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Does Postoperative Disc Position Following Double Suture Arthroscopic Discopexy Correlate With Improvements in Pain
Christopher K B Ward1, Johnson Cheung1, Jonathan P Troost2
1Former TMJ Surgery Fellow, Department of Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, MI.
Background:
Temporomandibular joint intra-articular pain and dysfunction (IPD) can arise from abnormal disc position. Arthroscopic double-suture discopexy (A-DSD) aims to restore disc position, but the association between disc position and patient-reported pain and quality of life (QoL) is unclear.
Purpose:
This study investigated the relationship between postoperative disc position and subject QoL and pain following A-DSD.
Study Design, Setting, Sample:
This retrospective cohort study included subjects at the University of Michigan who required arthroscopy for IPD between November 2020 and July 2023. Eligibility included subjects aged ≥18 to 75 years with Wilkes II-V IPD who underwent A-DSD with preoperative and postoperative magnetic resonance imagings (3 months minimum).
Predictor Variable:
The predictor variable was postoperative magnetic resonance imaging-based disc position: normal (ND), anteriorly displaced with reduction (ADDwR), anteriorly displaced without reduction (ADDwoR), or posteriorly displaced.
Main Outcome Variable(S):
Main outcomes are changes in QoL (Jaw Functional Limitation Scale [JFLS]) and pain (visual analog scale-100) at baseline and ≥3 months post-arthroscopy.
Covariates:
Covariates included demographics, perioperative variables, and arthroscopic findings.
Analyses:
Paired t-tests evaluated changes in perioperative outcomes stratified by postoperative disc position. For analysis of covariates and outcomes, linear regression was applied for JFLS (subject-level analysis); linear mixed-effects models, adjusting for nonindependent observations for bilateral cases, were used for pain (joint-level analysis). Statistical significance was P < .05.
Results:
A total of 240 subjects were screened and 37 were included with mean age 33 (±14.3) years and all were female sex (100%). Median follow-up was 9 months (interquartile range, 8 to 12). Postoperative disc positions were ND (70.2%), ADDwR (15.8%), ADDwoR (8.8%), and posteriorly displaced (5.3%). Postoperative disc position was associated with JFLS (P = .026) and pain (P = .0002), with worse outcomes for ADDwR. ND subjects experienced significant decreases in JFLS (36.3 ± 34.6, P < .0001) and pain (28.7 ± 27.8, P < .0001). ADDwoR subjects showed significant reduction in JFLS (47.1 ± 32.0, P = .03), but not pain. ADDwR subjects showed no significant outcome improvements. Subjects with systemic arthropathies (P = .01), closed lock (P = .03), and indirect trauma (P = .03) were associated with worse JFLS.
Conclusions And Relevance:
Postoperative ND and ADDwoR after A-DSD were associated with improved QoL and/or pain reduction, but postoperative ADDwR and the above comorbidities were associated with poorer outcomes.
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