Can Disc Perforation in Subjects With Intra-Articular Pain and Dysfunction Be Managed Arthroscopically?

BACKGROUND: Disc perforation represents an advanced stage of temporomandibular joint degeneration, and the optimal arthroscopic treatment remains controversial.

PURPOSE: The study purpose was to evaluate and compare the outcomes of 3 arthroscopic techniques-level II arthroscopy, discopexy, and discectomy-for disc perforations, and to identify variables associated with better results.

STUDY DESIGN, SETTING, AND SAMPLE: This prospective nonblinded cohort was conducted between 2022 and 2024 at a tertiary center (Clinica Bupa Santiago). The study included subjects with arthroscopically confirmed disc perforation. Exclusion criteria were prior open joint surgery, systemic connective tissue disease, incomplete imaging or operative data, and loss to follow-up.

PREDICTOR VARIABLE: The predictor variable was arthroscopic technique. Subjects were allocated to level II, discopexy, or arthroscopic discectomy based on intraoperative findings.

MAIN OUTCOME VARIABLES: The primary outcomes were pain, measured using a visual analogue scale (0 to 10), and maximum interincisal opening (MIO, mm), assessed preoperatively and at 1 week, and 1, 2, 3, and 6 months postoperatively.

COVARIATES: The covariates were demographic, clinical, and imaging variables.

STATISTICAL ANALYSES: Associations between clinical, imaging, and intraoperative variables and the arthroscopic treatment type were examined using χ 2, Fisher's exact, and Kruskal-Wallis tests. Independent predictors were identified through multinomial logistic regression. Variables with the highest discriminative performance (based on area under the curve and likelihood ratios) were subsequently integrated into a clinical decision algorithm to support treatment selection. Statistical significance was set at P < .05.

RESULTS: The sample included 99 joints from 75 subjects (mean age 41.2 ± 12.8 years; 60 females, 80%). At 6 months, pain and MIO improved significantly in all groups (P < .001), with no between-group differences for pain (P = .3) or MIO (P = .6). Disc perforation ≥7 mm, prior arthrocentesis, and crepitus were independently associated with treatment selection (odds ratios: 2.20, 5.81, and 4.03). The combination of perforation ≥7 mm and crepitus showed the highest discriminative ability for discectomy (area under the curve= 0.83; likelihood ratios + = 3.10).

CONCLUSION: All 3 arthroscopic techniques were associated with significant reductions in pain and improvements in MIO. Preoperative and intraoperative findings, particularly disc perforation size, joint crepitus, and prior arthrocentesis demonstrated discriminatory value in guiding the selection of the most appropriate arthroscopic treatment.