Platelet-Rich Plasma Versus Corticosteroid Injection as Treatment for Degenerative Pathology of the Temporomandibular Joint

1.0 BACKGROUND AND HYPOTHESES

1.1 Osteoarthritis is a continuous and entirely physiologic adaptive process that occurs in
every joint. These include the replication of cells that produce matrix, enzymes, protease
inhibitors, cytokines, and other peptides. Along with the synthesis of new tissue there is
a release of breakdown products into the synovial fluid. Enzymes and phagocytes are
required to clear these breakdown products. Normal tissue turnover involves synthesis and
breakdown in well-regulated balance. In the degenerative state this balance is upset
producing inflammation-derived alterations to the synovium, cartilage, capsule, tendons, and
bone. Common causes of such alterations include increased loading, physical stress, and
traumatic injury to the joint.

1.2 The rationale for the use of corticosteroids in temporomandibular joint therapy is that
they inhibit prostaglandin synthesis and decrease the activity of collagenase and other
enzymes that degrade the articular cartilage. Platelet rich plasma is a novel therapeutic
agent that has several potential advantages over corticosteroids for the treatment of
degenerative pathology of the temporomandibular joint. Platelet rich plasma has been shown
to have anti-inflammatory, analgesic, and anti-bacterial properties. It also restores
intra-articular hyaluronic acid, increases glycosaminoglycan condrocyte synthesis, balances
joint angiogenesis, and provides a scaffold for stem cell migration. Autologous platelet
rich plasma injections for treatment of knee cartilage degenerative lesions and
osteoarthritis have shown longer efficacy than hyaluronic acid injections in reducing pain
and recovering articular function. Similarly, platelet rich plasma has shown to have better
outcomes than corticosteroid injections in the management of lateral epicondylitis, and
better outcomes than hyaluronic acid injections in the management of osteochondral lesions
of the talus.

1.3 Current treatments for degeneration and osteoarthritis of the temporomandibular joint
are focused primarily on palliation by reducing inflammation and inflammatory mediators.
This study seeks to validate a therapeutic agent that has the potential to actively prevent
the progression of degeneration in addition to reducing pain and inflammation