The term internal derangement was first adopted to describe any pathologic entity that interfered with the smooth function of the temporomandibular joint (TMJ). The term is currently used exclusively to describe alterations in disc-fossa relations. Internal derangement of the TMJ does not always cause pain, although when the disc becomes displaced, noises and locking can occur and ligamentous, capsular or retrodiscal pain may dominate the clinical picture. Meniscopexy of TMJ was done in ten patients where clinical features suggest true internal derangement of the TMJ refractory to conservative treatment with restricted movement and pain identified as arising primarily from the joint. Magnetic resonance imaging was done to identify the cause of problem.