Can Disc Perforation in Subjects With Intra-Articular Pain and Dysfunction Be Managed Arthroscopically?

Area of Science:

• Temporomandibular joint (TMJ) disorders
• Arthroscopic surgery
• Orthopedic surgery

Background:

• Disc perforation is an advanced stage of temporomandibular joint (TMJ) degeneration.
• Optimal arthroscopic treatment for TMJ disc perforation remains debated.

Purpose of the Study:

• To compare outcomes of three arthroscopic techniques for disc perforations: level II arthroscopy, discopexy, and discectomy.
• To identify factors influencing treatment success in TMJ disc perforation.

Main Methods:

• Prospective cohort study of 75 subjects with arthroscopically confirmed TMJ disc perforation.
• Comparison of pain (visual analogue scale) and maximum interincisal opening (MIO) at baseline and 6 months post-surgery.
• Analysis of demographic, clinical, and imaging variables using logistic regression to predict treatment selection.

Main Results:

• All three arthroscopic techniques led to significant improvements in pain and MIO at 6 months (P < .001).
• No significant differences in pain or MIO were observed between the treatment groups (P = .3 and P = .6, respectively).
• Disc perforation size (≥7 mm), prior arthrocentesis, and joint crepitus were independently associated with treatment selection.

Conclusions:

• Level II arthroscopy, discopexy, and discectomy are all effective in managing TMJ disc perforation.
• Preoperative and intraoperative findings, including perforation size and crepitus, are valuable for guiding arthroscopic treatment selection.