Israeli Experience: From Arthroscopy Came Arthrocentesis, Why?

Abstract

TMJ arthrocentesis, a non-arthroscopic lavage, is a “low-tech, high-prudence” modality that is highly efficient in particular types of TMJ disorders. Its effectiveness in some disorders and ineffectiveness in others has led to a refinement of our understanding of TMJ function and dysfunction. This relatively simple procedure, used following the failure of non-surgical treatment, dramatically decreases the need for invasive surgical interventions and their consequences. TMJ arthrocentesis is carried out under local anaesthesia, in sterile conditions by introducing Ringer solution using the same points of entry described by McCaine. The procedure is complemented by taking steps to reduce joint loading (eg rest, soft diet, medication, relaxation techniques to reduce bruxism, interocclusal appliances, etc) and by physical therapy (eg, increasing joint movement, and muscle strength and length). As opposed to surgical arthroscopy, arthrocentesis of the upper compartment is limited to force apart the flexible disc from the surface of the fossa/eminence and to wash away inflammatory products. It is therefore effective in overcoming painful states or limited movement (LMO) caused by inability of the disc to slide due to increased friction or adhesive forces. Arthrocentesis is not expected to be effective in those disorders caused by non-washable causes such as displacement of the disc, adhesions or osteophytes. Arthrocentesis is, for example, highly efficient for releasing anchored disc phenomenon where it neutralizes the adhesive forces and separates the flexible disc from the rigid surface of the eminence. However, it is markedly less efficient in LMO caused by non-reducible disc. Similarly, artrocentesis is efficient for elimination of ’open lock’ and intermittent clicking and is highly effective in neutralizing pain localized to the joint (arthragia), In osteoarthritis, arthrocentesis is highly efficient in both reducing pain and increasing the range of movement in about 70% of the patients referred for surgery. In the remaining 30%, it acts as a diagnostic tool indicating that the pain and/or limitation are caused by an unwashable cause, such as fibrous adhesions or osteophytes that are not always easy to diagnose by imaging. Following proper instruction, arthrocentesis can be performed in peripheral outpatient clinics. In addition, the procedure can be complemented by injecting medication suitable to the joint disorder. New products aiming to encourage free movement will be discussed.