Platelet-Rich Plasma Gel Matrix (PRP-GM): Description of a New Technique

Abstract

Several musculoskeletal conditions are triggered by inflammatory processes that occur along with imbalances between anabolic and catabolic events. Platelet-rich plasma (PRP) is an autologous product derived from peripheral blood with inherent immunomodulatory and anabolic properties. The clinical efficacy of PRP has been evaluated in several musculoskeletal conditions, including osteoarthritis, tendinopathy, and osteonecrosis. When used in combination with hyaluronic acid (HA), a common treatment alternative, the regenerative properties of PRP are significantly enhanced and may provide additional benefits in terms of clinical outcomes. Recently, a new PRP-derived product has been reported in the literature and is being referred to as “plasma gel”. Plasma gels are obtained by polymerizing plasmatic proteins, which form solid thermal aggregates cross-linked with fibrin networks. Plasma gels are considered to be a rich source of growth factors and provide chemotactic, migratory, and proliferative properties. Additionally, clot formation and the associated fibrinolytic reactions play an additional role in tissue repair. There are only a few scientific articles focusing on plasma gels. Historically, they have been utilized in the fields of aesthetics and dentistry. Given that the combination of three products (PRP, HA, and plasma gel) could enhance tissue repair and wound healing, in this technical note, we propose a novel regenerative approach, named “PRP–HA cellular gel matrix” (PRP-GM), in which leukocyte-rich PRP (LR-PRP) is mixed with a plasma gel (obtained by heating the plasma up) and HA in one syringe using a three-way stopcock. The final product contains a fibrin–albumin network entangled with HA’s polymers, in which the cells and biomolecules derived from PRP are attached and released gradually as fibrinolytic reactions and hyaluronic acid degradation occur. The presence of leukocytes, especially monocytes and macrophages, promotes tissue regeneration, as type 2 macrophages (M2) possess an anti-inflammatory feature. In addition, HA promotes the viscosuplementation of the joint and induces an anti-inflammatory response, resulting in pain relief. This unique combination of biological molecules may contribute to the optimization of regenerative protocols suitable for the treatment of degenerative musculoskeletal diseases.

Plasma Gel Matrix as a Promising Carrier of Epigallocatechin Gallate for Regenerative Medicine

“…According to the consensus, for biomedical concerns [31], neither EDTA nor heparin was chosen for PRP preparation. Thus, as introduced elsewhere [32][33][34], when both PRP and PPP are prepared simultaneously and combined before thermal treatment and injection, it is better and more convenient to use the same anticoagulant. In addition to ACD-A, sodium citrate may be an alternative.…”

Optimizing tendon repair and regeneration: how does the in vivo environment shape outcomes following rupture of a tendon such as the Achilles tendon?

“…However, PRP is used in an autologous manner so the failure to enhance healing could be due to limitations related to the source of the PRP or the local injury environment they were injected into, the age of the donor, the timing of the injection or the volume. As the preparation of PRP can also vary [discussed in (Kydd and Hart, 2020;Godoi et al, 2022;Bagheri et al, 2023;Everts et al, 2023;Giannotti et al, 2023)], this may also influence outcomes.…”

Platelet-Rich Plasma Power-Mix Gel (ppm)—An Orthobiologic Optimization Protocol Rich in Growth Factors and Fibrin

“…Previously, we published a description of two techniques: the BMA Matrix [17] and the Platelet-Rich Plasma Gel Matrix (PRP-GM) [18]. Both techniques consist in the generation of a rich autologous biological matrix; the first one is obtained via the mixture of BMA with HA, and the second one requires mixing PRP, HA, and platelet-poor plasma gel.…”