Comparison of hyaluronic acid and platelet-rich plasma in knee osteoarthritis: a systematic review.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: I confirm that this original manuscript has been read and approved by all named authors for publication, and that the work is not under consideration in any other journal. Competing interests: The authors declare no competing interests. 10. Periodontol 2000. 2025 Oct;99(1):185-215. doi: 10.1111/prd.12626. Epub 2025 Mar 24. Platelet-rich plasma (PRP) versus injectable platelet-rich fibrin (i-PRF): A systematic review across all fields of medicine. Farshidfar N(1), Amiri MA(2), Estrin NE(3), Ahmad P(4), Sculean A(1), Zhang Y(5), Miron RJ(1). Author information: (1)Department of Periodontology, University of Bern, Bern, Switzerland. (2)Oral and Dental Disease Research Center, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran. (3)Lake Erie College of Osteopathic Medicine School of Dental Medicine, Bradenton, Florida, USA. (4)Department of Research, Advanced PRF Education, Jupiter, Florida, USA. (5)Department of Oral Implantology, University of Wuhan, Wuhan, China. This systematic review aimed to evaluate all available evidence across all fields of medicine regarding the comparative effectiveness of platelet-rich plasma (PRP) versus injectable platelet-rich fibrin (i-PRF). A comprehensive search was conducted in PubMed, Scopus, and Web of Science up to September 30, 2024. Following a thorough screening process, studies were divided into in vitro, in vivo, and clinical studies based on their tissue/clinical indications. The initial search generated 2192 articles, of which 23 met the inclusion criteria. The findings demonstrated that i-PRF yielded higher platelet concentrations and offered a more sustained, long-term release of growth factors over time when compared to PRP. Overall, it was determined from in vitro studies that i-PRF significantly improved the activity of many cell types, including for skin, cartilage, periodontal, bone, soft tissue around dental implants, and pulp cells. In vivo outcomes also generally indicated that i-PRF outperformed PRP in cartilage and testicular regeneration. However, in orthodontic tooth movement, PRP was found to lead to superior short-term effects, while i-PRF showed more beneficial long-term effects. Clinical studies also found superior outcomes of i-PRF in skin regeneration, cartilage, and pulp regeneration. Outcomes regarding orthodontic tooth movement utilizing i-PRF or PRP remain controversial. In 72% of studies, i-PRF was found to lead to better outcomes across the various fields of medicine when compared to PRP, whereas 24% found no differences between the groups. Reasons and inconsistencies across the studies may be attributed to protocol differences and tissue types. Overall, additional clinical studies are needed with well-designed research and centrifugation protocols to better understand the regenerative potential of platelet concentrates in medicine. i-PRF offers a more sustained and prolonged release of growth factors and was favored in the majority of studies over PRP and should, therefore, be favored for the majority of medical and dental applications. © 2025 The Author(s). Periodontology 2000 published by John Wiley & Sons Ltd. DOI: 10.1111/prd.12626 PMCID: PMC13428083