Abstract
Background: Magnetic resonance imaging (MRI) is widely regarded as the gold standard for diagnosing internal derangement; however, its accuracy in detecting disc perforations varies. Objectives: 1) Identify MRI features correlating with disc perforation, 2) identify preoperative variables correlating with disc perforation, and 3) develop a predictive model to ascertain the presence of disc perforation.
Materials and Methods: This cohort study involved 92 patients who underwent arthroscopic surgery to identify associated variables. Arthroscopically verified disc perforation was considered the primary predictor variable, while MRI interpretation of disc perforation served as the primary outcome variable. Demographic data, patient signs, and symptoms were treated as covariates. Statistical analyses were conducted at a significance level of 5%. Logistic regression models were mployed to predict disc perforation and diagnostic accuracy was assessed using receiver operating characteristic curves.
Results: Among the 155 joints analyzed (92 patients: 135 females, 20 males), MRI interpretations did not significantly correlate with verified disc perforation (p < 0.218), demonstrating 14.3% sensitivity and 92.5% specificity. Age, symptomatic onset, joint noise type, osteoarthritis diagnosis, altered disc shape, and Wilkes classification exhibited significant associations (p < 0.05). A logistic regression model utilized associated variables for predicting disc perforation. Risk factors included symptom onset time, joint crepitus, and osteoarthrosis diagnosis by MRI; joint click was considered protective.
Conclusion: The model demonstrated high diagnostic accuracy (area under the curve of 0.836, 95% CI 0.76–0.91). While MRI interpretation was unreliable, our model accurately predicted disc perforation. Identification of these factors could inform surgical decisions.

Key words: TMJ surgery, TMJ arthroscopic surgery, disc perforation, discectomy