Patients often ask which orthobiologic treatment is best. The honest answer is that there is no best — there is only best for a specific problem, in a specific person, at a specific stage.
PRP: the workhorse Platelet-rich plasma is a concentrate of your own platelets, spun down from a small blood draw. Platelets carry growth factors that signal repair. PRP is my most common starting point for tendon problems — tennis elbow, rotator cuff tendinopathy — and for early-to-moderate knee arthritis. It is the least invasive of the three, with the shortest in-office time.
BMAC: more cellular horsepower Bone marrow aspirate concentrate comes from a small draw of bone marrow, usually from the back of the pelvis. It contains not just growth factors but progenitor cells and a richer signaling environment. I reach for BMAC when the problem is more established — more advanced tendon degeneration or arthritis that has moved past the mild stage but is not yet surgical.
Microfragmented fat: cushion and signal Microfragmented adipose tissue — mFAT — is processed from a small amount of your own fat. It provides both a biologic signaling environment and a degree of physical scaffolding, which is useful in joints where the cushioning has thinned.
How the decision is actually made The choice is driven by imaging, examination, and the severity of what we see — not by preference or price. A mild tendinopathy does not need BMAC. Advanced degeneration will not be rescued by PRP alone. Matching the tool to the tissue is the entire job, and it is why the evaluation matters more than the injection.
This article is general education. The right option for your joint depends on your imaging and examination.