title: Intra-articular adhesions of the temporomandibular joint: Relation between arthroscopic findings and clinical symptoms.
abstract: BACKGROUND
  Intra-articular adhesion (IA) is one of the important pathologic signs of intracapsular temporomandibular joint (TMJ) diseases, but this factor has been rarely described with respect to its arthroscopic characteristics and histology. The purpose of this study was to describe the incidence and distribution of IA in patients with internal derangement (ID) and to investigate the correlation between adhesions and the clinical symptoms of patients with ID of TMJ with closed-lock.
  
  
  METHODS
  A retrospective analysis was conducted of 1822 TMJs with ID that were refractory to nonsurgical treatments and underwent arthroscopic surgery between May 2001 and June 2008 in our department. Clinical findings were assessed on the basis of mandibular range of motion, patients' age and locking duration at the initial visit. ID stages were judged according to the Wilkes and Bronstein classification based on clinical symptoms and pre-operative magnetic resonance imaging. 1506 patients (1822 joints) with ID were divided into an adhesion group (486 patients) and a non-adhesion group (1020 patients). The associations between the two groups with respect to interincisal opening, clicking duration, locking duration and patients' age were statistically analyzed using a t-test.
  
  
  RESULTS
  Arthroscopy confirmed occurrences of adhesion in 28.76% of the joints (524 joints out of a total of 1822). Grade 1 adhesion was found in 68.89% of those cases; grade 2 in 20.61%; grade 3 in 4.58%; and grade 4 in 5.92%. The percentages of instances of adhesion in different stages were as follows: 13.89% of the joints in Stage II had adhesion, 25.47% in Stage III, 37.99% in Stage IV, and 40.37% in Stage V. There were statistically significant differences for patients' age (t = 10.41, P < 0.001), interincisal opening (t = 9.54, P < 0.001), paining duration (t = 3.66, P < 0.001) and locking duration (t = 3.89, P < 0.001) between the two groups, while no statistically significant difference was found for clicking duration (t = 1.08, P > 0.05).
  
  
  CONCLUSIONS
  The arthroscopic findings confirmed that the incidence ratio of adhesion was high and occurred predominantly with older patients with longer locking duration and less interincisal opening. As the stage of ID increased, the adhesion grade rose.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, No 639, Zhi Zao Ju Rd, 200011 Shanghai, PR China. zhangshanyong@126.com
authors.forename: ShanYong
authors.initials: S
authors.lastname: Zhang
authors.forename: XiuMing
authors.initials: X
authors.lastname: Liu
authors.forename: Chi
authors.initials: C
authors.lastname: Yang
authors.forename: XieYi
authors.initials: X
authors.lastname: Cai
authors.forename: MinJie
authors.initials: M
authors.lastname: Chen
authors.forename: Majd S
authors.initials: MS
authors.lastname: Haddad
authors.forename: Bai
authors.initials: B
authors.lastname: Yun
authors.forename: ZhuoZhi
authors.initials: Z
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D001182:Arthroscopy / Q000379:methods*; D002648:Child; D015897:Comorbidity; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D015994:Incidence; D017746:Joint Capsule / Q000473:pathology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016059:Range of Motion, Articular / Q000502:physiology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013284:Stomatognathic System / Q000503:physiopathology; D013704:Temporomandibular Joint / Q000473:pathology* / Q000503:physiopathology; D013705:Temporomandibular Joint Disorders / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D000267:Tissue Adhesions / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D055815:Young Adult