The authors conducted a systematic review and meta-analysis to determine whether arthrocentesis or arthroscopy combined with platelet-rich plasma (PRP) or platelet-rich growth factor (PRGF) injection compared with no injection or saline injection (control group) or hyaluronic acid (HA) injection reduced pain and increased maximum mouth opening (MMO) in patients with temporomandibular joint (TMJ) osteoarthritis (OA).
The authors used the Cochrane Library, Embase, PubMed, Web of Science, Google Scholar databases and hand searched reference lists through May 4, 2018, to identify randomized controlled trials and controlled trials including patients with TMJ OA receiving injections (PRP or PRGF versus other). The authors assessed the risk of bias according to the Cochrane guidelines.
The authors screened 36 abstracts. They included 5 studies (3 randomized controlled trials and 2 controlled trials) with a total of 285 patients with TMJ OA in this review. The authors assessed all 5 studies as being at high risk of bias. The quality of evidence was very low owing to statistical heterogeneity, small sample size, or high risk of bias. Meta-analyses with 2 studies showed a visual analog scale pain improvement from baseline of -2.778 units (0-10 scale, 0 = no pain, 10 = worst pain) favorable to PRP or PRGF compared with findings in control groups (95% confidence interval [CI], -3.504 to -2.052; P < .001) and an improvement of -0.968 favorable to PRP or PRGF compared with findings in HA groups (95% CI, -1.854 to -0.082; P = .032). The authors found no significant increase in MMO in those receiving PRP or PRGF compared with that in the control or HA groups.
Although the results of the included studies showed that arthrocentesis or arthroscopy with PRP or PRGF, saline, or HA injections all reduced pain and increased mouth opening, the evidence was of very low quality. Further studies are needed to confirm these preliminary results showing that PRP or PRGF with arthrocentesis or arthroscopy significantly improved pain but did not increase MMO compared with findings in the control or HA groups.