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Joint Diseases and
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Original Article · Open access

Osteogenic effect of platelet-rich fibrin on a bone defect model of long bone in rabbits

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In Park

Shiley Center for Orthopedic Research & Education at Scripps Clinic, CA, USA Department of Orthopedic Surgery, College of Medicine, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea

ORCID: 0000-0003-2177-6142

Saerom Jeong

Department of Molecular Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea

ORCID: 0009-0002-4014-4802

Jihoon Ryu

Department of Orthopedic Surgery, University Hospital Sharjah, Sharjah, United Arab Emirates

ORCID: 0000-0001-8073-5426

Abstract

Objectives: This study aims to evaluate the osteogenic effect of platelet-rich fibrin (PRF) graft with periosteal repair on a bone defect of long bone in rabbits, compared to control group that underwent periosteal repair alone.

Materials and methods: A total of 12 female New Zealand white rabbits were used in this study. Two rabbits were designated for PRP preparation, mixed with a human thrombin agent to produce PRF. A bone defect (5 mm in diameter and 7 mm in depth) was created in both proximal tibiae of 10 rabbits. The defect site of the right proximal tibia was filled with PRF, followed by periosteal repair (PRF group). In contrast, only periosteal repair was performed on the left proximal tibia (control group). For histological evaluation, hematoxylin and eosin (HE) and Masson’s trichrome (MT) staining were performed at Weeks 4 and 8 after surgery. The bone healing ratio, defined as the proportion of newly formed bone area to surgically created defect area, was calculated to assess bone regeneration. For radiological examination, micro-computed tomography (micro-CT) was conducted at Week 8 after surgery.

Results: A total of nine rabbits survived until the planned euthanasia time points (four rabbits at Week 4 and five at Week 8). At Week 4 postoperatively, HE staining revealed a higher bone healing ratio in the PRF group compared to the control group; however, the difference was not statistically significant (PRF group: 71.0 ± 15.6, control group: 59.5 ± 18.1, p = 0.34). At Week 8 postoperatively, histological analysis showed no difference in the bone healing ratio between the two groups (PRF group: 79.3 ± 8.7, control group: 75.9 ± 13.2, p = 0.55). Micro-CT analysis demonstrated a superior LaneSandhu score in the PRF group compared to the control group, although this difference was not statistically significant (p = 0.15).

Conclusion: The PRF graft with periosteal repair appears to promote improved early-stage new bone formation in bone defects of long bone in an animal model compared to periosteal repair alone, although it does not reach statistical significance.

Declarations

Author Contributions

I.P.: Idea/concept, design, control/supervision, analysis and/or interpretation, writing the article, critical review; S.J., J.R.: Data collection and/ or processing, materials; I.P., S.J., J.R.: Literature review, references and fundings.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

The authors received no financial support for the research and/or authorship of this article.

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

AI Disclosure

The authors declare that artificial intelligence (AI) tools were not used, or were used solely for language editing, and had no role in data analysis, interpretation, or the formulation of conclusions. All scientific content, data interpretation, and conclusions are the sole responsibility of the authors. The authors further confirm that AI tools were not used to generate, fabricate, or ‘hallucinate’ references, and that all references have been carefully verified for accuracy.

References

  1. Devendra A, Imran A, Venkatramani H, Balaraman K, Dheenadhayalan J, Rajasekaran S. Reconstruction of a 10-cm defect in the distal humerus using a lambda-shaped free vascularized fibular flap: A case report. JBJS Case Connect 2025;15. DOI: 10.2106/JBJS.CC.24.00268.
  2. Issaoui H, Fekhaoui MR, Jamous M, Masquelet AC. Modified masquelet technique using allogeneic graft for a GustiloAnderson Type III-a open fracture of the femur with an 8 cm bone defect. Case Rep Orthop 2021;2021:8829158. DOI: 10.1155/2021/8829158.
  3. Lurin I, Burianov O, Yarmolyuk Y, Klapchuk Y, Derkach S, Gorobeiko M, et al. Management of severe defects of humerus in combat patients injured in Russo-Ukrainian war. Injury 2024;55:111280. DOI: 10.1016/j.injury.2023.111280.
  4. Gómez-Barrena E, Ehrnthaller C. Long bone uninfected non-union: Grafting techniques. EFORT Open Rev 2024;9:329-38. DOI: 10.1530/EOR-24-0032.
  5. Gordon A, Newsome F, Ahern DP, McDonnell JM, Cunniffe G, Butler JS. Iliac crest bone graft versus cell-based grafts to augment spinal fusion: A systematic review and metaanalysis. Eur Spine J 2024;33:253-63. DOI: 10.1007/s00586-023-07941-9.
  6. Castillo TN, Pouliot MA, Kim HJ, Dragoo JL. Comparison of growth factor and platelet concentration from commercial platelet-rich plasma separation systems. Am J Sports Med 2011;39:266-71. DOI: 10.1177/0363546510387517.
  7. Açan AE, Karakılıç A, Aydın ME, Bulmuş Ö, Özcan E, Turan G, et al. Comparison of tendon healing using local platelet-rich plasma, erythropoietin, and erythropoietinbevacizumab in a rat Achilles tenotomy model. Jt Dis Relat Surg 2025;36:383-93. DOI: 10.52312/jdrs.2025.2234.
  8. Çakar B, Aliyev R, Aydın A, Uzun MF. Clinical effectiveness of platelet rich fibrin combined with core decompression and grafting in early stage femoral head avascular necrosis. Jt Dis Relat Surg 2025;36:659-65. DOI: 10.52312/jdrs.2025.2276.
  9. Kido HW, Bossini PS, Tim CR, Parizotto NA, da Cunha AF, Malavazi I, et al. Evaluation of the bone healing process in an experimental tibial bone defect model in ovariectomized rats. Aging Clin Exp Res 2014;26:473-81. DOI: 10.1007/s40520-014-0199-x.
  10. Oktaş B, Çırpar M, Şanlı E, Canbeyli İD, Bozdoğan Ö. The effect of the platelet-rich plasma on osteogenic potential of the periosteum in an animal bone defect model. Jt Dis Relat Surg 2021;32:668-75. DOI: 10.52312/jdrs.2021.199.
  11. Corre P, Merceron C, Vignes C, Sourice S, Masson M, Durand N, et al. Determining a clinically relevant strategy for bone tissue engineering: An "all-in-one" study in nude mice. PLoS One 2013;8:e81599. DOI: 10.1371/journal.pone.0081599.
  12. Lin C, Zhang N, Waldorff EI, Punsalan P, Wang D, Semler E, et al. Comparing cellular bone matrices for posterolateral spinal fusion in a rat model. JOR Spine 2020;3:e1084. DOI: 10.1002/jsp2.1084.
  13. Lane JM, Sandhu HS. Current approaches to experimental bone grafting. Orthop Clin North Am 1987;18:213-25.
  14. Zhang D, Huang D, Huang Y, Liu Y, Lin B, Yu C, et al. Efficacy of combined therapy of periosteum and bone allograft in a critical-sized defect model in New Zealand white rabbits. Med Sci Monit 2014;20:2394-403. DOI: 10.12659/MSM.891103.
  15. Carvalho A, Ferreira AF, Soares M, Santos S, Tomé P, Machado-Simões J, et al. Optimization of plateletrich plasma preparation for regenerative medicine: Comparison of different anticoagulants and resuspension media. Bioengineering (Basel) 2024;11:209. DOI: 10.3390/bioengineering11030209.
  16. Darabi MK, Pezeshki SP, Nazeri Z, Zarezadeh V, Dariuni HA, Kheirollah A, et al. The effect of platelet-rich plasma on the osteoblastic differentiation of human adipose tissuederived mesenchymal stromal cells. Clin Lab 2023;69. DOI: 10.7754/Clin.Lab.2022.221206.
  17. Giannetti A, Pantalone A, Antonucci I, Verna S, Di Gregorio P, Stuppia L, et al. The role of platelet-rich plasma on the chondrogenic and osteogenic differentiation of human amniotic-fluid-derived stem cells. Int J Environ Res Public Health 2022;19:15786. DOI: 10.3390/ijerph192315786.
  18. Ahmad Z, Ang S, Rushton N, Harvey A, Akhtar K, DawsonBowling S, et al. Platelet-rich plasma augmentation of arthroscopic rotator cuff repair lowers retear rates and improves short-term postoperative functional outcome scores: A systematic review of meta-analyses. Arthrosc Sports Med Rehabil 2022;4:e823-33. DOI: 10.1016/j.asmr.2021.12.012.
  19. Trantos IA, Vasiliadis ES, Giannoulis FS, Pappa E, Kakridonis F, Pneumaticos SG. The effect of PRP augmentation of arthroscopic repairs of shoulder rotator cuff tears on postoperative clinical scores and retear rates: A systematic review and meta-analysis. J Clin Med 2023;12:581. DOI: 10.3390/jcm12020581.
  20. Dolkart O, Chechik O, Zarfati Y, Brosh T, Alhajajra F, Maman E. A single dose of platelet-rich plasma improves the organization and strength of a surgically repaired rotator cuff tendon in rats. Arch Orthop Trauma Surg 2014;134:1271-7. DOI: 10.1007/s00402-014-2026-4.
  21. Liu B, Jeong HJ, Yeo JH, Oh JH. Efficacy of intraoperative platelet-rich plasma augmentation and postoperative platelet-rich plasma booster injection for rotator cuff healing: A randomized controlled clinical trial. Orthop J Sports Med 2021;9:23259671211006100. DOI: 10.1177/23259671211006100.
  22. Bahraminasab M, Doostmohammadi N, Talebi A, Arab S, Alizadeh A, Ghanbari A, et al. 3D printed polylactic acid/ gelatin-nano-hydroxyapatite/platelet-rich plasma scaffold for critical-sized skull defect regeneration. Biomed Eng Online 2022;21:86. DOI: 10.1186/s12938-022-01056-w.
  23. Cao B, Lin J, Tan J, Li J, Ran Z, Deng L, et al. 3D-printed vascularized biofunctional scaffold for bone regeneration. Int J Bioprint 2023;9:702. DOI: 10.18063/ijb.702.
  24. Shi X, Wang Z, Guo M, Wang Y, Bi Z, Li D, et al. PRP coating on different modified surfaces promoting the osteointegration of polyetheretherketone implant. Front Bioeng Biotechnol 2023;11:1283526. DOI: 10.3389/fbioe.2023.1283526.
  25. Chen CF, Wang PF, Liao HT. Platelet-rich plasma lysate enhances the osteogenic differentiation of adipose-derived stem cells. Ann Plast Surg 2024;92:S12-20. DOI: 10.1097/SAP.0000000000003765.
  26. An W, Ye P, Zhu T, Li Z, Sun J. Platelet-rich plasma combined with autologous grafting in the treatment of long bone delayed union or non-union: A meta-analysis. Front Surg 2021;8:621559. DOI: 10.3389/fsurg.2021.621559.
  27. Ranjan R, Kumar R, Jeyaraman M, Arora A, Kumar S, Nallakumarasamy A. Autologous platelet-rich plasma in the delayed union of long bone fractures - A quasi experimental study. J Orthop 2022;36:76-81. DOI: 10.1016/j.jor.2022.12.013.
  28. Zhang Y, Xing F, Luo R, Duan X. Platelet-rich plasma for bone fracture treatment: A systematic review of current evidence in preclinical and clinical studies. Front Med (Lausanne) 2021;8:676033. DOI: 10.3389/fmed.2021.676033.
  29. Ghaffarpasand F, Shahrezaei M, Dehghankhalili M. Effects of platelet rich plasma on healing rate of long bone non-union fractures: A randomized double-blind placebo controlled clinical trial. Bull Emerg Trauma 2016;4:134-40.
  30. Narayanaswamy R, Patro BP, Jeyaraman N, Gangadaran P, Rajendran RL, Nallakumarasamy A, et al. Evolution and clinical advances of platelet-rich fibrin in musculoskeletal regeneration. Bioengineering (Basel) 2023;10:58. DOI: 10.3390/bioengineering10010058.
  31. Dashore S, Chouhan K, Nanda S, Sharma A. Preparation of platelet-rich plasma: National IADVL PRP taskforce recommendations. Indian Dermatol Online J 2021;12:S12-23. DOI: 10.4103/idoj.idoj_269_21.
  32. Le ADK, Enweze L, DeBaun MR, Dragoo JL. Current clinical recommendations for use of platelet-rich plasma. Curr Rev Musculoskelet Med 2018;11:624-34. DOI: 10.1007/s12178-018-9527-7.
  33. Nacopoulos C, Dontas I, Lelovas P, Galanos A, Vesalas AM, Raptou P, et al. Enhancement of bone regeneration with the combination of platelet-rich fibrin and synthetic graft. J Craniofac Surg 2014;25:2164-8. DOI: 10.1097/SCS.0000000000001172.
  34. Colnot C, Zhang X, Knothe Tate ML. Current insights on the regenerative potential of the periosteum: Molecular, cellular, and endogenous engineering approaches. J Orthop Res 2012;30:1869-78. DOI: 10.1002/jor.22181.
  35. Xie H, Cao L, Ye L, Du J, Shan G, Hu J, et al. Autogenous bone particles combined with platelet-rich plasma can stimulate bone regeneration in rabbits. Exp Ther Med 2020;20:279. DOI: 10.3892/etm.2020.9409.