Use of platelet-rich fibrin for bone repair: a systematic review and meta-analysis of preclinical studies

This systematic review evaluated the potential utility of platelet-rich fibrin (PRF) in bone repair in animals. The question is: can the use of PRF in bone defects in healthy rats induce bone repair compared to clot? This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (Prisma). The protocol was registered with Prospero (CRD [42020162319]). The literature search involved nine databases, including grey literature. All studies evaluated the bone defects created in rats filled with PRF and clots (control). Biomaterial evaluation was also performed in this study. The risk of bias was assessed using the Systematic Review Center for Laboratory Animal Experimentation (Syrcle) tool for animal studies. A meta-analysis of quantitative data was performed to estimate the effect of PRF on bone repair in rats. Heterogeneity among the studies was assessed using the I-2 statistic. The literature search retrieved 685 studies, 10 of which fulfilled the eligibility criteria, and 4 were included in the quantitative assessment. Analysis of the risk of bias revealed that most studies had a high risk of bias in performance and detection. Meta-analysis yielded divergent results and the absence of a statistically significant effect: PRF with control (standardized mean difference 2.54, 95% confidence interval - 0.80-5.89; p = 0.14). In general, study heterogeneity was high (I-2 = 75.0%). The quality of the studies that influenced the conclusion of the review was based on the PICO, the sources and form of the search, the study selection criteria, the form of evaluation of publication bias, the evaluation of the quality of the studies, and data extraction by two researchers. PRF did not provide significant benefits for bone repair, resulting in unpredictable effects.