Don't know your grade? Take the free Knee Self-Assessment first →
Your name, number and answers are shared only with our clinic team so we can contact you. MRI / X-ray reports are sent only through WhatsApp — never uploaded to this website. Not for emergencies.
This page is for patient education and is not personal medical advice. Published study percentages describe specific study groups and are not a guarantee of individual results. Not every patient is a candidate. Risks, alternatives and expected outcomes will be discussed in person during consultation. See our disclaimer.