Comparison of Short-Term Outcomes of Hyaluronic Acid and Hyaluronic Acid with Platelet-Rich Plasma Injections Following Arthrocentesis

Abstract

Objective: The aim of the present study was to evaluate the clinical efficacy of intra-articular PRP+HA injection following arthrocentesis in patients with disc displacement with reduction (DDwR) and disc displacement without reduction (DDwoR). Methods: This retrospective study included medical records of patients aged 17–60 who underwent unilateral or bilateral temporomandibular joint arthrocentesis at Bezmialem Vakıf University between 2017 and 2024. The joints were categorized into two groups: Group I received hyaluronic acid (HA); and Group II received platelet-rich plasma and hyaluronic acid (PRP+HA) following arthrocentesis. Pain intensity, maximum mouth opening pain-free (MMO-PF), maximum mouth opening with pain (MMO-P), and lateral and protrusive movements were recorded as outcome variables. Pre-operative outcome variables, and post-operative measurements at 1 and 3 month follow-up visits, were collected. All statistical analyses were conducted with a significance level set at α = 0.05 (two-tailed). Results: 36 joints from 23 patients were included in the study and divided into two groups, with 18 joints per group. Both groups demonstrated improvement in pain, but a statistically significant difference was observed only in Group II (p<0.05). No significant differences were observed in MMO-PF, MMO-P, and lateral movements. Conclusion: This study demonstrates that administration of PRP+HA following arthrocentesis is an effective treatment for managing pain in TMDs. However, when compared with HA or PRP alone, the combination did not show a statistically significant superiority.

Keywords

• Temporomandibular joint
• arthrocentesis
• hyaluronic acid
• platelet-rich plasma

Artrosentez Sonrası Uygulanan Hyaluronik Asit Enjeksiyonu ile Hyaluronik Asit ve Plateletten Zengin Plazma Enjeksiyonlarının Kısa Dönem Sonuçlarının Karşılaştırılması

Abstract

Amaç: Bu çalışmanın amacı, redüksiyonlu disk deplasmanı ve redüksiyonsuz disk deplasmanı hastalarında artrosentez sonrasında intraartiküler Plateletten Zengin Plazma ve Hyaluronik Asit (PRP+HA) enjeksiyonunun klinik etkinliğini değerlendirmektir. Yöntem: 2017–2024 yılları arasında Bezmialem Vakıf Üniversitesi’nde tek taraflı veya çift taraflı temporomandibular eklem artrosentezi uygulanmış, 17–60 yaş aralığındaki hastalar bu retrospektif çalışmaya dahil edilmiştir. Eklemler iki gruba ayrılmıştır: Grup I’de artrosentez sonrasında hyaluronik asit uygulanmış, Grup II’de ise artrosentezden sonra plateletten zengin plazma ve hyaluronik asit uygulanmıştır. Ağrı şiddeti (VAS), ağrısız maksimum ağız açıklığı (MMO-PF), ağrılı maksimum ağız açıklığı (MMO-P) ile lateral ve protruziv mandibular hareketler incelenmiştir. Preoperatif ölçümler ile postoperatif 1. ve 3. ay takip verileri değerlendirilmiştir. Tüm istatistiksel analizler, anlamlılık düzeyi α = 0,05 (çift yönlü) olacak şekilde gerçekleştirilmiştir. Bulgular: Çalışmaya 23 hastaya ait toplam 36 eklem dahil edilmiş ve her biri 18 eklem içerecek şekilde iki gruba ayrılmıştır. Her iki grupta da ağrı düzeylerinde iyileşme gözlenmiş olmakla birlikte, istatistiksel olarak anlamlı fark yalnızca Grup II’de saptanmıştır (p<0,05). MMO-PF, MMO-P ve lateral hareketlerde gruplar arasında istatistiksel olarak anlamlı bir fark bulunmamıştır. Sonuç: Bu çalışma, artrosentez sonrasında PRP+HA uygulanmasının temporomandibular eklem hastalıklarında ağrı kontrolü açısından etkili bir tedavi yöntemi olduğunu göstermektedir. Ancak, HA veya PRP uygulamaları ile karşılaştırıldığında, kombine tedavinin istatistiksel olarak anlamlı bir üstünlük sağlamadığı görülmüştür.

Keywords

• temporomandibular eklem
• artrosentez
• hyaluronik asit
• plateletten zengin plazma

References

1. 1. Nitzan DW. The process of lubrication impairment and its involvement in temporomandibular joint disc displacement: A theoretical concept. J Oral Maxillofac Surg. 2001;59(1):36–45.
2. 2. Yilmaz O, Korkmaz YT, Tuzuner T. Comparison of treatment efficacy between hyaluronic acid and arthrocentesis plus hyaluronic acid in internal derangements of temporomandibular joint. J Craniomaxillofac Surg. 2019;47(11):1720–1727.
3. 3. Karadayi U, Gursoytrak B. Randomised controlled trial of arthrocentesis with or without PRF for internal derangement of the TMJ. J Craniomaxillofac Surg. 2021;49(5):362–367.
4. 4. Tang YH, Zhang M, Duan X, et al. Arthrocentesis versus nonsurgical intervention as initial treatment for temporomandibular joint arthralgia: A randomized controlled trial with long-term follow-up. Int J Oral Maxillofac Surg. 2023;52(5):595–603.
5. 5. Andre A, Kang J, Dym H. Pharmacologic treatment for temporomandibular and temporomandibular joint disorders. Oral Maxillofac Surg Clin North Am. 2022;34(1):49–59.
6. 6. Nitzan DW, Dolwick MF, Garza A, Martinez A. Temporomandibular joint arthrocentesis: A simplified treatment for severe, limited mouth opening. J Oral Maxillofac Surg. 1991.
7. 7. Cömert Kılıç S, Güngörmüş M. Is arthrocentesis plus plateletrich plasma superior to arthrocentesis plus hyaluronic acid for the treatment of temporomandibular joint osteoarthritis? A randomized clinical trial. Int J Oral Maxillofac Surg. 2016;45(12):1538–1544.
8. 8. Guarda-Nardini L, Olivo M, Ferronato G, Salmaso L, Bonnini S, Manfredini D. Treatment effectiveness of arthrocentesis plus hyaluronic acid injections in different age groups of patients with temporomandibular joint osteoarthritis. J Oral Maxillofac Surg. 2012;70(9):2048–2056.

9. 9. Hegab AF, Al Hameed HIA, Hassaneen AM, Hyder AEK. Synergistic effect of platelet-rich plasma with hyaluronic acid injection following arthrocentesis to reduce pain and improve function in TMJ osteoarthritis. J Stomatol Oral Maxillofac Surg. 2023;124(1).
10. 10. Barac B, Damjanov N, Zekovic A. The new treatment approach in knee osteoarthritis: Efficacy of cellular matrix combination of platelet rich plasma with hyaluronic acid versus two different types of hyaluronic acid. Int J Clin Rheumatol. 2018.
11. 11. Renevier JL, Marc JF, Adam P, Sans N, Le Coz J, Prothoy I. Cellular matrix PRP-HA as a treatment option for osteoarthritis: Results of a pilot multicenter French study with long-term followup. Int J Clin Rheumatol. 2018;13(4).
12. 12. Hosgor H. Is arthrocentesis plus hyaluronic acid superior to arthrocentesis alone in the treatment of disc displacement without reduction in patients with bruxism? J Craniomaxillofac Surg. 2020;48(11):1023–1027.
13. 13. Nitzan DW. Arthrocentesis: Incentives for using this minimally invasive approach for temporomandibular disorders. Oral Maxillofac Surg Clin North Am. 2006.
14. 14. Tran C, Ghahreman K, Huppa C, Gallagher JE. Management of temporomandibular disorders: A rapid review of systematic reviews and guidelines. Int J Oral Maxillofac Surg. 2022;51(9):1211–1225.
15. 15. Nitzan DW, Naaman HL. Arthrocentesis: What, when, and why? Oral Maxillofac Surg Clin North Am. 2022.
16. 16. Betancor Pérez M, Loro Ferrer JF, Martín Hernán F, Velázquez Cayón RT. Effectiveness of combined arthrocentesis with plateletrich plasma, platelet-rich fibrin, hyaluronic acid, corticosteroids and NSAIDs in temporomandibular joint osteoarthritis: A systematic review and meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol. 2025;140(5):528–538.
17. 17. Xie Y, Zhao K, Ye G, et al. Effectiveness of intra-articular injections of sodium hyaluronate, corticosteroids, platelet-rich plasma on temporomandibular joint osteoarthritis: A systematic review and network meta-analysis. J Evid Based Dent Pract. 2022;22(3):101720.
18. 18. Altman R, Bedi A, Manjoo A, et al. Anti-inflammatory effects of intra-articular hyaluronic acid: A systematic review. Cartilage. 2019;10(1):43–52.
19. 19. Xie X, Zhang C, Tuan RS. Biology of platelet-rich plasma and its clinical application in cartilage repair. Arthritis Res Ther. 2014;16(1):204.
20. 20. Abd ElMonem Arboud KA, Shoushan MM, El Sharif AM. Evaluation of intra-articular injection of hyaluronic acid with platelet-rich plasma for temporomandibular joint anterior disc displacement with and without reduction. Tanta Dent J. 2022;19(2):89–97.
21. 21. Asadpour N, Shooshtari Z, Kazemian M, et al. Combined platelet-rich plasma and hyaluronic acid can reduce pain in patients undergoing arthrocentesis for temporomandibular joint osteoarthritis. J Oral Maxillofac Surg. 2022;80(9):1474–1485.
22. 22. Harba AN, Harfoush M. Evaluation of the participation of hyaluronic acid with platelet-rich plasma in the treatment of temporomandibular joint disorders. Dent Med Probl. 2021;58(1):81–88.
23. 23. Chęciński M, Lubecka K, Bliźniak F, Chlubek D, Sikora M. Hyaluronic acid/platelet-rich plasma mixture improves temporomandibular joint biomechanics: A systematic review. Int J Mol Sci. 2024;25(17):9401.