Comparative efficacy of arthrocentesis, platelet-rich plasma (PRP), and conservative therapies for TMJ disorders: A...

Temporomandibular joint (TMJ) arthrocentesis has emerged as a minimally invasive intervention to improve jaw function and alleviate orofacial pain. To investigate the effects of arthrocentesis on pain and mandibular movement in patients with specific subtypes of temporomandibular disorders (TMD), including anterior disc displacement without reduction (ADDwoR) and osteoarthritis. We conducted a literature search in the Cochrane Library, EMBASE, MEDLINE and Web of Science to identify relevant studies published before 2025-11-27. Randomized controlled trials, non-randomized controlled trials and observational studies were included which compared the outcomes of different arthrocentesis and with other interventions in TMD patients. The mean difference (MD) was used to assess continuous outcomes. This systematic review and meta-analysis included 31 studies involving 1718 participants. Ultrasound-guided arthrocentesis showed significant improvement in maximal mouth opening (MMO) (MD = 2.30 mm, P = 0.04). Single-puncture and double-puncture arthrocentesis showed equivalent efficacy. Compared to platelet-rich plasma (PRP) injection, arthrocentesis showed benefit on MMO improvement at 1 week (MD = 2.61 mm, P = 0.05). At 6 months, PRP demonstrated significant superiority for pain management (MD = 1.53, P = 0.02). Meta-analysis of 3 RCTs demonstrated persistent superiority of arthrocentesis over splint therapy in improving MMO and relieving pain. Ultrasound-guided puncture significantly improves mouth opening while single- and double-needle approaches showed equivalent efficacy. The results suggest that a multimodal strategy combining arthrocentesis for immediate functional improvement with biological injectables like PRP for sustained pain relief is optimal for refractory TMD.