Correlation of MRI and arthroscopic findings with clinical outcome in temporomandibular joint disorders: a retrospective cohort study

Kobbe Vervaeke, Pieter-Jan Verhelst, Kaan Orhan, Bodil Lund, Daniel Benchimol, Fréderic Van der Cruyssen, Antoon De Laat, Reinhilde Jacobs, Constantinus Politis, Kobbe Vervaeke, Pieter-Jan Verhelst, Kaan Orhan, Bodil Lund, Daniel Benchimol, Fréderic Van der Cruyssen, Antoon De Laat, Reinhilde Jacobs, Constantinus Politis

Abstract

Background: Arthroscopy is a minimally invasive diagnostic tool and treatment strategy in patients suffering from temporomandibular disorders (TMD) when conservative treatment fails. This study aimed to find specific variables on pre-operative MRI or during arthroscopy that could predict success of arthroscopic lysis and lavage.

Methods: This retrospective analysis compared pre-operative maximum interincisal opening (MIO), pain and main complaint (pain, limited MIO or joint sounds) with results at short-term and medium-term follow-up (ST and MT respectively). Different variables scored on MRI or arthroscopy were used to make a stepwise regression model, subsequently a combined analysis was conducted using variables from both MRI and arthroscopy.

Results: A total of 47 patients (50 joints) met the inclusion criteria. The main complaint improved by 62 and 53% at ST and MT respectively. The absolute or probable absence of a crumpled disc scored on MRI predicted success at ST and MT (p = 0.0112 and p = 0.0054), and remained significant at MT in the combined analysis (p = 0.0078). Arthroscopic findings of degenerative joint disease predicted success at ST (p = 0.0178), absolute or probable absence of discal reduction scored during arthroscopy significantly predicted success in the combined analysis at ST (p = 0.0474).

Conclusion: To improve selection criteria for patients undergoing an arthroscopic lysis and lavage of the TMJ, future research might focus on variables visualized on MRI. Although more research is needed, disc shape and in particular the absolute or probable absence of a crumpled disc might be used as predictive variable for success.

Keywords: Arthroscopy; Crumpled disc; Degenerative joint disease; MRI; Temporomandibular disorders; Temporomandibular joint.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Example of a patient with a crumpled disc [1] visualized on T1-weighted MRI. The left image was taken with a closed mouth, the right image with an open mouth. Also note the anterior disc displacement without reduction. The condyle [2] only showed minor degenerative changes

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