Objectives: To study the possible efficacy of injecting plasma rich growing factors (PGRF) in the TMJ after arthroscopic disc anterior release and electrocoagulation of the posterior disc attachment in patients with advanced internal derangements.
Methods: Patients with MRI diagnosis of anteriorly displaced discs with osteoartrosis entered this randomized (injection – group A – versus non injection – group B – of PGRF) prospective clinical trial. Only unilateral cases were selected. After TMJ arthroscopy with release of the anterior and coagulation of the posterior disc attachment was performed injection of PGRF in the inferior joint space was accomplished in the randomized A group of patients. Pain (VAS) and maximum interincisal opening (MIO in mms) were analyzed before and after surgery (3, 6, 12, 18 and 24 months).
Results: 92 joints were treated (42 group A, 50 group B). Mean age was 35.8 (17–67). Most of the cases were females (86). No statistical differences were found between both groups of patients regarding age, pain and MIO preoperatively. A significant reduction in pain were noticed in both groups after surgery. VAS pre (7.9), VAS 24 (1.4). Significant clinical better results were obtained for the group A when compared with group B of patients after 6 and 12 months, however no statistical clinical differences were found after 18 and 24 months of arthroscopy. MIO increased after surgery in both groups: MIO pre (26.2), MIO 24 (36.8). No statistical differences were found comparing both groups of patients.
Conclusions: The arthroscopic technique used reliably decreased pain and increased the maximum interincisal opening distance in all the patients studied. The injection with PGRF group had better pain outcomes than the other group. Injection of PGRF should be considered in the management of patients with degenerative TMJ disease.
Key words: internal derangements; arthroscopy; plasma reach growing factors