Treating Knee Osteoarthritis
Autologous blood therapy with PRP instead of surgery
Knee pain caused by osteoarthritis limits daily activities—whether climbing stairs, exercising, or sleeping at night. By incorporating the body’s own regenerative capabilities into your treatment, I treat knee osteoarthritis using a regenerative, targeted approach that does not require surgery. At my private practice in Kronberg, I use the IMPACT® Platform—a certified system for autologous cell therapies.
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Key Points at a Glance
Knee Osteoarthritis & PRP: Key Points at a Glance
What is knee osteoarthritis (gonarthrosis)?
Degenerative wear and tear of the knee joint cartilage, leading to pain, stiffness, and limited mobility.
Common symptoms:
Pain upon taking the first step, pain when climbing stairs, nighttime pain, swelling, and warmth in the joint.
Which type of PRP is used?
Depending on the stage: White PRP (anabolic, regenerative) for cartilage damage, Red PRP or ACS (anti-inflammatory) for active osteoarthritis.
How many sessions?
Typically 1–3 injections spaced about 2 weeks apart. Duration of effect: 6–12 months.
How much does the treatment cost?
€260–270 per treatment, plus the GOÄ injection fee. Approximately 70% of private health insurance plans cover the costs.
What happens in your joint when you have knee osteoarthritis?
The knee joint is one of the joints in the body that bears the heaviest load. In knee osteoarthritis—medically known as gonarthrosis—the protective layer of cartilage that covers the joint surfaces of the thighbone and shinbone breaks down. Without this cushion, bone rubs against bone: a process that causes pain, inflammation, and further accelerates the breakdown of cartilage.
The condition progresses in stages. At first, the pain subsides after a short period of movement—what is known as “start-up pain.” Over time, it also occurs during physical activity: when climbing stairs, walking for long periods, or playing sports. In the advanced stage, the knee hurts even at rest and at night.
What many people don’t realize is that symptoms don’t always correspond to X-ray findings. A supposedly severe case of osteoarthritis isn’t necessarily a reason for surgery—and a moderate diagnosis can still cause significant discomfort. That’s why a thorough clinical evaluation is crucial before discussing treatment options.
Indications
Who is PRP suitable for in cases of knee osteoarthritis?
PRP therapy is not suitable for every stage of osteoarthritis. Here is my clinical assessment:
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Early stage (Grade 1–2): White PRP for cartilage regeneration
At these stages, the cartilage is still present but damaged and inflamed. This is where I specifically use White PRP—leukocyte-poor, anabolic platelet-rich plasma. The reduced leukocyte content lowers the risk of an additional inflammatory reaction in the joint; the concentrated growth factors support the body’s own cartilage regeneration. In this phase, the potential benefits of autologous blood therapy are greatest.
Moderate stage (Grade 3): Individualized – White PRP, Red PRP, or a combination
In cases of significant cartilage damage, I carefully review the findings and the current condition of the joint. If the primary goal is regeneration, White PRP remains the first choice—combined, if necessary, with hyaluronic acid, which nourishes the cartilage. If the joint is acutely inflamed and swollen, I can switch to Red PRP or ACS to first break the cycle of inflammation. These two approaches are not mutually exclusive; they can be used sequentially.
Active osteoarthritis with severe inflammation: ACS – the "natural cortisone"
When the knee is experiencing an acute flare-up—with swelling, heat, and severely limited mobility—cortisone is the standard immediate treatment. As a natural alternative, I offer ACS (Autologous Conditioned Serum). This procedure involves a complex process that isolates anti-inflammatory substances from your own blood—with an anti-inflammatory effect that can be comparable to cortisone, but without its known side effects, such as cartilage damage with repeated use.
Advanced Stage (Grade 4): An Honest Assessment
In cases of severe, extensive cartilage damage, the options for autologous blood therapy are limited. At this stage, treatment can help relieve pain and reduce inflammation—I will discuss openly with you whether and when a knee replacement might be appropriate. If surgery has already been recommended, seeking an independent second opinion can be a sensible first step.
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Procedure
Autologous blood therapy using the IMPACT® Platform – this is how I work in my practice
Not all PRP procedures are the same, and not all practices are authorized to offer or produce autologous cell therapies. Production in accordance with the German Medicines Act requires official approval. My practice has received this approval from the Darmstadt Regional Council. This means that all procedures, quality standards, and hygiene requirements have been reviewed and approved by the state.
Production is carried out using the IMPACT® Platform:
Blood draw under local anesthesia
Approximately 10–15 ml of blood is drawn from a vein in the arm. The entire rest of the process takes place in a closed, sterile system—the blood is never handled in an open environment.
Fully automated processing
The IMPACT® Platform processes blood fully automatically. A built-in optical sensor detects the blood fractions and precisely controls the separation process. Depending on the desired preparation (White PRP, Red PRP, or ACS), different fractions are concentrated. The result is a highly concentrated, autologous preparation that is ready for injection.
Ultrasound-guided injection into the knee joint
The prepared solution is injected directly into the knee joint under ultrasound guidance. Ultrasound guidance ensures that the PRP reaches the target area precisely. The injection is performed under local anesthesia.
The entire procedure takes about 45–60 minutes and is completed in a single session. You may leave the office on your own afterward; I recommend resting the knee joint for the rest of the day.
For more information on the IMPACT® Platform: autologe-zelltherapien.de
Medical assessment
Why, as a surgeon, I make a distinction between White PRP, Red PRP, and ACS
As a specialist in orthopedics and trauma surgery, I perform knee surgeries: arthroscopies, meniscus procedures, and, when necessary, preparatory procedures for knee replacement. I know the path to the operating room. And I know what comes next: rehabilitation, the risks involved, and what my patients can realistically expect after receiving a knee replacement.
If I decide to undergo autologous blood therapy today, I don’t take a one-size-fits-all approach. A knee joint with grade 2 osteoarthritis needs a different treatment than an acutely inflamed grade 3 joint. White PRP focuses on tissue regeneration. It is anabolic and regenerative, suitable for joints that need help rebuilding. Red PRP and ACS are designed to reduce inflammation: catabolic and anti-inflammatory, for joints where the cycle of inflammation and pain must first be broken.
This distinction determines which medication actually acts on the joint.
My goal is not to avoid surgery at all costs. My goal is for you to make the right decision for your knee and for the treatment we choose to be appropriate for your condition.
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Types of therapy
White PRP, Red PRP, ACS, and cortisone—what’s the difference?
Three treatments, three mechanisms of action—and different indications depending on the stage and findings. Here is my clinical assessment:
White PRP – leukocyte-poor plasma (anabolic)
For regenerative applications: fresh cartilage damage, early stages of osteoarthritis, sports injuries. The reduced white blood cell concentration minimizes the risk of an additional inflammatory reaction in the joint; the concentrated growth factors activate the body’s own repair process.
Red PRP – platelet-rich plasma (catabolic)
For persistent chronic inflammatory conditions. The higher concentration of white blood cells can help break the cycle of chronic inflammation and prompt the body to initiate a new healing response.
ACS – Autologous Conditioned Serum (anti-inflammatory)
"Bio-Cortisone": a serum derived from the body’s own substances, containing highly concentrated anti-inflammatory agents. For acute flare-ups of osteoarthritis where an immediate cortisone-like effect is desired without the known side effects of a cortisone injection. Unlike cortisone, ACS can be administered repeatedly as needed, since it contains only the body’s own substances.
Cortisone injection
It acts quickly and has strong anti-inflammatory effects—making it useful as an immediate measure. According to current research, repeated use of cortisone can have cartilage-damaging effects—which is why it is generally not used as a long-term treatment in orthopedics. That is precisely why I often find ACS to be the better choice as a natural alternative.
Hyaluronic acid injection
Hyaluronic acid is a natural component of synovial fluid and nourishes the cartilage. In cases of degenerative, inflammatory processes, the body can no longer fulfill its original function of producing sufficient hyaluronic acid and is primarily occupied with its inflammatory response. In such situations, it is possible to inject synthetically produced hyaluronic acid into the joint to correct the existing deficiency. This can then resume nourishing the cartilage and strengthen the existing cartilage.
Costs
Costs and Coverage
Autologous blood therapy under the German Medicines Act (AMG) requires an official manufacturing license, and that is precisely why the manufacturing process in my practice adheres to a different standard than a standard PRP procedure performed without a license. We have obtained the necessary approval from the Darmstadt Regional Council.
The production cost per treatment (White PRP, Red PRP, or ACS) is €260–270. In addition, there are fees for the injection based on the GOÄ. You will receive a full breakdown of costs before treatment begins.
AMG autologous blood therapy is a private medical service. Currently, approximately 70% of private health insurance plans cover the costs. Upon request, I can prepare a customized claim form for you to submit before treatment begins, ensuring you have full cost certainty. Self-pay patients are welcome.
PRP/autologous blood therapy is a personalized medical service (IGeL). Clinical studies—including Görmeli et al. (2014) —have documented a significant reduction in pain and improved joint function over a 12-month period in patients with knee osteoarthritis. Conclusive scientific evidence meeting the criteria of evidence-based medicine is still pending for some indications. Individual treatment results may differ from published study results.
Dr. Braune's practice is a private practice and is open exclusively to private patients and self-pay patients.
Schedule an appointment now for knee osteoarthritis treatment in Kronberg
Patients from Frankfurt, Bad Homburg, Königstein, and throughout the Hochtaunus district come to my private practice in Kronberg im Taunus for treatment. Appointments are often available on short notice. Please contact us for current availability.
