Is advanced arthroscopic debridement in patients with end-stage TMJ degenerative joint disease associated with improved quality of life and pain reduction?

Abstract

BackgroundTemporomandibular joint (TMJ) advanced arthroscopic debridement (Level II arthroscopy) is a minimally invasive procedure involving micro-surgical debridement of degenerated tissues with aid of a fibre-optic camera. Its use for treating intra-articular pain and dysfunction (IPD) in advanced TMJ degenerative disease remains debated. PurposeThe primary purpose was to evaluate if Level II arthroscopy was associated with improvement in pain and quality of life in subjects with advanced TMJ degenerative disease, and to identify clinical factors that influence outcomes. Study DesignThis was a retrospective cohort study conducted on subjects who presented to the University of Michigan oral and maxillofacial surgery clinic between November 2020 and July 2023 who required arthroscopy for IPD. Inclusion criteria were unilateral or bilateral IPD, Wilkes V disease, arthroscopically verified disc perforation, and 3-month minimum follow-up. Subjects with Level I/III arthroscopy or with Wilkes I-IV disease were excluded. CovariatesThe covariates included demographics (age, gender), preoperative variables (body mass index, allergies, environmental sensitivities, condylar degeneration, systemic arthropathy, serology, prior arthrocentesis, pre-operative jaw functional limitation scale (JFLS) and pain), and operative variables (synovitis, chondromalacia, adhesions, laterality, debridement, and injections). Main outcome variablesPrimary outcomes were changes in quality of life and pain measured via the JFLS and visual analogue pain scale (VAS), respectively, at minimum 3-months post-arthroscopy. AnalysesLinear regression analyzed JFLS with covariates, and linear-mixed effects models adjusted for non-independent pain from bilateral TMJ sides. Paired t-tests compared mean JFLS and pain scores with significance set at p<0.05. ResultsA total of 240 subjects were screened and 40 subjects completed the study with mean age of 49.33 (+/- 13.62) years, 95% subjects were female, and median follow-up of 7 months (interquartile range 6-8). Mean JFLS decreased from 73.3 (+/-34.94) to 43.8 (+/-35.35) post-operatively (p<0.0001). Mean pain scores decreased from 60.0 (+/-21.2) to 38.0 (+/-28.5) post-operatively (p<0.0001). Environmental sensitivity was the only covariate significantly associated with higher post-operative JFLS (p=0.002). Three subjects (7.5%) required total arthroplasty post-Level II arthroscopy. Conclusions and RelevanceAdvanced arthroscopic debridement (level II arthroscopy) is associated with reduced pain and improved quality of life in subjects with Wilkes V degenerative joint disease.