Topic 25 · Everything else

Platelet-Rich Fibrin (PRF) - Beyond PRP

A step past PRP in theory. The ankle evidence is starting to arrive — small and uncontrolled, but arriving.

→ PRF is like PRP but contains more of the healing factors and a fibrin scaffold. Simpler preparation, no additives needed. May provide longer-lasting effects than PRP.

Update, September 2026: the largest PRF-for-OLT series yet — 36 patients, mean 3.8 years

A Brazilian group (Universidade Federal de Minas Gerais / Hospital Felício Rocho) published a retrospective series of 36 patients with symptomatic OLT treated arthroscopically with lesion preparation plus an intraoperatively prepared autologous PRF scaffold (an advanced-PRF membrane combined with injectable i-PRF), with a minimum 8 months and a mean 3.8 years of follow-up [454]:

54.1→82.6

AOFAS improvement (p<0.001)

7.58→2.69

VAS pain reduction (p<0.001)

>80%

returned to sports, mean 7.6 months

11%

complications, one reoperation

This more than doubles the size of the previous largest PRF-for-OLT series (the 15-patient Bulgarian study below) and adds mid-term follow-up. The honest limit is the same one that has haunted every entry on this page: no control arm. The lesions were debrided and marrow-stimulated before the PRF went in, so the design cannot say what the scaffold added over the debridement alone — the authors themselves close by calling for comparative studies. Two senior authors disclose industry consultant/speaker relationships. What the paper does establish: the single-stage, no-additive PRF approach is being used at mid-term scale outside its original Eastern-European niche, and its complication profile stays low.

2024 Bulgarian Study on PRF for OLT

A retrospective study of 15 patients with stage IV OLT found [143]:

52.8→84.9

AOFAS improvement (p<0.05)

44.9→16.5

VAS pain reduction (p<0.05)

Mean follow-up: 38.8 months
All surgeries used same arthroscopic algorithm with PRF application

PRF + Autologous Osteochondral Transplantation (2025)

A study combining PRP with AOT in patients with OLT + chronic lateral ankle instability found [144]:

Both groups showed significant VAS and AOFAS improvements
AOT + PRP group showed significantly better "surface of repair tissue" scores on MOCART 2.0

PRF vs PRP

PRF provides a natural fibrin-based biomaterial scaffold rich in platelets, growth factors, and cytokines that facilitates cellular migration and proliferation essential for tissue healing.