Long-term outcomes after level II/III temporomandibular joint arthroscopy for temporomandibular dysfunction: results from a five-year follow-up study.

The objective of this paper was to evaluate the long-term efficacy of temporomandibular joint (TMJ) arthroscopy regarding functional outcomes and quality of life, and to identify factors influencing these results. A cohort of 74 patients (99 TMJs) treated by level II/III arthroscopy were followed for ≥five years. Pain (100-mm visual analogue scale [VAS]), maximum inter-incisal opening (MIO), protrusion, and lateral excursions were recorded preoperatively and at one, six, 12 months, and ≥five years postoperatively. Quality of life was assessed with OHIP-14. Arthroscopic findings (synovitis, adhesions, chondromalacia, disc perforation, anterior space obliteration) were graded intraoperatively. Bruxism was clinically recorded. Outcomes were classified as: success, re-arthroscopy <five years, re-arthroscopy ≥five years, or open surgery. Mean (SD) VAS significantly decreased from 56 (22) to 18 (21) mm (p < 0.001), and MIO increased from 32.3 (8.8) to 38.9 (5.9) mm (p < 0.001), surpassing established Minimal Clinically Important Differences (MCID). A total of 82% of joints met all AAOMS-2024 functional goals. Grade III-IV chondromalacia (24%) and anterior space obliteration (29%) correlated significantly with higher pain (+12 mm) and lower MIO (-4 mm) throughout follow up (p < 0.05). Disc perforation had no significant impact. Re-intervention rates were 12% (early) and 5% (late), with 4% progressing to open surgery. Bruxism (55%) did not increase postoperative condylar tenderness but predicted poorer outcomes: higher VAS at five years (30 [31] vs 19 [21] mm; p = 0.032), lower MIO (35.7 (7.0) vs 38.7 (4.3) mm; p = 0.012), lower surgical success (58% vs 68%), and worse OHIP-14 scores. TMJ arthroscopy provides durable pain relief and functional improvement beyond five years. Chondromalacia, anterior obliteration, and bruxism negatively affect outcomes and should inform patient selection and counselling.