Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons · 2026
Closed Lock Duration Is Associated With an Increasing Prevalence of Disc Perforation and Degenerative Arthroscopic Findings in the Temporomandibular Joint.
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Sang Yingning, Danquah Sheridan, Lee Susie, Gustaldi Fernando, Choi Daniel D
Аннотация
BACKGROUND: Prolonged temporomandibular joint (TMJ) closed lock may be associated with progressive intra-articular degeneration, including disc perforation. The relationship between lock duration and arthroscopic findings remains unclear.
PURPOSE: To measure the association between TMJ closed-lock duration and disc perforation identified at arthroscopy.
STUDY DESIGN, SETTING, SAMPLE: This retrospective cohort study included patients who underwent TMJ arthroscopy for closed lock associated with anterior disc displacement without reduction February 2022-February 2026, Massachusetts General Hospital, Boston, Massachusetts. Subjects were included if lock duration and arthroscopic findings were documented and excluded if either was unavailable or if they underwent repeat arthroscopy.
PREDICTOR VARIABLE: Closed-lock duration, defined as the interval (months) between onset of persistent closed-lock symptoms and operation.
MAIN OUTCOME VARIABLE(S): The primary outcome variable was disc perforation. Secondary outcomes include other arthroscopic findings (chondromalacia, synovitis, neovascularization, adhesions).
COVARIATES: Demographics (age, sex) and perioperative variables (unilateral vs bilateral, Wilkes).
ANALYSES: Locking duration was compared between joints with and without perforation using nonparametric testing. Logistic regression was used to evaluate the association between locking duration and perforation, adjusting for age. Prevalence of perforation across increasing locking-duration intervals was analyzed. Statistical significance was at P < .05.
RESULTS: The study included 119 subjects (119 joints). Mean age was 39.2 ± 17.1 years, and 109 subjects (91.6%) were female. Disc perforation was identified in 67 joints (56.3%). Median lock duration was longer in joints with perforation than without perforation (17.0 vs 10.0 months; P = .002). In unadjusted analysis, each additional year of locking was associated with increased odds of disc perforation (odds ratio, 1.11; 95% CI, 1.03 to 1.26; P = .032). After adjustment for age, this association remained significant (adjusted odds ratio, 1.13; 95% CI, 1.02 to 1.29; P = .038).
CONCLUSIONS AND RELEVANCE: Longer closed lock was associated with increased odds of disc perforation at arthroscopy. Prolonged locking may reflect an ongoing disease progression rather than a stable condition. Earlier identification of patients unlikely to improve may help guide the timing of surgical intervention and reduce the risk of advanced joint degeneration.
PURPOSE: To measure the association between TMJ closed-lock duration and disc perforation identified at arthroscopy.
STUDY DESIGN, SETTING, SAMPLE: This retrospective cohort study included patients who underwent TMJ arthroscopy for closed lock associated with anterior disc displacement without reduction February 2022-February 2026, Massachusetts General Hospital, Boston, Massachusetts. Subjects were included if lock duration and arthroscopic findings were documented and excluded if either was unavailable or if they underwent repeat arthroscopy.
PREDICTOR VARIABLE: Closed-lock duration, defined as the interval (months) between onset of persistent closed-lock symptoms and operation.
MAIN OUTCOME VARIABLE(S): The primary outcome variable was disc perforation. Secondary outcomes include other arthroscopic findings (chondromalacia, synovitis, neovascularization, adhesions).
COVARIATES: Demographics (age, sex) and perioperative variables (unilateral vs bilateral, Wilkes).
ANALYSES: Locking duration was compared between joints with and without perforation using nonparametric testing. Logistic regression was used to evaluate the association between locking duration and perforation, adjusting for age. Prevalence of perforation across increasing locking-duration intervals was analyzed. Statistical significance was at P < .05.
RESULTS: The study included 119 subjects (119 joints). Mean age was 39.2 ± 17.1 years, and 109 subjects (91.6%) were female. Disc perforation was identified in 67 joints (56.3%). Median lock duration was longer in joints with perforation than without perforation (17.0 vs 10.0 months; P = .002). In unadjusted analysis, each additional year of locking was associated with increased odds of disc perforation (odds ratio, 1.11; 95% CI, 1.03 to 1.26; P = .032). After adjustment for age, this association remained significant (adjusted odds ratio, 1.13; 95% CI, 1.02 to 1.29; P = .038).
CONCLUSIONS AND RELEVANCE: Longer closed lock was associated with increased odds of disc perforation at arthroscopy. Prolonged locking may reflect an ongoing disease progression rather than a stable condition. Earlier identification of patients unlikely to improve may help guide the timing of surgical intervention and reduce the risk of advanced joint degeneration.