What are the outcomes of jaw function and pain reduction with advanced TMJ arthroscopy after failed lysis and lavage procedures?

When temporomandibular joint (TMJ) lysis and lavage procedures fail to treat intraarticular pain and dysfunction (IPD), the therapeutic effectiveness of advanced arthroscopy to treat persistent symptoms remain debatable. This is a retrospective study of 34 subjects at the University of Michigan from November 2020 to July 2023 with persistent IPD (Wilkes II-V diagnosis) after arthrocentesis or arthroscopic lysis and lavage, who then underwent advanced arthroscopy. Subjects had a mean age of 35.9±15.3 years and 33 (97%) were female with minimum 3-month follow-up. Outcomes were jaw function (measured by jaw functional limitation scale) and pain intensity (by visual analogue scale from 0-100). Linear regression was used to analyze the impact of subject demographics, pre-operative and intra-operative variables on JFLS outcomes while linear mixed-effects models assessed the potential impact of the same variables on pain scores. Paired t-tests assessed pre- versus postoperative changes. Statistical significance was set at p<0.05. Mean JFLS improved from 79.9±27.9 to 55.4±37.0 (p=0.004), and mean pain decreased from 64.7±20.4 to 43.0±32.8 (p<0.0001). Among covariates, only positive serologic markers correlated with greater functional limitation (p=0.012). These results suggest that advanced arthroscopy is associated with improvements in subjects with persistent IPD after failing lysis and lavage procedures.