Comparison of the effects of platelet-rich fibrin and platelet-rich plasma on experimental tendon injury in rabbits

Abstract

This study aimed to compare the early-phase histopathological and immunohistochemical effects of platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) following their application in the inflammatory phase of experimentally induced calcaneal tendon injuries in a rabbit model. A complete calcaneal tenotomy was performed and repaired using the modified Kessler technique. In the PRP group, 0.5–1 ml of non-activated liquid PRP was injected into the paratenon. In the PRF group, a PRF membrane was wrapped around the tenotomy site. The Control group received sutures only. On the 14th postoperative day, tendon tissue samples were collected for analysis. Healing was assessed via histopathology (HE, Masson's trichrome) and immunohistochemistry for key growth factors (TGF-β, VEGF, FGF-β) and inflammatory markers (iNOS, nitrotyrosine). Histopathological evaluation revealed that both PRP and PRF groups exhibited superior healing compared to the Control group, characterized by reduced inflammatory cell infiltration, less edema, and a more organized, parallel arrangement of newly synthesized collagen fibers. Compared to controls, both treatment groups showed significantly increased expression of the pro-regenerative FGF-β and decreased expression of TGF-β and VEGF. Furthermore, levels of iNOS and nitrotyrosine were markedly lower in the PRP and PRF groups. Both PRP and PRF demonstrated comparable and significant efficacy in enhancing the quality of early tendon repair. Their therapeutic effect appears to be multifactorial, created by a pro-regenerative and anti-inflammatory microenvironment that favorably modulates growth factor expression and reduces inflammatory tissue damage. These findings support the use of both preparations as effective strategies to promote healing in acute tendon injuries.