Correlation of temporomandibular joint effusion on MRI with Wilkes staging, arthroscopic findings, and synovial fluid biomarkers in temporomandibular disorders

Abstract

Magnetic resonance imaging (MRI) has advanced the understanding of temporomandibular joint (TMJ) disorders, particularly in detecting structural changes and effusion. This study aims to explore the relationship between TMJ effusion, Wilkes staging, arthroscopic findings, and synovial fluid biomarkers. Clinical data from 93 patients (109 TMJs) with TMJ effusion on MRI who underwent arthroscopy from 2008 to 2022 were reviewed retrospectively. Patients included were refractory to conservative treatments, had a diagnosis of temporomandibular disorder confirmed by MRI, and were classified according to Wilkes stages. Data were collected on arthroscopic findings, including synovitis, chondromalacia, adhesions, and disc perforations, and biochemical analysis was performed on synovial fluid samples. Results showed that effusion positively correlated with higher Wilkes stages, indicating advanced joint involvement and significant relationships between age, chondromalacia, and synovitis. Age correlated significantly with chondromalacia and disease severity, while synovitis showed a strong correlation with both chondromalacia and Wilkes stage, indicating progression with inflammation. Synovial protein concentrations were elevated in cases with chondromalacia, suggesting a link with joint degeneration, while glucose levels tended to decrease in inflammatory cases. Sodium, potassium, and chloride levels were stable across stages. Arthroscopy allowed precise visualization of TMJ pathologies, supporting its diagnostic and therapeutic value in severe temporomandibular disorders. This study highlights effusion as a potential marker of advanced TMJ degeneration, emphasizing the need for early diagnosis and targeted treatment in patients with joint inflammation.