An Adapted Single-Needle Arthrocentesis Technique for the Temporomandibular Joint to Enhance Circuit Stability and Enable Synovial Fluid Sampling

Abstract

Background: Temporomandibular joint (TMJ) arthrocentesis is an effective procedure for lysis and lavage of the joint, typically performed using either double-puncture (DPA) or single-puncture arthrocentesis (SPA) techniques. The SPA technique described by Guarda-Nardini et al. has become one of the most studied and widely used approaches due to its procedural simplicity and reduced trauma. Objective: To describe an adaptation of the single-puncture arthrocentesis technique that enhances circuit stability and enables integrated synovial fluid sampling by relying on intra-articular pressure generation. Technique: This adaptation uses intra-articular pressure-driven fluid dynamics to maintain consistent lavage with minimal needle repositioning and reduced patient involvement. A straightforward push-and-pull protocol enables macroscopic analysis and semi-qualitative biomarker detection (presence/absence). The technique retains the original benefits of reduced trauma, lower anesthesia requirements, and procedural efficiency while adding diagnostic potential. Conclusion: This adaptation enhances single-puncture TMJ arthrocentesis by enabling synovial fluid sampling while maintaining procedural advantages. Further validation is recommended to assess efficacy across different anatomical variants and clinical conditions.