Massive Rotator Cuff Tear Reconstruction

NCT ID: NCT03425500

Last Updated: 2023-08-29

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

60 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-05-01

Study Completion Date

2025-08-31

Brief Summary

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To compare bridging reconstruction to superior capsular reconstruction using human dermal allograft augmentation for repair of massive rotator cuff tears.

Detailed Description

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A total of 60 patients will be enrolled in the study. In the pre-operative period, there will be no additional time requirements for the patient, except for the informed consent process for the study. Routine radiographs including an AP and Y view of the shoulder as well as a pre-operative MRI are obtained for all patients undergoing rotator cuff surgery.

The patients will complete a structured clinical examination conducted by a sports medicine fellowship trained orthopaedic consultant. The examination will consist of range of motion testing by goniometer as well as strength testing by hand dynamometer. The patient will also complete the WORC questionnaire.

Surgical Technique

All patients will undergo a 15-point arthroscopic shoulder examination as per the method outlined by Snyder. An arthroscopic acromioplasty will be performed if needed according to the technique described by Snyder. The bursal side of the tear will be evaluated. If the cuff can be re-approximated to its anatomic position on the greater tuberosity without excessive tension, a standard rotator cuff reconstruction will be attempted. If this is not possible the surgeon will determine that the cuff is "irreparable" and the randomization envelope will be opened.

Wong et al. described the surgical procedure for patients in the "Bridging" group. The bursa will be debrided thoroughly and rotator cuff edges will be shaved down to stable tissue. Following this, an acellular human dermal patch will be rehydrated in saline solution for 15 minutes. The patch is stretched to remove the manufacturing surface irregularities. The patch is then sewn in place with braided polyester suture material. Multiple sutures, approximately 5 to 10 mm apart from one another will be used. The medial sutures are placed into the remnants of supraspinatus and infraspinatus tendons. The patch is then attached to the greater tuberosity in a double row configuration.

The technique described by Burkhart et al will be followed for patients in the "SCR" group. The bursa will be debrided thoroughly and rotator cuff edges will be shaved down to stable tissue. Following this, an acellular human dermal patch will be rehydrated in saline solution for 15 minutes. The patch is stretched to remove the manufacturing surface irregularities. Measurement of defect size (coronal and sagittal) will take place, following that the glenoid and humeral footprint preparation will be performed utilizing an arthroscopic burr, arthroscopic bone anchors will be inserted on the glenoid footprint and graft is inserted with double pully technique. The graft is then tensioned to greater tuberosity using a double row configuration.

Postoperative protocol

The shoulder will be immobilized in a sling for one week postoperatively, and only passive forward flexion and external rotation will be allowed for eight weeks. The patient then progresses to active shoulder motion. Strengthening will begin at twelve weeks postoperatively.

The patient will follow-up with the attending surgeon (IW) at 2 weeks post-operatively for a wound check. Then further follow-up appointments will be at 6 weeks, 3 months, 6 months, 12 and 24 months, as per current clinical practice.

At the 3, 6, 12, and 24 month visits the patient will again undergo the structured clinical examination conducted by a sports medicine fellowship trained orthopaedic consultant who is blinded to the patients' treatment group. The patient will also complete the (WORC) questionnaire at these follow-up appointments. Radiograph will be taken also to obtain the postoperative measurements. MRI will be done to assess healing at 12 months.

Conditions

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Rotator Cuff Tear Arthropathy

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Randomized Control Trial
Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Outcome Assessors

Study Groups

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Bridging Rotator Cuff Group

Bridging Rotator Cuff Reconstruction of massive rotator cuff tear using GRAFTJACKET™ allograft.

Group Type EXPERIMENTAL

Bridging Rotator Cuff Reconstruction

Intervention Type PROCEDURE

Bridging Rotator Cuff Reconstruction of massive rotator cuff tear using a GRAFTJACKET™ allograft

GRAFTJACKET™ allograft

Intervention Type DEVICE

The acellular human dermal allograft in used in the bridging rotator cuff reconstruction

Superior Capsular Group

Superior Capsular Reconstruction of massive rotator cuff tear

Group Type ACTIVE_COMPARATOR

Superior Capsular Reconstruction

Intervention Type PROCEDURE

Superior Capsular Reconstruction of massive rotator cuff tear

Interventions

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Bridging Rotator Cuff Reconstruction

Bridging Rotator Cuff Reconstruction of massive rotator cuff tear using a GRAFTJACKET™ allograft

Intervention Type PROCEDURE

Superior Capsular Reconstruction

Superior Capsular Reconstruction of massive rotator cuff tear

Intervention Type PROCEDURE

GRAFTJACKET™ allograft

The acellular human dermal allograft in used in the bridging rotator cuff reconstruction

Intervention Type DEVICE

Other Intervention Names

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Acellular human dermal allograft

Eligibility Criteria

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Inclusion Criteria

* Magnetic resonance imaging (MRI) proven diagnosis of a large or massive (\>3cm), two-tendon (supraspinatus and infraspinatus) tear of the shoulder rotator cuff

Exclusion Criteria

* Presence of subscapular tear
* Presence of glenohumeral osteoarthritis
* WORC score \> 70%
* Uncontrolled diabetes
* Pregnancy
* Presence of local or systemic infection
* Paralysis of the shoulder
* Poor nutritional state
* Contracture of the shoulder
* Presence of cuff tear arthropathy
* MRI proven nonvascular surgical sites
* Cancer
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Nova Scotia Health Authority

OTHER

Sponsor Role lead

Responsible Party

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Ivan Wong

Orthopaedic Surgeon MD FRCS(C), Dip. Sports Medicine

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Ivan H Wong, MD

Role: PRINCIPAL_INVESTIGATOR

Nova Scotia Health Authority

Locations

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Nova Scotia Health Authority

Halifax, Nova Scotia, Canada

Site Status

Countries

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Canada

Other Identifiers

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IW-002

Identifier Type: -

Identifier Source: org_study_id

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