Does intra-articular injection of platelet-rich plasma/platelet-rich fibrin improve outcomes after temporomandibular joint arthrocentesis? A systematic review and meta-analysis.

Platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) have been used as adjuncts to temporomandibular joint (TMJ) arthrocentesis but without any high-quality evidence. This systematic review collated data from published randomised controlled trials (RCTs) to provide level-1 evidence on its efficacy. Trials published on the databases of PubMed, Scopus, Embase, CENTRAL, and Web of Science up to 4 August 2023 and comparing intra-articular PRP/PRF with control after TMJ arthrocentesis were eligible. Primary outcomes were pain and maximal mouth opening (MMO). Twelve RCTs were included. Pooled analysis showed that pain scores were significantly reduced with the use of PRP/PRF as compared with control at one month (MD: -0.96 95% CI: -1.58 to -0.35 I = 86%), three months (MD: -1.22 95% CI: -1.86 to -0.59 I = 85%), and ≥six months (MD: -1.61 95% CI: -2.22 to -1.00 I = 88%). Similarly, MMO was significantly improved in the PRP/PRF group at one month (MD: 2.40 95% CI: 1.02 to 3.77 I = 88%), three months (MD: 3.17 95% CI: 1.63 to 4.72 I = 91%), and ≥six months (MD: 2.98 95% CI: 1.86 to 4.10 I = 75%) as compared with the control group. Subgroup analysis for PRP and PRF failed to show any difference in outcomes. Moderate quality evidence suggests that PRP and PRF may significantly improve pain and MMO when used as adjuncts to TMJ arthrocentesis. Due to the small effect size, the clinical significance of the results is questionable. The high heterogeneity in PRP/PRF preparation methods is a significant limitation.