ART-TMJ: Arthroscopic real-time classification system for temporomandibular joint disorders

Temporomandibular joint (TMJ) Level II arthroscopy offers unparalleled diagnostic and therapeutic capabilities by enabling direct visualization and manipulation of the articular disc and intra-articular structures. This prospective study introduces a novel, evidence-based classification system that integrates clinical findings, radiological imaging, and arthroscopic assessment to improve diagnostic precision and guide personalized treatment planning. A cohort of 160 patients (295 joints) underwent standardized clinical evaluation, MRI, and Level II and III arthroscopy between 2019 and 2024. Patients were stratified into five stages, reflecting combined clinical, imaging, and arthroscopic findings. The cohort was predominantly female (84.6%) with a mean age of 41 years, and 83.8% had bilateral involvement. Arthroscopic findings frequently revealed more advanced joint pathology than clinical and radiological assessments alone (p = 0.005), underscoring the added diagnostic value of direct joint inspection. Patients' outcomes support the treatment algorithm. This integrated classification system bridges existing gaps in TMJ disorder staging by encompassing anatomical, functional, and pathological parameters, thereby facilitating tailored stage-specific interventions ranging from conservative management to advanced arthroscopic procedures and joint reconstruction. By enhancing diagnostic accuracy and treatment alignment, this system serves as a practical tool to optimize outcomes and improve communication among TMJ surgeons in minimally invasive joint surgery.