Platelet-Rich Plasma vs Corticosteroid Injection as Treatment for Degenerative Pathology of the Temporomandibular Joint
Status:
Withdrawn
Trial end date:
1969-12-31
Target enrollment:
Participant gender:
Summary
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