Regenerative Medicine
Regenerative medicine in orthopaedics: PRP and biological therapies in Brescia.
PRP, adipose tissue and other preparations obtained from the patients themselves are now used or studied for some forms of osteoarthritis, for tendinopathies and for some musculotendinous injuries. The idea is to act on the biological environment of the joint or tendon; however, the proven effects, where they exist, mainly concern pain and function, not the structure of the tissue.
At Palazzo Manzoni, the lead orthopaedic specialist for regenerative medicine is Dr. Claudio Gilardoni, a specialist in Orthopaedics and Traumatology, who has been working in orthopaedic regenerative medicine at Palazzo Manzoni since 2016. Every injection is preceded by a precise diagnosis: “regenerative” does not mean rebuilding worn tissue.
Diagnosis first
Consultation and tests before any injection
Ultrasound-guided
When needed, the needle is guided by ultrasound
Since 2016
Orthopaedic regenerative medicine at Palazzo Manzoni
Realistic goals
The goal: less pain and better function, not new cartilage
What It Is
Orthobiologics: treating with the patient’s own biology.
Regenerative medicine includes various strategies that seek to use or stimulate the body’s natural repair mechanisms. In orthopaedics, the main ones are PRP (platelet-rich plasma) and, in selected settings, preparations obtained from adipose tissue or bone marrow: together, these are called orthobiologics.
PRP is obtained from your blood using a centrifuge and is injected into the affected site; in joints and tendons this is often done under ultrasound guidance, which allows the doctor to see the structures and control precisely where the needle goes. Adipose tissue, on the other hand, requires a small fat harvest and preparation in the same session.
It is important to avoid false expectations. These therapies may help to control pain and recover function in selected patients, but they do not rebuild a worn joint and do not replace surgery when surgery is indicated.
Did you know?
In 2006, PRP for tennis elbow was still a novelty: a pilot study of 20 patients with persistent pain who were considering surgery treated 15 of them with a single PRP injection and reported less pain, calling for further investigation. Today, tennis elbow is one of the most studied applications of PRP.
Source: Mishra A, Pavelko T, American Journal of Sports Medicine 2006
The Conditions
The problems we consider it for
Effectiveness is not the same for every condition. That is why we always start from a precise diagnosis and assess whether biological treatment is genuinely indicated at the stage the problem has reached.
For some conditions the evidence is fair, for others it is weak or negative: you will find it below, unfiltered.
01
Knee osteoarthritis
The most studied application, particularly in early and intermediate forms. PRP injections for the knee
02
Hip osteoarthritis
The indications issued in Italy by the Italian National Blood Centre (Centro Nazionale Sangue) include grade 1-3 knee and hip osteoarthritis among the conditions with a strong recommendation; other international guidelines are more cautious or advise against it, and there are fewer studies on the hip.
03
Chronic tendinopathies
Lateral epicondylitis and some disorders of the shoulder tendons, particularly when they respond poorly to conservative treatment; for the Achilles tendon and the patellar tendon, placebo-controlled studies are negative, and we tell you so beforehand.
04
Shoulder and rotator cuff
PRP is also used during arthroscopic rotator cuff repair, to support tendon healing.
05
Muscle and musculotendinous injuries
The evidence is limited, and controlled studies on acute muscle injuries have not shown a clear benefit: it is considered only in selected cases, within a rehabilitation programme.
06
Cartilage and meniscus disorders
Adipose tissue, injected under ultrasound guidance, is being evaluated in some cartilage and meniscus disorders and in early-stage osteoarthritis. Adipose tissue and mesenchymal cells
Tendons
PRP and tendinopathies: results differ from tendon to tendon
PRP is used or studied in various tendinopathies, particularly chronic ones. But the best studies, those comparing it with a placebo, give very different results depending on the tendon. You should know this before choosing.
→Tennis elbow
Against placebo, a meta-analysis of 6 randomised studies found no difference; compared with cortisone, cortisone gives more relief in the first few weeks, and PRP beyond 6 months. Antunes Júnior 2026; Maroun 2025
→Achilles tendon
Two studies published in JAMA, in 2010 and in 2021 with 240 patients, showed no benefit of PRP over placebo in chronic tendinopathy. de Vos 2010; Kearney 2021
→Patellar tendon
In 57 athletes, a single PRP injection combined with exercises was no more effective than saline. Scott 2019
→Rotator cuff
During arthroscopic repair, PRP or similar products reduce re-tears to a statistically significant extent, although, according to the authors, the clinical relevance does not appear significant. Chen 2026
For this reason, in tendinopathies PRP is never the automatic first choice: specific exercise and physiotherapy remain the foundation of treatment.
Two Frequently Asked Questions
PRP or hyaluronic acid? And can it avoid the need for a joint replacement?
PRP and hyaluronic acid are not the same thing, and one does not necessarily have to replace the other. Hyaluronic acid has been used for many years in injections for osteoarthritis; PRP uses biological components from your own blood. The choice depends on the joint, the grade of osteoarthritis, your individual characteristics and your goals; in some situations, sequential or combined strategies are considered.
In early or intermediate osteoarthritis, a conservative programme may help to control symptoms and preserve joint function. This does not mean that PRP can replace a joint replacement when there is a clear indication for surgery: according to a systematic review, the data are still insufficient to say that injections delay surgery.
In advanced forms, particularly with significant structural damage or deformity, surgical treatment may remain the most appropriate solution. Dr. Gilardoni is also an orthopaedic surgeon: the assessment considers every option.
Did you know?
PRP has also been through anti-doping scrutiny. The World Anti-Doping Agency added it to the list of prohibited substances in 2010 and removed it the following year: since 2011, autologous PRP has been permitted in competitive sport, because there is no evidence that it improves performance.
Sources: Dhillon RS et al., Arthritis Research & Therapy 2012; Scully D, Matsakas A, International Journal of Sports Medicine 2019
The Lead Orthopaedic Specialist
Dr. Claudio Gilardoni
Specialist in Orthopaedics and Traumatology. He works in shoulder, hip and knee replacement surgery, arthroscopic surgery of the shoulder, knee and ankle, and sports traumatology and, at Palazzo Manzoni since December 2016, in orthopaedic regenerative medicine for sports-related and degenerative conditions.
Specialisation
Orthopaedics and Traumatology, University of Brescia, 1994
Knee and arthroscopy
from 1997 to 1999 in the knee surgery and arthroscopy unit of the Spedali Civili di Brescia
Regenerative medicine
PRP and ultrasound-guided adipose tissue grafting
Scientific societies
SIGASCOT, SIOT and SIA
An Integrated Pathway
Regenerative medicine, physiotherapy and exercise
A biological therapy should never be considered in isolation. The result also depends on body weight, muscle strength, physical activity, joint biomechanics and the rehabilitation programme.
The highest-quality guidelines on hip and knee osteoarthritis consistently recommend education, exercise and weight management: they are the foundation on which a biological therapy can add something.
01
Diagnosis
Orthopaedic consultation and targeted tests: X-ray, ultrasound or MRI when needed.
02
Indication
We establish whether biological treatment makes sense, in what form and at what point.
03
Treatment
PRP or adipose tissue injection, under ultrasound guidance when useful.
04
Rehabilitation
Exercise, physiotherapy and advice on weight-bearing, with a rehabilitation physician and a physiotherapist when needed.
05
Review
Follow-up visits to measure pain and function and decide on the next steps.
Your Journey
How it works, in Brescia
Step 01
Book your consultation
By phone, email, WhatsApp or online form. Bring with you any X-rays, ultrasound scans or MRI scans you have already had.
Step 02
The orthopaedic consultation
Dr. Gilardoni goes through the history of your pain, examines the joint and reviews your tests, requesting further ones if necessary.
Step 03
The plan
The right question is not “Can I have PRP?” but “What is the most suitable treatment for my condition, at the stage it has reached?”
Step 04
The treatment
An outpatient PRP injection, or harvesting and grafting of adipose tissue in the operating theatre in the same session.
Step 05
Rehabilitation and follow-up
An exercise programme and scheduled follow-up visits: improvement, when it occurs, is gradual.
Frequently Asked Questions
Frequently asked questions
about regenerative medicine in orthopaedics
What is regenerative medicine in orthopaedics?
It is the use of preparations obtained from the patients themselves, mainly PRP and adipose tissue, to act on the biological environment of joints, tendons and muscles. It is used in some forms of osteoarthritis, in tendinopathies and in some musculotendinous injuries, always after a precise diagnosis.
Does PRP work for tendinitis?
It depends on the tendon. For the Achilles tendon and the patellar tendon, placebo-controlled studies have shown no benefit; for tennis elbow, PRP did not outperform placebo, but beyond 6 months it gave better results than cortisone. Specific exercise and physiotherapy remain the foundation.
Is PRP useful for the shoulder?
In the shoulder, PRP is mainly used to support arthroscopic rotator cuff repair, where it reduces re-tears, although according to a recent meta-analysis the clinical relevance does not appear significant. For injections without surgery, the indication is assessed case by case after an ultrasound or MRI scan.
Can PRP be used for the hip?
Yes, in selected cases. The indications issued in Italy by the Italian National Blood Centre (Centro Nazionale Sangue) include grade 1-3 hip and knee osteoarthritis among the conditions with a strong recommendation, but other international guidelines are more cautious or advise against it, and there are fewer studies on the hip. As the hip is a deep joint, the injection is performed under ultrasound guidance.
How many PRP injections are needed?
There is no single protocol: it depends on the condition, the type of preparation and your individual characteristics. For osteoarthritis, the Italian indications refer to a course of 3 applications. You will be given the precise plan after the consultation.
Can PRP avoid the need for surgery?
In early or intermediate osteoarthritis it may help to control symptoms, but it is not a substitute for a joint replacement when surgery is indicated. A systematic review concludes that the data are insufficient to state that PRP delays knee replacement.
Are the injections painful?
The discomfort is generally mild and short-lived; in the following days, pain or swelling may appear at the injection site. Adipose tissue harvesting is performed under local anaesthetic, possibly with sedation tailored to the individual case.
Who performs the treatments at Palazzo Manzoni?
Dr. Claudio Gilardoni, Specialist in Orthopaedics and Traumatology, is the lead orthopaedic specialist for regenerative medicine. For treatments with adipose tissue, he works with Dr. Stefano Di Nonno, who is responsible for harvesting and preparing the fat.
Take the Next Step
Your next step starts
with a conversation
At Palazzo Manzoni in Brescia, every consultation is personal, unhurried, and designed to give you clarity about your next step.
Address
Via dei Mille 14, 25122 Brescia, Italia
Phone
Hours
Mon-Fri 8:30-18:30 · Sat 9:00-13:00
01
Get in touch
Call, email, WhatsApp, or book online.
02
Meet your specialist
A personal consultation to understand your situation.
03
Your plan, your pace
Together you decide the best path forward.
Content reviewed by Dr. Claudio Gilardoni, specialist in Orthopaedics and Traumatology.