Start with what may help, then weigh the harder choices

Comfortable movement is often the first choice

A useful exercise plan isn’t the same as being told to move more. It has to fit your strength and the motion you still have. You can shorten a walk, split a heavy chore, or rest before the joint gets badly stirred up. Weight loss won’t suit everyone, but it may ease strain for some people.

This care takes patience, though it carries less risk than a shot. If it hasn’t helped enough, your doctor can check the cause and change the exercise plan.

PRP is a blood-based shot with mixed results

PRP means platelet-rich plasma. To make it, clinic staff take a tube of blood. A machine then spins the blood, leaving a liquid with more platelets. These are the blood pieces that begin clotting. The medical provider uses the liquid for a shot in the aching joint. People don’t all report the same result. Some say the joint is less sore or works better.

In some careful trials, one group got PRP while another got saline, sterile salt water used as a test shot, so doctors could compare how the two groups felt afterward. PRP didn’t clearly help more than the salt-water shot in those trials. A doctor can’t tell you in advance which result you’ll have.

The broad word orthobiologics covers material from blood, marrow, fat, or a donor that is used in joint shots. Those choices aren’t all alike. For a marrow choice, marrow is drawn from the pelvis, spun, and then put into the joint. You’ll have a second sore area and more recovery to discuss.

If basic care hasn’t helped, compare every cost and limit

After an exam, QC Kinetix can discuss regenerative treatment options for soreness, which means non-surgical choices such as the PRP shot described above. The talk shouldn’t leave out medicine, exercise, another opinion, or surgery when one of those may fit better.

Ask for a written total. Find out how many visits are planned, what later care is included, and who handles a problem afterward. Insurance rules can change, so call your insurer before relying on an estimate. It’s fine to leave without deciding.

Sources

1. The 2015 Cochrane review of 27 trials (1,767 participants) found intra-articular corticosteroid better than sham for knee OA pain (SMD -0.40, 95% CI -0.58 to -0.22; NNTB 8), but the benefit decayed with time: moderate at 1-2 weeks, small at 13 weeks, and no evidence of any effect at 26 weeks. All outcomes were graded LOW quality.

   Jüni P, et al. — Intra-articular corticosteroid for knee osteoarthritis.. Cochrane Database Syst Rev, 2015. DOI: 10.1002/14651858.CD005328.pub3.

2. The BMJ meta-analysis of viscosupplementation pooled 169 trials (21,163 participants) and found clear evidence of small-study effects and publication bias. In the prespecified main analysis of 24 LARGE placebo-controlled trials (8,997 participants) hyaluronic acid reduced pain by SMD -0.08 (95% CI -0.15 to -0.02), equivalent to 2.0 mm on a 100 mm scale - far below the -0.37 minimal important difference - and trial sequential analysis showed there has been CONCLUSIVE evidence of clinical equivalence to placebo since 2009. Fifteen large trials showed a significantly higher risk of serious adverse events (RR 1.49).

   Pereira TV, et al. — Viscosupplementation for knee osteoarthritis: systematic review and meta-analysis.. BMJ, 2022. DOI: 10.1136/bmj-2022-069722.

3. RESTORE, the largest and most rigorously blinded placebo-controlled PRP trial in knee OA (n=288, participant-, injector- and assessor-blinded), gave three weekly injections of a commercial leukocyte-poor PRP or saline. At 12 months the change in knee pain was -2.1 vs -1.8 points (difference -0.4; 95% CI -0.9 to 0.2; P=.17) and the change in medial tibial cartilage volume was -1.4% vs -1.2% (difference -0.2%; P=.81). Twenty-nine of 31 prespecified secondary outcomes showed no between-group difference. The authors concluded the findings do not support the use of PRP for knee OA.

   Bennell KL, et al. — Effect of Intra-articular Platelet-Rich Plasma vs Placebo Injection on Pain and Medial Tibial Cartilage Volume in Patients With Knee Osteoarthritis: The RESTORE Randomized Clinical Trial.. JAMA, 2021. DOI: 10.1001/jama.2021.19415.

4. The largest head-to-head trial of cell-based orthobiologics to date randomised 480 patients with KL II-IV knee OA across four arms: autologous bone marrow aspirate concentrate, autologous adipose stromal vascular fraction, allogeneic umbilical cord tissue-derived MSCs, and a corticosteroid injection control. At 12 months NONE of the three orthobiologic injections was superior to another or to the corticosteroid control on either co-primary endpoint (VAS pain, KOOS pain), and none of the four groups showed a significant change in MRI osteoarthritis score from baseline. No procedure-related serious adverse events were reported.

   Mautner K, et al. — Cell-based versus corticosteroid injections for knee pain in osteoarthritis: a randomized phase 3 trial.. Nature Medicine, 2023. DOI: 10.1038/s41591-023-02632-w.

5. The 2025 Cochrane review of stem cell injections for knee osteoarthritis pooled 25 randomised trials (1,341 participants) and found that, compared with placebo injection, stem cell injection MAY slightly improve pain (1.2 points better on a 0-10 scale, 7 studies, 445 participants) and function (14.2 points better on a 0-100 scale, 7 studies, 432 participants) up to six months - both rated LOW-certainty evidence, downgraded for indirectness (cell source, preparation and dose varied across studies) and suspected publication bias, since up to three larger RCTs were conducted and withdrawn before reporting results. Radiographic progression was not assessed in any included study.

   Whittle SL, et al. — Stem cell injections for osteoarthritis of the knee.. Cochrane Database of Systematic Reviews, 2025. DOI: 10.1002/14651858.CD013342.pub2.

6. A phase III double-blind placebo-controlled trial of a SINGLE injection of culture-expanded autologous adipose-derived MSCs in 261 patients with KL grade 3 knee OA found significantly better VAS pain (25.2 vs 15.5 mm improvement; P=.004) and total WOMAC (21.7 vs 14.3; P=.002) at 6 months versus placebo, with no serious treatment-related adverse events - but MRI showed NO significant difference in cartilage-defect change between groups. Culture-expanded cells of this kind are a drug in the United States and are not available outside a trial.

   Kim KI, et al. — Clinical Efficacy and Safety of the Intra-articular Injection of Autologous Adipose-Derived Mesenchymal Stem Cells for Knee Osteoarthritis: A Phase III, Randomized, Double-Blind, Placebo-Controlled Trial.. American Journal of Sports Medicine, 2023. DOI: 10.1177/03635465231179223.

7. The ADIPOA2 phase 2b trial randomised 135 patients with mild-to-moderate knee OA to low-dose (2 million) or high-dose (10 million) culture-expanded autologous adipose-derived stromal cells or saline placebo. At 6 months 47.3% of ADSC patients were OARSI/OMERACT strict responders versus 54.8% on placebo (relative risk 0.86; P=.46), and no secondary outcome differed significantly. A single injection of expanded adipose stromal cells did NOT improve pain or function versus saline.

   Pers YM, et al. — Effect of intra-articular adipose-derived mesenchymal stromal cell versus placebo injection on pain and function in patients with knee osteoarthritis: the ADIPOA2 phase 2b randomised clinical trial.. Annals of the Rheumatic Diseases, 2025. DOI: 10.1016/j.ard.2025.07.026.

8. The only randomized controlled trial of alpha-2-macroglobulin for knee osteoarthritis allocated 75 patients with KL grade 2-3 disease to A2M-rich concentrate, conventionally prepared PRP, or methylprednisolone, with 12-week follow-up. The A2M group improved significantly from baseline on VAS, WOMAC, KOOS and Tegner; the PRP group improved on none; the steroid group improved on Lysholm only. Critically, the CHANGE in scores did not differ significantly between the three groups - A2M was comparable to, not better than, PRP and corticosteroid.

   Thompson K, et al. — The Effectiveness of Alpha-2-Macroglobulin Injections for Osteoarthritis of the Knee.. Bulletin of the Hospital for Joint Diseases, 2024.

9. A systematic review of 105 clinical orthopaedic PRP studies found only 11 (10%) described the preparation protocol well enough to be repeated, and only 17 (16%) reported quantitative metrics on the composition of the final PRP product - so 'PRP' in one trial is frequently not the same product as 'PRP' in another.

   Chahla J, et al. — A Call for Standardization in Platelet-Rich Plasma Preparation Protocols and Composition Reporting: A Systematic Review of the Clinical Orthopaedic Literature.. J Bone Joint Surg Am, 2017. DOI: 10.2106/JBJS.16.01374.