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Does Combining Arthrocentesis With Injectable Platelet-Rich Fibrin Outperform Arthrocentesis or Injectable
Ram Sundar Chaulagain1, Saurabh S Simre2, Sagrika Shukla3
1Consultant, Department of Oral and Maxillofacial Surgery, College of Medical Sciences, Bharatpur, Chitwan, Nepal.
Background:
Arthrocentesis (AC), with/without intra-articular agents like hyaluronic acid, steroids, platelet-rich plasma, and platelet-rich fibrin, is used with varying effectiveness to manage temporomandibular joint (TMJ) intra-articular pain and dysfunction (IPD).
Purpose:
The purpose of this study was to measure changes in pain, range of motion, and quality of life (QOL) in subjects with IPD who underwent AC/injectable platelet-rich fibrin (i-PRF)/AC + i-PRF injection. Study design, setting and sample: A single-centre randomized clinical trial was conducted at All India Institute of Medical Sciences, Rishikesh, on patients with unilateral IPD (Wilkes II, III, and IV) confirmed by magnetic resonance imaging. Exclusion criteria included age below 18/above 50 years, autoimmune diseases, magnetic resonance imaging contraindications, previous TMJ surgery, congenital/developmental TMJ disorders, and TMJ lesions.
Predictor Variable:
Predictor variables were treatment modalities (AC/i-PRF/AC + i-PRF) assigned using computer generated randomization.
Main Outcome Variable:
The primary outcome was TMJ pain at 3 months measured with visual analog scale. Secondary outcomes included range of motion, muscle tenderness, and QOL. Data was collected preoperatively (T0) and postoperatively at 10 days (T1), 1 month (T2), and 3 months (T3) by a blinded observer.
Covariates:
Covariates included age, sex, and involved joint (right/left) and Wilkes staging.
Analyses:
Repeated measure analysis of variance with post hoc analysis was used (P < .05).
Results:
The study included 48 patients with mean ages of 29.9 ± 7.8 years (AC), 36.5 ± 10.9 years (i-PRF), and 27.2 ± 8.5 years (AC + i-PRF) (P = .019), with a higher female prevalence: 68.8% in AC and i-PRF, and 87.5% in AC + i-PRF (P = .4). TMJ pain significantly reduced at T3 in AC + i-PRF compared to AC (mean difference[MD]: 2.1, 95% confidence interval [CI]: 3.3 to 0.9; P < .01) and i-PRF (MD: 1.5, 95% CI: 2.7 to 0.3; P = .012).AC + i-PRF also showed significant improvement in mouth opening (MD: 3.9, 95% CI: 1.1 to 6.8; P = .005) and QOL compared to AC (MD: -4.3, 95% CI: -7.7 to -0.9; P = .009) and i-PRF (MD: -3.6, 95% CI: -6.9 to -0.2; P = .03).
Conclusion:
AC + i-PRF outperforms AC/i-PRF alone in improving pain, range of motion and overall QOL in Wilkes II, III, and IV, making it a promising treatment option for TMJ IPD.
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