(39) Arthroscopic Posterior Suture Plication in Class V Bronstein Merrill Patients: A Retrospective Study

Abstract: Arthroscopic Posterior Suture Plication in Class V Bronstein Merrill Patients: A Retrospective Study

Comparative data on arthroscopic repair of TMJ with advanced internal derangement is limited. Current research shows a 50-63% success rate following arthroscopic surgery in Class V Wilkes and Bronstein Merrill patients.1,2 There is little data comparing arthroscopic techniques when making the clinical decision to perform posterior suture plication of the articular disc as opposed to laser debridement. Typically Class V Bronstein Merrill patients are poor candidates for suture plication due to disrepair of the articular disc; however, some clinical presentations allow for plication. The objective of this study is to identify whether suture plication of the articular disc in TMJ arthroscopic surgery improves outcomes for patients that present with Bronstein Merrill Class V internal derangement.

A retrospective study was performed to identify patients that underwent unilateral arthroscopic repair of anterior disc dislocation of the TMJ from 2010-2020 at an academic medical center. Inclusion criteria included patients that underwent arthroscopic surgery, presented with anterior disc displacement (ADD), and returned for follow-up care. Exclusion criteria included patients who underwent bilateral TMJ procedures or multiple procedures on a single TMJ. Clinical and surgical variables were documented from all pre-operative, surgical, radiographic, and post-operative charts. Patients were then selected for Class V arthroscopic Bronstein Merrill Stage and AAOMS arthroscopic success rates identified. Failure was denoted as an additional reparative procedure being performed. Statistics were reported for patient descriptors as means, proportions or P values when appropriate.

Over a ten-year period, 52 patients were classified as Bronstein Merrill Class V and underwent arthroscopic repair for ADD, with 17 receiving posterior suture plication and 35 undergoing laser debridement without suture plication. The only significant difference between patient groups was age. Patients receiving sutures had a mean age of 43.9 (SD 13.6) and a mean follow-up duration of 14.5 months (SD 21.9). Patients with laser debridement had a mean age of 53.5 (SD 14.5) and a mean follow-up duration of 11.0 months (SD 10.8). Patients with and without sutures showed similar reductions in pain, -55.8% (SD 90.6) and -68.5% (SD 42.2) respectively. Increases in MIO were minimal as patients with sutures had 3.4% (SD 15.9) improvement and patients without had 8.7% (SD 22.5) improvement. Both patient groups had an. AAOMS arthroscopy success rate of 62.5%. An additional surgical TMJ repair following posterior suture plication occurred in 17.6% of patients and in 17.1% of patients following laser debridement. Additionally, the time to failure in patients receiving sutures was 19.7 months (SD 12.2) and 12.0 months (SD 6.3) in patients with laser debridement.

The results of this study suggest that posterior suture plication in Bronstein Class V patients does not significantly improve clinical outcomes. Despite patient populations that had only a statistically significant difference in age, no discernable differences were observed in pain reduction, improvement in MIO, AAOMS success, failure rates, or time to failure. AAOMS success rates for each patient population were similar to the literature success rate of 50-63%. The data from this study indicates that Bronstein Merrill Class V TMJ arthroscopy patients do not derive benefit from posterior sutures when there is adequate articular disc tissue to allow for plication.

1. Bronstein S, Merrill R. Clinical staging for TMJ internal derangement: Application to arthroscopy. J Craniomandib Disord Facial Oral Pain. 1992;6:7–16.

2. Holmlund A, Gynther G, Axelsson S. Efficacy of arthroscopic lysis and lavage in patients with chronic locking of the temporomandibular joint. Int J Oral Maxillofac Surg. 1994;23(5):262-265. doi:10.1016/s0901-5027(05)80104-3