Comparison of Different Intraarticular Injection Substances Followed by Temporomandibular Joint Arthroscopy

Abstract

Nowadays, temporomandibular joint (TMJ) arthroscopies are often finished with intraarticular injections. There are a couple of different substances that can be injected into the articular cavity following arthroscopy; however, it is still unclear which one can help to reach the best clinical results. The aim of this systematic review was to compare different substances that can be injected intraarticularly following TMJ arthroscopy to enhance clinical success. A review protocol was registered in PROSPERO (Registration number: CRD42018114833). An electronic search was performed using PubMed, Cochrane Library, PlosOne, and Science Direct databases using a combination of the terms “temporomandibular” and “arthroscopy” to identify clinical trials published from 2009 until 2019. Mean differences of pain levels were evaluated in random-effect meta-analysis. In total, 951 records were screened, of which only 3 fulfilled the inclusion criteria and were included into qualitative data synthesis, and only 2 articles were included into quantitative data analysis. The results showed that subjects who received plasma rich in growth factors intraarticular injections had statistically significantly lower pain levels 18 months postoperatively than patients who received hyaluronic acid injections. The results of the meta-analysis revealed that intraarticular injections followed by TMJ arthroscopy were more effective than arthroscopy alone in pain management (mean difference = −1.00, 95% confidence interval: −4.76 to 2.77, I 2 = 97% with significant heterogeneity). The authors conclude that, although the sample is not extensive (only 3 studies), a tendency towards the superiority of plasma rich in growth factors over other treatments is seen in pain management of TMD.

Hyaluronic acid injections for pain relief and functional improvement in patients with temporomandibular disorders: An umbrella review of systematic reviews

“…Only Xie et al 28 reported no effects of HA injections on functional outcomes; on the contrary, improvements in MMO have been reported by nine articles. 29,30,[35][36][37][38]41,43,45 When compared to placebo, treatments including HA showed better results: data obtained by Al-Moraissi et al 39…”

“…Publication date of the included studies ranged between 2010 and 2022, and interesting to note, 13 systematic reviews or meta-analyses were published in the last 5 years. Thirteen studies [28][29][30][33][34][35][36][37][38][39][40][41][42] included only randomized controlled clinical trials (RCTs) and eight systematic reviews 28,34,36,38,39,[43][44][45] also performed a meta-analysis on the data of the included studies. All articles but one 44 performed a systematic search on at least two databases.…”

“…The adjunct of HA injections to arthroscopy has been judged effective by two studies. 29,37 One study 37 reported that the adjunct of IA injections was more effective than arthroscopy alone at 6 months and both studies 29,37 reported that HA had poorer results than platelet derivates in adjunct to arthroscopy on relieving pain.…”

“…All studies but two 34,42 performed a functional evaluation. Twelve systematic reviews [28][29][30]35,[36][37][38][39][40][41]43,45 considered the changes in MMO for the evaluation of jaw-movement limitation, whereas three articles 44,46,47 reported effectiveness on improving non-specified functional outcomes.…”

“…Concerning the functional outcomes, the MMO has been the most frequently used measure for evaluating the functional improvement, and several of the included studies have assessed the effectiveness of HA injections (with or without arthrocentesis) on function. 29,30,[35][36][37][38][39][40][41]43,45 MMO was often measured as the maximum interincisal distance, and it was reported to range from 53 to 58 mm in healthy subjects.…”