Arthroscopic Discopexy Techniques for Articular Disc Displacement: A Systematic Review and Meta-Analysis.

Abstract

<b>Background/Objectives</b>: Anterior disc displacement (ADD) is a common temporomandibular joint (TMJ) disorder and may progress to internal derangements. Although arthroscopic discopexy (minimally invasive disc repositioning with fixation) has been adopted, suggested techniques and pooled outcomes have not been comprehensively synthesized. The aim of the present study was to summarize the effectiveness of arthroscopic discopexy in treating patients with disc-related TMJ disorders. <b>Methods</b>: This systematic review and meta-analysis followed Cochrane guidance and PRISMA 2020 protocol. Four databases were searched through 1 September 2025. A total of 26 studies were included in this review. Nine studies met the eligibility criteria for meta-analysis and were pooled. The remaining 17 studies were narratively described, focusing on surgical characteristics. Continuous outcomes (MIO, pain score (VAS 0-10)) were pooled as mean differences (MD) with 95% confidence intervals (CIs), and joint sounds were synthesized as dichotomous outcomes. Analyses and heterogeneity were performed in RevMan 5.4. Certainty was graded with GRADE. (PROSPERO: CRD420251145229). <b>Results</b>: 1086 TMJs were analyzed. Arthroscopic discopexy significantly improved MIO, pain, and joint sounds at all time points. The MD of MIO was 10.58 mm (95% CI: 4.46 to 16.70; <i>p</i> ≤ 0.001), 9.83 mm (95% CI: 4.09 to 15.57; <i>p</i> ≤ 0.001), and 13.06 mm (95% CI: 4.40 to 21.72; <i>p</i> ≤ 0.001), respectively. The MD of the pain score was -4.36 (95% CI: -6.89 to -1.82; <i>p</i> ≤ 0.001), -3.91 (95% CI: -6.23 to -1.59; <i>p</i> ≤ 0.001), and -4.56 (95% CI: -7.81 to -1.31; <i>p</i> < 0.01), respectively. At 12 months, joint sounds were less frequent than preoperatively (OR = 0.07; 95% CI: 0.01 to 0.37; <i>p</i> < 0.01). Overall, the certainty of evidence according to the GRADE approach was rated as low. Therefore, the results should be interpreted with caution, as high heterogeneity was observed across the three follow-up time points and the included studies were observational. <b>Conclusions</b>: These findings underscore the significance of arthroscopic discopexy in enhancing TMJ function and alleviating symptoms. Current evidence, characterized by a low risk of bias and low certainty, supports the advantage of arthroscopic discopexy. Due to the observational evidence base and heterogeneity, high-quality randomized trials conducted under standardized treatment protocols and with longer follow-up are needed.