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How to judge the evidence
The most reliable evidence comes from randomised trials and their reviews, where a method is compared with placebo or another treatment. Small studies without a control group, patient testimonials and “before and after” images do not prove effectiveness. For many regenerative methods only small studies exist so far.
What is known by diagnosis
| Diagnosis | PRP / CGF | BMAC / MFAT | Basis of treatment in guidelines |
|---|---|---|---|
| Knee osteoarthritis | Moderate evidence: pain decreases for months in some patients; in the RESTORE trial PRP was no better than placebo | Little data | Exercise, weight loss; injections as an add-on |
| Hip osteoarthritis | Limited evidence | Little data | Exercise; joint replacement in advanced disease |
| Tennis elbow, plantar fasciitis | Conflicting evidence, some studies show benefit | Little data | Loading exercises, shockwave therapy |
| Herniated disc | Intradiscal injections — small studies, experimental | Experimental | Activity, exercise therapy, epidural injections, surgery when indicated |
| Avascular necrosis (early stage) | Little data | Limited evidence (BMAC with core decompression) | Core decompression early, joint replacement late |
| Rotator cuff tear | Limited evidence | Little data | Exercise therapy; repair for a complete tear |
What regenerative methods do not do
- They do not grow new cartilage: cartilage volume did not increase after injections in studies.
- They do not correct deformity or mechanical joint instability.
- They do not replace surgery for nerve compression with weakness or numbness.
- They do not guarantee a result: some patients see no effect.
How cell preparations are regulated in the EU
Minimally processed preparations from your own blood, bone marrow or fat (PRP, BMAC, MFAT) are used by doctors as part of medical practice. If cells are treated with enzymes or grown in a laboratory (for example SVF or cultured stem cells), they count as an advanced therapy medicinal product in the EU and need an authorisation. Offers of “stem cells” without such authorisation are a warning sign.
How to judge a clinic’s offer
- What studies exist for my diagnosis and stage?
- How many procedures are planned, and what if there is no effect?
- Which preparation is used and how is it obtained?
- Is it injected under ultrasound or X-ray guidance?
- What does the price include and which costs may be added?
We send your request to several clinics, so you can compare what each offers and how it justifies it. If you wish, send your images for a second opinion.
Scientific evidence
Guidelines and studies this page is based on:
- Bannuru RR et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage, 2019.
- 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.
- Belk JW et al. Platelet-rich plasma versus hyaluronic acid for knee osteoarthritis: a systematic review and meta-analysis of randomized controlled trials. Am J Sports Med, 2021.
- Pas HI et al. Stem cell injections in knee osteoarthritis: a systematic review of the literature. Br J Sports Med, 2017.
- Peerbooms JC et al. Positive effect of an autologous platelet concentrate in lateral epicondylitis in a double-blind randomized controlled trial. Am J Sports Med, 2010.
- Tuakli-Wosornu YA et al. Lumbar intradiskal platelet-rich plasma (PRP) injections: a prospective, double-blind, randomized controlled study. PM R, 2016.
Frequently asked questions about the evidence
Has it been proven that stem cells restore cartilage?
No. The studies are small, and they have not confirmed growth of new cartilage. Possible pain relief does not mean that tissue has been restored.
Which is better for knee osteoarthritis — PRP or hyaluronic acid?
In several reviews PRP reduced pain slightly more, but results vary, and in one large trial PRP was no better than placebo. Exercise and weight loss remain the basis of treatment.
Why do clinics promise different things?
Clinics interpret the same data differently and use different preparations. That is why it helps to compare several offers and ask which studies each one relies on.
Does RegenPAS publish its own studies?
RegenPAS is a patient service centre in Munich, not a clinic. We review your images and symptoms and send a request to several partner clinics at once. Clinics that can accept you send their own conditions and price; prices differ between clinics, and you choose the option that suits you. The coordinator replies within 24 hours, and a clinic physician’s preliminary opinion follows in 1–3 business days. We then arrange the appointment, visa invitation, interpreter, transfers and accommodation. Treatment decisions are made by the clinic physician. Contact a coordinator.
Where can I read the studies myself?
The study links lead to the PubMed database. We list them on the condition and treatment pages.
How can RegenPAS help?
RegenPAS is a patient service centre in Munich, not a clinic. We review your images and symptoms and send a request to several partner clinics at once. Clinics that can accept you send their own conditions and price; prices differ between clinics, and you choose the option that suits you. The coordinator replies within 24 hours, and a clinic physician’s preliminary opinion follows in 1–3 business days. We then arrange the appointment, visa invitation, interpreter, transfers and accommodation. Treatment decisions are made by the clinic physician. Contact a coordinator.
Want to know what suits you? Send your images
Send your MRI or ultrasound and describe where and when it hurts. The coordinator replies within 24 hours; a clinic physician gives an opinion in 1–3 business days.
Send images