Intra-articular therapies for synovial joint dysfunction: a comprehensive integrative review

Area of Science:

• Orthopedics and Regenerative Medicine
• Oral and Maxillofacial Surgery
• Biomaterials Science

Background:

• Synovial joint dysfunction, particularly osteoarthritis of the temporomandibular joint (TMJ), presents a significant clinical challenge.
• Current treatment paradigms range from palliative measures to more advanced regenerative approaches.

Purpose of the Study:

• To synthesize current evidence on intra-articular therapies for synovial joint disorders, with a focus on TMJ osteoarthritis.
• To evaluate regenerative, lubricating, anti-inflammatory, and adjunctive/combination therapies.

Main Methods:

• An integrative narrative review of studies published between 2020 and 2025.
• Inclusion of randomized trials, systematic reviews, meta-analyses, and preclinical studies from major databases.
• Prioritization of TMJ-specific data and extrapolation from other synovial joints where applicable.

Main Results:

• Mesenchymal stem cells demonstrated significant pain reduction and functional improvement with good safety profiles.
• Injectable platelet-rich fibrin (i-PRF) showed sustained bioactive release, modulated inflammatory cytokines, and promoted chondral preservation.
• Hyaluronic acid (HA) provided consistent pain relief with excellent safety, while corticosteroids offered short-term benefits with chondrotoxic risks.
• Adjunctive therapies and combinations showed promising outcomes.

Conclusions:

• Intra-articular therapies are evolving towards mechanism-driven disease modulation.
• Mesenchymal stem cells and i-PRF exhibit strong disease-modifying potential, with HA serving as a foundational treatment.
• Standardization of preparation and reporting, alongside dedicated TMJ clinical trials, is crucial for advancing treatment.