2.1 Study design

This study employed a bibliometric analysis to assess the global research trends on PRP in surgical practice. This study aimed to examine all the literature on PRP in the realm of surgery, in order to identify the research productivity, scientific progression, research hotspots, emerging trends, and influence of contributions in this field.

2.2 Search strategy

The original data in our study were obtained from the Science Citation Index Expanded (SCI-EXPANDED) database within the Web of Science Core Database (WoSCC). WoSCC is a huge database collection, and incorporating heterogeneous databases in a single bibliometric analysis could introduce methodological bias.^10,11 Among these, SCI-EXPANDED stands out as the most prudent and extensively accepted choice for bibliometric analysis.¹² Therefore, because of the bibliometric analysis's scientific and rigorous character, we employed SCI-EXPANDED database as the sole data source.

Table S1 (in the supplement) illustrates the detailed retrieval strategy and inclusion procedures used in this study. The retrieval strategy was established as follows: 1. The title contains “PRP” or “PRF” related fields, and the title or abstract contains “surgery” related fields; 2. the time frame for inclusion was from inception to 2024; 3. document types include only articles and reviews; 4. the language is restricted to English.

2.3 Data extraction, standardization, and analysis

Two independent reviewers retrieved and exported all eligible publications in “Plain Text” format containing full records and cited references from the SCI-EXPANDED of the WoSCC database. The R package bibliometrix (4.0.0) was utilized to conduct the bibliometric analysis and visualization of countries/regions, affiliations, title, authors, publication year, keywords, citations, references and network concerning the articles.¹³

3.1 Study characteristics

Table 1 provides a comprehensive overview of this analysis. A total of 1898 articles (including 1654 articles and 244 review articles) were retrieved from 1984 to 2024, spanning 41 years. The annual growth rate of publications is 14 %. The number of publications increased steadily from 1 in 1984 to 189 in 2024. Since 2018, the number of publications related to PRP and surgery has exceeded one hundred, showing a rapid growth trend.

3.2 Analysis of the contributions of countries/regions

The analysis of country and regional contributions to PRP research in surgery reveals both the globalization of the field and notable inequalities between research productivity and influence. Fig. 1A shows the global distribution of publications in PRP and surgery and Fig. 1B lists the top 10. China (n = 938), the USA (n = 711), and Italy (n = 583) are identified as the top three countries contributing to the field, accounting for 38 % of all publications. Temporal trends indicate that the USA and Italy were more active in early PRP studies., laying much of the foundational work, whereas China experienced rapid growth in the last decade. (Fig. 1C). Among the corresponding author's countries, China (n = 328), the USA (n = 268) and Italy (n = 182) contributed the most. The USA had the most multi-country publications (MCP) at 54, while Korea had the highest MCP rate (25.9 %) (Fig. 1D).

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Fig. 1 Visualization of productivity, impact, and collaboration by countries/regions in the field of PRP in surgery. (A) World map showing the distribution of global publications on PRP in surgery; (B) top 10 productive countries; (C) top 10 country production over time; (D) corresponding author's countries; (E) top 10 cited countries; (F) network of the countries/regions' collaboration. Abbreviations: SCP: single country publications; MCP: multiple country publications.

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However, when evaluating impact through citations, a clear distinction emerges between countries with high productivity and those with high influence. Studies originating from the USA and Italy have more citations than China, reflecting greater global influence (Fig. 1E). This may also result from the fact that the USA and Italy contributed earlier and had a more solid foundation in this field. Fig. 1F and S1 present a visualization map of collaboration between different countries. The thickness of connecting lines represents the strength of collaboration between the nodes. China and the USA belong to the same cooperation cluster (red), indicating that they exhibit similar network characteristics in the global cooperation model. Although Italy belongs to the blue cluster and has closer cooperation with European countries, the strong connection between the USA and Italy suggests that there exists an extremely close bilateral cooperation relationship between the two countries in this field.

3.3 Analysis of the contributions by institutions

Institutional contributions to PRP research in surgical practice reveal both productivity and influence distributed across global centers. The top 3 contributing affiliations were Egyptian Knowledge Bank (EKB) (n = 140), KU Leuven (n = 59), Universidade Estadual Paulista (n = 56) (Fig. 2A). Fig. 2B shows the collaboration network between affiliations. The top 50 affiliations were divided into 12 clusters. The density visualization further highlighted influential research hubs, where high-impact institutions were concentrated in a few regions, especially the EKB, reflecting both productivity and centrality in the research network (Fig. 2C).

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Fig. 2 Visualization of productivity, impact, and collaboration by institutions in the field of PRP in surgery. (A) Top 10 relevant affiliations; (B) a network visualization map on the top 50 institutions' collaboration; (C) a density visualization map of the top 50 institutions.

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3.4 Analysis of the contributions by sources

This study includes 558 journals. The most relevant sources included The American Journal of Sports Medicine (n = 50), Journal of Periodontology (n = 43), and Journal of Oral and Maxillofacial Surgery (n = 43) (Fig. 3A). Analysis of publication dynamics demonstrated that most sources showed a constant increase in output. Journal of Clinical Medicine has grown rapidly since 2022 and reached a peak at 10 articles in 2024 (Fig. 3B).

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Fig. 3 Visualization of productivity and impact by sources in the field of PRP in surgery. (A) Top 10 most relevant sources; (B) top 10 sources' production over time; (C) top 10 local cited sources; (D) sources' local impact by H-index and total citations; (E) a density visualization map of the top 50 journals.

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Local citation analysis identified The American Journal of Sports Medicine (3153 citations), Journal of Periodontology (2410 citations), and Journal of Oral and Maxillofacial Surgery (1816 citations) as the most influential journals in terms of citation frequency (Fig. 3C). Furthermore, The American Journal of Sports Medicine exhibited the highest H-index with 34 and total citations with 5644, reflecting its sustained scientific impact (Fig. 3D). Co-citation network mapping and density visualization of the top 50 sources revealed a dense core of interlinked journals (Fig. 3E and S2). The top 50 sources are divided into 3 categories, with The American Journal of Sports Medicine, Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontics, and Biomaterials at the center, dominating knowledge dissemination in this field.

3.5 Analysis of authors’ impact and collaboration

Table 2 and Fig. 4A illustrate the top 10 influential authors in the field of PRP on surgery. Articles' fractionalized frequency quantifies an individual author's contributions to a published set of papers. Six of these authors are from Italy, and the remaining four authors are from South Korea, USA, Spain and England. Pietro Gentile from Italy emerged as the most prolific author with 18 publications and a fractional authorship of 3.15 %. Following closely behind were Giuseppe Filardo (15 publications) and Valerio Cervelli (14 publications), both from Italy as well. The impact of these authors is also evident in their citation indices, with David M. Dohan Ehrenfest from South Korea leading with the highest total citation (TC) count of 2210 (Table 2) and the highest local citation of 554 (Fig. 4B), significantly outpacing others. The H-index, which reflects both the quantity and the impact of an author's publications, revealed that Pietro Gentile was the most influential in this field with an H-index of 17. Additionally, the G-index, which emphasizes highly-cited papers, also emphasized his academic influence (Table 2).

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Fig. 4 Visualization of author productivity, impact, and collaboration in the field of PRP in surgery. (A) The top 10 relevant authors; (B) the top 25 local cited authors; (C) the top 10 authors' production over time; (D) a network visualization map on the top 50 authors' collaboration; (E) a density visualization map of the top 50 authors.

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Fig. 4C illustrates the temporal distribution of scientific output by the top 10 most productive authors in the field of PRP in surgery. It also demonstrates the field's evolution from initial concentrated contributions by a few pioneers (2006–2010) toward a broader and more distributed authorship network in the later years (2012–2024). Fig. 4D shown the collaboration network between authors. The top 50 authors are divided into eight categories. However, collaboration is limited to three main clusters. The density visualization further illustrated the interconnections among these top authors, highlighting a robust collaborative network, particularly between Italian authors, who dominate the field. Three leading authors, Pietro Gentile, Giuseppe Filardo and David M. Dohan Ehrenfest, have made significant contributions to collaborative efforts (Fig. 4E).

3.6 Analysis of highly cited study

The most cited publications in the field demonstrate the pivotal contributions that have shaped the scientific and clinical understanding of PRP in surgery. Table 3 lists the ten most cited studies, with over half cited more than 400 times, reflecting their lasting influence on the field. The article “Platelet-Rich Plasma: From Basic Science to Clinical Applications” by Foster et al. (2009) received the highest number of citations (908),¹⁴ underscoring its impact in elucidating the mechanisms and therapeutic potential of PRP in the field of orthopaedic surgery and sports medicine. The second most cited article “Platelet quantification and growth factor analysis from platelet-rich plasma: Implications for wound healing” by Eppley et al. (2004), quantified the platelet count and growth factor levels in PRP, confirming the potential promoting effect of PRP in wound healing and plastic surgery.¹⁵ Other landmark studies—such as Mishra et al. (2006)¹⁶ and Sánchez et al. (2007),¹⁷ expanded PRP's application to tendon and ligament healing, reinforcing its clinical relevance in sports medicine. Similarly, Anitua et al. (2006)¹⁸ and Ehrenfest et al. (2009)¹⁹ contributed to theoretical advancements by clarifying the preparation methods and applications of PRF, marking the transition from PRP to PRF technologies.

Locally cited documents exhibited similar patterns, highlighting the same key authors and journals that have guided the internal evolution of the field (Table 4). Eppley et al. (2004) was again the most locally cited (119 citations), reflecting its foundational influence.¹⁵ Ehrenfest et al. (2009)¹⁹ and Foster et al. (2009)¹⁴ also ranked highly in local citation frequency, with 99 and 98 local citations respectively. Additionally, later studies by Ehrenfest et al. (2010–2012) emphasized the biological rationale and preparation standardization of PRF, signaling the field's methodological maturation^20–22.

3.7 Keywords analysis

The keyword analysis provided important insights into the thematic structure and evolving research focuses of PRP in surgical practice. Fig. 5A and B shows the most relevant keywords and visualization through a word cloud. Words that occurrences higher than 100 include: platelet-rich plasma, growth-factors, platelet-rich fibrin, prp, repair, regeneration, plasma, growth-factor, proliferation, surgery, gel, prf, management, cells, combination, growth factors, in-vitro, bone regeneration, efficacy, wound healing, defects, therapy, osteoarthritis, injection. The tree map analysis of subject categories further illustrates research hotspots, such as surgery, dentistry oral surgery & medicine, orthopedics, sports sciences, and medicine general & internal, illustrating the diversification of PRP applications across different surgical specialties (Fig. 5C).

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Fig. 5 Visualization of keywords analysis. (A) Most relevant words; (B) word cloud of the top keywords in the field of PRP in surgery; (C) tree map of subject categories; (D) network visualization between the top countries, affiliations and keywords; (E) keywords co-occurrence network.

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As shown in Fig. 5D, the network visualization illustrated the proportion of core thematic keywords associated with each country and affiliation, revealing the collaborative distribution of research interests in PRP and surgical regeneration. On the institutional side, KU Leuven and Sichuan University demonstrated prominent engagement with themes such as “growth factors,” and “regeneration,” whereas the Universidade Estadual Paulista and Mashhad University of Medical Sciences showed greater emphasis on “cells.” In terms of countries, the United States and China made the largest contributions to these high-frequency keywords. Italy also showed strong involvement in “gel,” “surgery,” “management,” and “cells”.

The co-occurrence network analysis of these keywords and density visualization (Fig. 5E and S3) show that the keywords are divided into two core clusters with platelet-rich plasma and platelet-rich fibrin in the center. The platelet-rich plasma cluster (blue) was closely associated with keywords such as tendon healing, rotator cuff repair, osteoarthritis, and cartilage, reflecting the concentration of research in musculoskeletal and orthopedic applications. In contrast, the platelet-rich fibrin cluster (red) was primarily linked with wound healing, dental implants, regenerative medicine, mesenchymal stem cells, and tissue engineering, suggesting its expanding role in biomaterial-based regeneration and dental or soft-tissue reconstruction.

3.8 Analysis of references

The reference analysis highlights the seminal studies that established the theoretical and methodological foundation of PRP research in surgical practice. Table 5 lists the most frequently local cited references, which collectively trace the scientific evolution of PRP from its early clinical introduction to its modern regenerative applications. The most cited reference, Marx RE (1998), with 354 citations, first confirmed the significant effect of PRP in improving the maturity rate of bone transplantation and bone density, providing a scientific basis for the application of PRP in oral and maxillofacial surgery.²³ Choukroun J (2006)²⁴ and Dohan David M^25,26 introduced PRF concept, with 479 citations totally, signifying a pivotal shift from liquid platelet concentrates toward fibrin-based matrices. Subsequent highly cited works further expanded on classification systems, preparation techniques, biology, mechanisms and applications of PRP and PRF.

3.9 Changes in trends of research

The thematic map (Fig. 6A) classified research domains into four quadrants. Motor themes, such as platelet-rich fibrin, regeneration, osteoarthritis, injection, and efficacy, representing well-developed and central concepts. Basic themes, including platelet-rich plasma, and growth factors, forming the backbone of the field; Emerging or declining themes, such as cardiac-surgery which reflect that are underdeveloped or fading. Niche themes, such as vitrectomy representing that are well-developed but less important research directions.

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Fig. 6 Visualization of changes in trends of research in the field of PRP in surgery. (A) Thematic map; (B) trend topics; (C) thematic evolution map.

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The evolution of research topics over time provides valuable insight into shifting priorities and emerging frontiers in PRP-related surgical studies. As shown in Fig. 6B, trend analysis revealed that early-stage research (2000–2010) focused mainly on cells in-vitro, periodontal osseous defects, bovine bone, osseointegration, and growth-factor-beta. From 2010 to 2018, the emphasis shifted toward autogenous bone, guided tissue regeneration, grafts, enhancement, platelets, collagen, intrabony defects, bone regeneration, augmentation, gel, and proliferation. Recent studies (post-2018) show interest around platelet-rich fibrin, lumbar disc herniation, free gingival graft, ankle osteoarthritis, dentistry, meta-analysis, risk, efficacy, management, injection, tissue regeneration, and cells. The thematic evolution map (Fig. 6C) illustrates how research topics have gradually developed. The early clusters dominated by oral surgery such as mandibular reconstruction and periodontal regeneration evolved into musculoskeletal areas such as lateral epicondylitis, anterior cruciate ligament, and tendinosis. In recent years, osteoarthritis and cardiac-surgery attract more research interest.

3.10 Recent advance in 2024

We conducted a further analysis of PRP-related surgical literature published in 2024 to identify emerging trends and research directions. The top three institutions contributing the most publications in 2024 were the EKB (n = 17), KU Leuven (n = 12), and Aristotle University of Thessaloniki (n = 9) (Fig. 7A). In terms of corresponding author affiliations, China ranked first with the highest publication output (n = 46), followed by Italy (n = 16) and the United States (n = 15) (Fig. 7B). Citation analysis revealed that China (n = 132), the United States (n = 84), and Israel (n = 44) were the top three most-cited countries (Fig. 7C).

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Fig. 7 Recent advance in the field of PRP in surgery in 2024. (A) Most relevant affiliations; (B) corresponding author's countries; (C) most cited countries; (D) tree map of keyword analysis; (E) tree map of subject categories. Abbreviations: SCP: single country publications; MCP: multiple country publications.

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Hotspot analysis from the 2024 keyword tree map highlighted “platelet-rich plasma” as the dominant term (n = 82; 15 %), alongside “platelet-rich fibrin” (n = 32; 6 %), and “repair” (n = 26; 5 %). Besides, “wound healing” (n = 16; 3 %) and “pain” (n = 15; 3 %) are the most productive applications (Fig. 7D). Subject-area mapping located the 2024 literature chiefly within orthopedics (n = 38; 13 %), dentistry oral surgery & medicine (n = 30; 10 %), medicine general & internal (n = 28; 10 %), surgery (n = 27; 9 %), engineering biomedical (n = 16; 6 %), and sports sciences (n = 15; 5 %) (Fig. 7E).

4.1 Key results

This bibliometric analysis provides a comprehensive overview of global research activity on PRP in surgical practice from 1984 to 2024. A total of 1898 publications were identified, revealing a sustained upward trend in both annual output and scholarly influence. China, the USA, and Italy were the leading contributors, while Europe and the USA maintained higher citation impact, reflecting mature research quality. Institutionally, the EKB emerged as the central hub in the collaborative network, indicating strong regional academic cohesion but limited cross-continental cooperation. The source analysis revealed that The American Journal of Sports Medicine, Journal of Periodontology, and Journal of Oral and Maxillofacial Surgery were the most productive and influential journals in PRP-related surgical research.

Author analysis demonstrated that Pietro Gentile, Giuseppe Filardo, and Valerio Cervelli were among the most productive researchers. Italian scholars contributed a significant portion of the total output. These leading authors formed tightly connected collaborative clusters, reflecting the consolidation of scientific leadership in Europe and Asia. Highly cited papers by Foster et al. (2009) and Eppley et al. (2004) demonstrated the biological and clinical foundation of PRP.^14,15 Besides, contributions of Anitua et al. and Ehrenfest et al. were especially critical in promoting the evolution from PRP to PRF^18–22.

Keyword co-occurrence analysis demonstrated two dominant clusters centered on PRP which corresponds to musculoskeletal domains and PRF which corresponds to oral surgery, bone grafts and wound-healing domains. Trend and thematic analyses showed a clear chronological evolution of research priorities. Early work focused on oral and maxillofacial surgery and bone regeneration, while subsequent studies expanded into musculoskeletal repair, plastic surgery, sports medicine, wound healing and even cardiac surgery.

The 2024 data reinforced this trend—China led global publication output and citations, and platelet-rich plasma, platelet-rich fibrin, repair, and wound healing remained the most frequent keywords. The dominant subject areas in 2024 included orthopedics, dentistry, biomedical engineering, and sports medicine, underscoring the field's interdisciplinary maturation. Collectively, these findings illustrate that PRP have evolved from experimental research to clinical application as a key component of surgical regenerative strategies, with its impact now expanding into biomaterial-assisted therapeutic approaches.

4.2 Future directions

The future trend of PRP research in surgery will depend on deepening international collaboration, expanding clinical applications, integrating advanced technologies, and resolving persistent methodological and mechanistic challenges.

First, there is an urgent need to enhance cross-continental and cross-institutional cooperation. Although PRP research has grown substantially worldwide, existing collaborations remain largely regional and fragmented. Enhancing inter-institutional cooperation is essential for facilitating the exchange of research findings and advancing collective scientific innovation.²⁷ Constructing globally shared health databases could facilitate the acceleration of scientific progress and medical innovation, while also enhancing our comprehension of diverse and heterogeneous patient populations worldwide.²⁸ Besides, collaboration between surgeons, biomaterial scientists, and bioengineers across different regions could accelerate translational progress and establish unified guidelines for PRP preparation, characterization, and clinical evaluation.

Second, forthcoming research frontiers are anticipated to emphasize broadening the clinical spectrum of PRP applications while fostering the development of next-generation therapeutic strategies. Beyond its established roles in orthopedic, plastic, and oral-maxillofacial surgery, emerging evidence suggests that PRP holds promise in new surgical fields. Recent studies have reported that PRP are beneficial in treating degenerative spinal disease, including its analgesic effect on low back pain and radicular pain, especially combined with percutaneous endoscopic lumbar discectomy, as well as accelerating bone union during spinal fusion surgery^29–33. Likewise, PRP has the potential to facilitate cellular repair and regeneration during the early phases of cardiac injury, enhance postoperative tissue recovery, and decrease the incidence of deep sternal wound infections after cardiac operations^34–36. At the same time, PRP research is advancing toward integration with cutting-edge biomaterials, 3D printing, and nanotechnology, enabling the design of customizable scaffolds and controlled growth factor delivery systems^37–41. These technological synergies are expected to transform PRP into a precision-engineered regenerative therapy.

Finally, several critical issues are significant but underdeveloped. The lack of standardized preparation and application protocols remains a major obstacle, as differences in platelet concentration, leukocyte content, and activation methods lead to inconsistent therapeutic effects.⁴² Moreover, the biological mechanisms underlying PRP's regenerative functions are not yet fully understood. While platelet-derived growth factors are known key contributors,⁴³ the roles of exosomes, extracellular vesicles, and immune modulation require further elucidation^44–46. In addition, to formulate clinically reliable, evidence-based guidelines, it is necessary to conduct randomized controlled trials that encompass multiple centers and large participant cohorts.