Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons · 2026
Comparative Efficacy of Intra-Articular Adjuvants Following Double-Needle Arthrocentesis for Intra-Articular Pain and Dysfunction: A Network Meta-Analysis.
СтатьяNetwork Meta-AnalysisСравнительное исследованиеОбзорНазвание и аннотация: Перевод пока не подготовлен
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Sivaramakrishnan Gowri, Sridharan Kannan, Al Muharraqi Mohammed Abdulla
Аннотация
BACKGROUND: Double-needle arthrocentesis (DA) is an established minimally invasive treatment; however, the additional clinical benefit of intra-articular injection (IAI) adjuvants remains uncertain.
PURPOSE: The purpose of this study was to compare the efficacy of IAI adjuvants administered following DA (intervention) versus DA without adjuvant (comparator), on therapeutic outcomes including pain reduction and improvement in maximum mouth opening (MMO), in patients with intra-articular pain and dysfunction (population).
DATA SOURCES: A comprehensive search on PubMed, Scopus, Embase, and Cochrane was conducted from database inception until November 30, 2025. References of eligible studies were also screened.
STUDY SELECTION: Randomized and nonrandomized studies were included. Study selection was performed independently by 2 reviewers, with disagreements resolved by consensus or a third reviewer.
DATA EXTRACTION AND SYNTHESIS: Data extraction and quality assessment were conducted in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analysis-network meta-analysis guidelines. Risk of bias was assessed using the Cochrane tool and Newcastle-Ottawa Scale. A random-effects network meta-analysis was performed using standardized mean difference (SMD) as the effect estimate. Surface under the cumulative ranking probabilities were also calculated.
MAIN OUTCOMES AND MEASURES: Pain (measured using visual analog scale) and MMO (measured using the interincisal distance) were reported at 3 and/or 6 months.
RESULTS: Twenty-four studies were included. Intra-articular hyaluronic acid plus platelet-rich plasma (HA + PRP) demonstrated significantly greater improvement in MMO at both 3 months (SMD = 2.12; 95% CI, 0.81 to 3.44; P = .0016) and 6 months (SMD = 2.07; 95% CI, 1.18 to 2.96; P < .001) compared with no adjuvant and ranked highest by surface under the cumulative ranking. For pain reduction, HA + PRP was the most effective intervention at 3 months (SMD = -3.11; 95% CI, -5.75 to -0.47; P = .021), while platelet-rich fibrin combined with splint therapy ranked highest at 6 months (SMD = -2.53; 95% CI, -4.78 to -0.27; P = .028). Substantial heterogeneity was observed across all networks.
CONCLUSIONS AND RELEVANCE: Among available adjuvants, HA + PRP provided the most consistent short-term and medium-term benefits following DA for intra-articular pain and dysfunction. Integrated, dual-mechanism adjuvant strategies may optimize clinical outcomes, though heterogeneity and limited long-term data warrant cautious interpretation.
PURPOSE: The purpose of this study was to compare the efficacy of IAI adjuvants administered following DA (intervention) versus DA without adjuvant (comparator), on therapeutic outcomes including pain reduction and improvement in maximum mouth opening (MMO), in patients with intra-articular pain and dysfunction (population).
DATA SOURCES: A comprehensive search on PubMed, Scopus, Embase, and Cochrane was conducted from database inception until November 30, 2025. References of eligible studies were also screened.
STUDY SELECTION: Randomized and nonrandomized studies were included. Study selection was performed independently by 2 reviewers, with disagreements resolved by consensus or a third reviewer.
DATA EXTRACTION AND SYNTHESIS: Data extraction and quality assessment were conducted in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analysis-network meta-analysis guidelines. Risk of bias was assessed using the Cochrane tool and Newcastle-Ottawa Scale. A random-effects network meta-analysis was performed using standardized mean difference (SMD) as the effect estimate. Surface under the cumulative ranking probabilities were also calculated.
MAIN OUTCOMES AND MEASURES: Pain (measured using visual analog scale) and MMO (measured using the interincisal distance) were reported at 3 and/or 6 months.
RESULTS: Twenty-four studies were included. Intra-articular hyaluronic acid plus platelet-rich plasma (HA + PRP) demonstrated significantly greater improvement in MMO at both 3 months (SMD = 2.12; 95% CI, 0.81 to 3.44; P = .0016) and 6 months (SMD = 2.07; 95% CI, 1.18 to 2.96; P < .001) compared with no adjuvant and ranked highest by surface under the cumulative ranking. For pain reduction, HA + PRP was the most effective intervention at 3 months (SMD = -3.11; 95% CI, -5.75 to -0.47; P = .021), while platelet-rich fibrin combined with splint therapy ranked highest at 6 months (SMD = -2.53; 95% CI, -4.78 to -0.27; P = .028). Substantial heterogeneity was observed across all networks.
CONCLUSIONS AND RELEVANCE: Among available adjuvants, HA + PRP provided the most consistent short-term and medium-term benefits following DA for intra-articular pain and dysfunction. Integrated, dual-mechanism adjuvant strategies may optimize clinical outcomes, though heterogeneity and limited long-term data warrant cautious interpretation.