Efficacy and Safety of Intra-Articular Therapies for Temporomandibular Disorders: A Systematic Review and Meta-Analysis.

The hierarchy of different treatments for arthrogenous temporomandibular disorders: A network meta-analysis of randomized clinical trials

What's New in Sports Medicine.

EFFECTIVENESS OF INTRA-ARTICULAR INJECTIONS OF SODIUM HYALURONATE, CORTICOSTEROIDS, PLATELET-RICH PLASMA ON TEMPOROMANDIBULAR JOINT OSTEOARTHRITIS: A SYSTEMATIC REVIEW AND NETWORK META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS.

The prevalence of temporomandibular joint (TMJ) osteoarthritis is 18–85 % of all TMJ dysfunctional conditions. Most patients are elderly, especially women. Today, intra-articular injections are often used for treatment, so it is necessary to study the effectiveness of drug administration on the course of the disease. The number of studies on the effectiveness of certain drugs most commonly used to treat TMJ osteoarthritis is limited, that does not allow correct treatment planning in each individual case. Aim: to evaluate the effectiveness of TMJ osteoarthritis treatment with monotherapy with hyaluronic acid, corticosteroids, and platelet-rich plasma. Materials and methods. We included 90 patients who received intra-articular injections. Patients were randomly divided into 3 groups: group I, which received platelet-rich plasma (PRP, n = 30), group II, which received hyaluronic acid (HA, n = 30), group III, which received corticosteroids (CS, n = 30). To objectively evaluate the effectiveness of TMJ osteoarthritis treatment with monotherapy of hyaluronic acid, corticosteroids and platelet-rich plasma, the following indicators were used: filling in the visual analogue pain scale, maximum mouth opening (mm) and cortical plate density of the articular head of the mandible according to the Hounsfield scale using CBCT. Results. PRP therapy demonstrated the highest efficacy in the form of monotherapy for all study parameters (p < 0.05). The fastest pain reduction was achieved with the use of corticosteroids (p < 0.05). In general, during the treatment period, the reduction of pain according to the visual analogue scale in group I was 85.71 %. In patients of group II (HA) and group III (CS) – by 71.42 %. Maximum mouth opening after treatment in group I increased by 24.32 %, in group II – by 15.79 %, in group III – by 18.92 %. The density of the articular head according to the Hounsfield scale after treatment in group I increased by 12.56 %, in group II – by 6.97 %, in group III – by 4.87 %. Conclusions. All of the studied drugs demonstrated a positive effect on the treatment of TMJ osteoarthritis, but monotherapy with intra-articular PRP injections demonstrated the highest effectiveness according to the studied parameters (p < 0.05).

ABSTRACTBackground:Temporomandibular joint (TMJ) internal derangement (ID) is a prevalent disorder causing significant pain and dysfunction. Initial treatment typically involves conservative methods, with ozone gas injection emerging as a potential therapy. This study evaluates the efficacy of intra-articular ozone gas injection in treating TMJ ID.Methods:Twenty patients diagnosed with Wilkes stage II and III TMJ ID received ozone gas injections into the periarticular tissues and superior joint space. Maximal interincisal mouth opening and TMJ pain scores were assessed at 28 and 42 days post treatment.Results:There were significant improvements in maximal mouth opening and reductions in TMJ pain scores from baseline to the 42nd day post injection.Conclusion:Intra-articular ozone gas injection offers a minimally invasive, cost-effective treatment for TMJ ID, showing substantial benefits before considering more invasive procedures.

Intra-articular injection of a mixture of hyaluronic acid and corticosteroid versus arthrocentesis in TMJ internal derangement

Sub-acromial injections are a therapeutic option for rotator cuff injuries; however, evidence regarding the most effective drug in this context is unclear, which needs to be investigated. To evaluate the effectiveness of various sub-acromial injections for rotator cuff injuries. We conducted a systematic review and pair-wise and network meta-analyses of randomized clinical trials (RCTs) comparing sub-acromial injections for rotator cuff injuries. The interventions evaluated were hyaluronic acid (HA), platelet-rich plasma (PRP), prolotherapy, and corticosteroids. The outcomes of interest were pain and functional improvement, which were evaluated with standardized scores. The Risk of Bias 2 tool and the Grading of Recommendations, Assessment, Development and Evaluation methodology were used to assess data quality. Twenty RCTs, comprising 1479 participants, were included. In the short term, HA achieved the best outcomes [pain mean difference (MD) = -1.48, 95% confidence interval (CI) -2.37 to -0.59; function MD = 10.18, 95%CI: 4.96-15.41]. In the medium term, HA, PRP, HA + PRP, and corticosteroids were not superior to placebo in improving pain. Based on function, HA + PRP was superior to placebo, corticosteroids, and PRP (MD = 26.72; 95%CI: 8.02-45.41). In the long term, HA, PRP, and corticosteroids were not superior to placebo in reducing pain. However, based on function, HA + PRP, PRP, and HA were superior to placebo, and HA + PRP had the best result (MD = 36.64; 95%CI: 31.66-33.62). HA provides satisfactory short-term results, while HA with PRP demonstrates functional improvement in the medium and long terms. However, no intervention maintained the pain-relief effect on > 3-month follow-up.

Efficacy of computer-guided versus conventional sodium hyaluronate injection in superior joint space in treatment of temporomandibular joint (TMJ) internal derangement: Comparative randomized controlled trial

We aimed to assess the relationship between myeloperoxidase (MPO) and internal derangement (ID) of temporomandibular joint (TMJ) and effects of arthrocentesis procedure, either alone or in combination with hyaluronic acid (HA) injection on the prognosis of ID of TMJ. A prospective randomised controlled trial has been conducted through patients, who underwent arthrocentesis for the treatment of ID of TMJ, were randomly divided into two groups. Group SS (n=10) and Group HA (n=14) patients were assigned 0·9% NaCl solution and sodium hyaluronate intra-articularly, respectively. Synovial fluid samples were assayed for MPO at the time of arthrocentesis and pain visual analogue scale (VAS) and maximum mouth opening (MMO) scores were recorded at pre- and post-operative periods as well as first-week, first-month and third-month intervals. There was a statistically significant decrease in MPO levels between the first to second arthrocenteses only in Group 2 (P=0·001). Both VAS scores and MMO measurements decreased in the course of time following arthrocentesis and donot differ between the patients administered HA or SS. Similarly MPO levels do not change significantly between the two groups at either first or second arthrocenteses. In HA group, MPO levels significantly decreased from first to second sessions. In HA group, MPO levels decreased significantly only in patients with clinical success. Arthrocentesis procedure improves both pain VAS and MMO scores in the course of time, but these parameters do not differ between patients receiving either HA or SS. HA significantly reduces levels of MPO in synovial fluid, but SS does not. HA appears to alleviate inflammation inside the TMJ in patients with TMJ-ID.

Background: In younger patients and those without severe degenerative changes, the efficacy of intra-articular (IA) injections as a nonoperative modality for treating symptomatic knee osteoarthritis (OA)–related pain while maintaining function has become a subject of increasing interest. Purpose: To assess and compare the efficacy of different IA injections used for the treatment of knee OA, including hyaluronic acid (HA), corticosteroids (CS), platelet-rich plasma (PRP), and plasma rich in growth factors (PRGF), with a minimum 6-month patient follow-up. Study Design: Meta-analysis of randomized controlled trials; Level of evidence, 1. Methods: A systematic review was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using the following databases: PubMed/MEDLINE, Scopus, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Google Scholar. Mean or mean change from baseline and standard deviation for outcome scores regarding pain and function were recorded at the 6-month follow-up and converted to either a 0 to 100 visual analog scale score for pain or a 0 to 100 Western Ontario and McMaster Universities Osteoarthritis Index score for function. A frequentist network meta-analysis model was developed to compare the effects of HA, CS, PRP, PRGF, and placebo on patient-reported outcomes. Results: All IA treatments except CS were found to result in a statistically significant improvement in outcomes when compared with placebo. PRP demonstrated a clinically meaningful difference in function-related improvement when compared with CS and placebo due to large effect sizes. Studies evaluating outcomes of PRGF reported significant improvement when compared with placebo due to large effect sizes, whereas a potential clinically significant difference was detected in the same comparison parameters in pain evaluation. With regard to improvements in pain, function, and both combined, PRP was found to possess the highest probability of efficacy, followed by PRGF, HA, CS, and placebo. Conclusion: PRP yielded improved outcomes when compared with PRGF, HA, CS, and placebo for the treatment of symptomatic knee OA at a minimum 6-month follow-up. Further investigations evaluating different IA and other nonoperative treatment options for patients with knee OA are warranted to better understand the true clinical efficacy and long-term outcomes of nonsurgical OA management.

Temporomandibular joint disorders (TMDs) are a common source of orofacial pain and dysfunction. Arthrocentesis of the temporomandibular joint (TMJ) is a minimally invasive treatment that can be augmented with intra-articular injections. This study aimed to compare the clinical efficacy of platelet-rich plasma (PRP) versus hyaluronic acid (HA) injections following TMJ arthrocentesis in patients with TMDs unresponsive to conservative therapy. Sixty patients (72 joints) were randomized into three equal groups. Group A underwent arthrocentesis with Ringer's lactate (RL) alone (control), Group B received PRP injection post-arthrocentesis, and Group C received HA injection post-arthrocentesis. Pain intensity (VAS), maximum mouth opening (MMO), and TMJ sounds were evaluated at baseline, 1 week, 12 weeks, and 24 weeks. Repeated-measures ANOVA and chi-square tests were used for analysis (p < 0.05). All groups showed significant improvements in pain and MMO over time. Mean VAS pain scores decreased from ~ 4.8 to < 1.0 at 24 weeks (p < 0.001), while MMO increased from ~ 32mm to ~ 40mm (p < 0.001). No significant differences were found between the PRP and HA groups in pain or function at any follow-up point, nor between either treatment group and the control group. TMJ clicking resolved or improved in > 95% of joints across all groups. No adverse events were recorded. TMJ arthrocentesis alone provides substantial pain relief and functional gains. PRP and HA did not confer additional benefit over lavage alone within the 6-month timeframe. Further studies are required to assess any potential long-term differences.

Use of platelet-rich plasma, platelet-rich growth factor with arthrocentesis or arthroscopy to treat temporomandibular joint osteoarthritis: Systematic review with meta-analyses

ObjectiveThis study aims to compare the efficacy of intra-articular injections of hyaluronic acid (HA), platelet-rich plasma (PRP), and platelet-rich fibrin (PRF) for treating temporomandibular disorders (TMDs) and summarize their mechanisms of action.MethodsRandomized controlled trials (RCTs) published until November 13, 2021, were identified using electronic and manual searches. Each study was evaluated for the risk of bias using the Cochrane risk of bias tool. The studies found via searches were categorized by follow-up time (1, 3, or 6 months). Evidence quality was graded according to the GRADE system.ResultsTwelve RCTs were included that involved 421 patients with TMD. The network meta-analysis showed that all treatment groups improved compared to the placebo groups in terms of pain and maximal mouth opening (MMO). For pain evaluated via the visual analog scale, PRF exhibited better analgesic effects than PRP or HA after 1 and 3 months. PRP appeared to be more effective than PRF was after 6 months but there were no statistically significant differences between the two. For MMO, the effect of PRP was superior to those of PRF and HA after 1 month. However, after 3 and 6 months, PRF provided more encouraging results in improving MMO.ConclusionPRP and PRF exhibited similar short-term efficacy in treating TMD, while PRF was more advantageous in terms of long-term efficacy. Therefore, PRF was recommended for treating TMD.

Combined Platelet-Rich Plasma and Hyaluronic Acid can Reduce Pain in Patients Undergoing Arthrocentesis for Temporomandibular Joint Osteoarthritis

Temporomandibular joint disorders (TMDs) are widely researched diseases in medical literature. They are associated with many symptoms, such as pain, limited mouth opening and joint sounds, resulting in decreased quality of life for the patient. Both the hyaluronic acid (HA) injection and the plateletrich plasma (PRP) injection have a remarkable efficacy in the treatment of TMDs. This study aimed to evaluate the participation of HA with PRP in the treatment of TMDs. The sample consisted of 24 patients with unilateral or bilateral TMDs. They were divided into 2 groups: HA+PRP was used in the test group (12 patients); and HA alone was used in the reference group (12 patients). The injection protocol for both groups was 4 times at 2-week intervals. Pain at mastication, masticatory efficiency, joint sounds, maximum mouth opening (MMO), and functional limitation in the mandibular movement were evaluated at 2 weeks, 1 month, 3 months, and 6 months after the last injection. The outcome variables were the visual analog scale (VAS) evaluations. The Likert-type scale was used to evaluate the functional limitation in the mandibular movement. The mean age was 30.58 years in the reference group, and 23.92 years in the test group. There was alleviation of symptoms in both groups through the follow-up periods. There were significant differences between the groups regarding pain at mastication, masticatory efficiency, MMO, and functional limitation at the end of the follow-up period (p < 0.05). The study results suggest that the HA and PRP injection provides greater improvement in patients with TMDs as compared to the HA injection alone; this may be due to taking advantage of the properties of both HA and PRP.