Objectives To determine the effects of hyaluronic acid (HA) as an adjunct to temporomandibular joint (TMJ) arthroscopy, relative to standard TMJ arthroscopy, in Wilkes stage‐III and stage‐IV patients. Methods A randomized clinical trial design was utilized (ClinicalTrials.gov NCT04110587). 51 patients were allocated to a TMJ arthroscopy (n = 25) or a TMJ arthroscopy plus HA (n = 26) group. Visual analog scale joint pain scores, maximum mouth opening (MMO), and muscle pain were measured at baseline, and at 3, 6, 9, and 12 months. Disk position on magnetic resonance imaging was evaluated at baseline and 12 months. Oral health‐related quality of life (OHRQoL) was assessed at baseline, and at 6 and 12 months. Results No group differences were observed in clinical or radiographic measurements (p ≥ .05). The results do not indicate any benefit of HA as an adjuvant therapy to arthroscopy during follow‐up months 3–12. TMJ arthroscopy improved OHRQoL at 6 and 12 months (Oral Health Impact Profile‐14 questionnaire scores of −14.59 and −14.27, 95% confidence intervals = −17.55 to −11.63 and −17.27 to −11.27) respectively, as well as pain and MMO, at all follow‐up time points (p < .001). Conclusions A beneficial effect of HA injection during TMJ arthroscopy after the 3‐month follow‐up was not observed.

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