Physician Commentary: Injectable Platelet-Rich Fibrin in Orthopedics—What This New Review Means for Patients

Injectable Platelet-Rich Plasma in Orthopoedics: Promising but Technique Still Matters

A physician’s perspective

Platelet-rich fibrin (PRF) has generated increasing interest as an alternative to conventional platelet-rich plasma (PRP). The recently published review The Role of Injectable Platelet-Rich Fibrin in Orthopedics: Where Do We Stand? summarizes the current understanding of injectable PRF and highlights its potential role in regenerative musculoskeletal medicine.

The review provides a useful overview of the underlying biology. However, it also reinforces an important reality that patients should understand: regenerative medicine is not defined by the product alone. Clinical outcomes depend just as much on diagnosis, patient selection, physician technique, and precise image-guided delivery as they do on whether PRP or PRF is used.

What is injectable PRF?

Injectable PRF is produced using lower centrifugation speeds and without anticoagulants. Compared with many PRP preparations, injectable PRF generally contains:

* Higher concentrations of leukocytes
* Platelets suspended within a fibrin matrix
* Gradual release of growth factors over time

This slower release has generated considerable interest because it may prolong biologic activity after injection.

The concept is scientifically appealing, although the clinical significance is still being defined.

What the review demonstrates

The review summarizes encouraging laboratory and early clinical evidence suggesting injectable PRF may support:

* Tendon healing
* Ligament healing
* Cartilage biology
* Bone regeneration
* Soft tissue repair

These findings are promising and justify continued investigation.

However, much of the literature remains heterogeneous. Different investigators use different centrifuges, collection tubes, spin protocols, injection techniques, and outcome measures, making direct comparison difficult.

Why technique matters

One of the most important messages often missing from discussions about regenerative medicine is that biologic products are only one component of treatment.

Two physicians may both advertise PRF, yet perform dramatically different procedures.

Important variables include:

* Accurate diagnosis
* Appropriate patient selection
* Ultrasound-guided needle placement
* Treatment of the actual pain source rather than simply injecting a joint
* Preparation technique
* Processing protocol
* Injection volume and distribution

The biologic itself cannot compensate for an incorrect diagnosis or inaccurate delivery.

PRF versus PRP

Patients frequently ask whether PRF is “better” than PRP.

The current literature does not support such a simple conclusion.

Each preparation has theoretical advantages depending on the tissue being treated, treatment goals, and physician technique.

In many situations, high-quality PRP remains an excellent option. In others, injectable PRF may offer advantages through its fibrin scaffold and slower release of growth factors.

The optimal choice should be individualized rather than driven by marketing claims.

What this means for patients

For patients considering regenerative medicine, the conversation should begin with diagnosis—not with the biologic itself.

Persistent pain often results from multiple structures rather than a single abnormal MRI finding. Determining what is actually causing symptoms is the first step toward selecting the appropriate treatment.

Only after identifying the true source of pain can meaningful decisions be made regarding PRP, PRF, prolotherapy, bone marrow concentrate, or other biologic therapies.

My perspective

Regenerative medicine continues to evolve rapidly, and injectable PRF represents another promising tool within a growing field.

The biology is encouraging, but careful interpretation of the evidence remains important. Larger, standardized clinical trials will be necessary before definitive conclusions can be drawn regarding superiority over existing biologic treatments.

Until then, the emphasis should remain on thoughtful diagnosis, image-guided precision, individualized treatment planning, and realistic patient expectations.

Those principles are likely to influence outcomes more than the specific biologic preparation alone.

References

Costa FR, Souza SAL, Martins RA, et al. The Role of Injectable Platelet-Rich Fibrin in Orthopedics: Where Do We Stand? Current Issues in Molecular Biology. 2025.

Brian E. Bernhardt, MD

Triple Board-Certified Anesthesiologist & Interventional Pain Physician

Alypos Regenerative Pain & Wellness

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