(66) Outcomes of Advanced Arthroscopy on Patients Who Previously Failed TMJ Arthrocentesis/Arthroscopic Lysis and Lavage

Abstract: Advanced arthroscopic procedures can be performed in patients with evidence of internal derangement, hypo-mobility due to adhesions, synovitis, degenerative joint disease, and hyper-mobility resulting in painful subluxation or dislocation. Arthroscopic lysis and lavage and temporomandibular joints (TMJ) arthrocentesis are minimally invasive and routine procedures used to treat the above conditions, and studies have reinforced the importance of these procedures as an efficient first line treatment option with better results in the earlier stages of disease compared to later stages. However, there is little evidence to show the clinical effectiveness of advanced surgical arthroscopy for patients who previously failed arthrocentesis or arthroscopic lysis and lavage procedures. Therefore, the purpose of this study was to determine the clinical outcome of patients who underwent advanced arthroscopic surgery after already having failed arthroscopic lysis and lavage and/or arthrocentesis. Inclusion criteria for this study consists of patients who had received a prior arthrocentesis or arthroscopic lysis and lavage and patients who later underwent an advanced arthroscopic procedure. Clinical outcomes are measured in terms of jaw functional limitation scores (JFLS-20) and pain visual analogue scores (0-100). Mean differences in pre- to postoperative scores were calculated. We also analyze a series of clinical and surgical predictor variables that could influence these outcome measures. Predictive variables included age, sex, BMI, allergies, sensitivity, serology, duration of pain, laterality of disorder, TMJ Wilkes classification, previous TMJ surgery, and history of clicking, closed lock, and open lock. Surgical predictor variables include use of targeted injections and arthroscopic findings of synovitis, chondromalacia, perforations, and adhesions. Statistical analysis involved linear regression analysis to study the impact of the aforementioned predictor variables and their impacts on the outcome measures. Data was collected from 49 patients who fulfilled the inclusion criteria above. Of the 49 patients, 96% of the patients were female and the average age of the patient who underwent advanced arthroscopy was 35 years old. The average duration of a patients’ dysfunction was 86 months. The average preoperative JFLS was 82.84 (out of 200). The average preoperative pain score for the left TMJ is 57.06 and the right TMJ is 52.81. The average postoperative JFLS score for patients was 58.36 (out of 200). The average postoperative TMJ pain score for left TMJ was 36.43 and for right TMJ was 40.19. The average follow-up time was 9.94 months. The mean change in JFLS score after advanced arthroscopy was -24.56, with SD of 34.6. The mean percentage change in JLFS score after advanced arthroscopy was -30% with SD of 0.41. The mean change in pain levels for left TMJ was -25.30 with SD 30.5 and for right TMJ was -16.32 with SD of 31.6. Patients who previously failed to improve with arthrocentesis and/or lysis and lavage arthroscopy present with an overall 30% decrease in JFLS and a 37% decrease in TMJ pain levels after further undergoing advanced arthroscopy. Therefore, the current study demonstrates that advanced arthroscopy is an effective treatment option to this patient population who continue to exhibit pain and dysfunction after lysis and lavage arthroscopy or arthrocentesis.

References
1. McCain JP, Hossameldin RH. Advanced arthroscopy of the temporomandibular joint. Atlas Oral Maxillofac Surg Clin North Am. 2011 Sep;19(2):145-67. doi: 10.1016/j.cxom.2011.06.001. PMID: 21878249.
2. Israel HA, Behrman DA, Friedman JM, Silberstein J. Rationale for early versus late intervention with arthroscopy for treatment of inflammatory/degenerative temporomandibular joint disorders. J Oral Maxillofac Surg. 2010;68(11):2661-2667. doi:10.1016/j.joms.2010.05.051