Prophylactic Conjoint Tendon Lengthening During Reverse Shoulder Arthroplasty Outcomes
NCT ID: NCT06729983
Last Updated: 2025-03-07
Study Results
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Basic Information
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RECRUITING
NA
110 participants
INTERVENTIONAL
2025-03-31
2029-03-31
Brief Summary
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Detailed Description
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However, some patients may experience persistent anterior shoulder pain after RSA, which can limit their function and quality of life. The exact cause and prevalence of this complication are not well understood, but several possible mechanisms have been proposed, such as impingement, instability, infection, nerve injury, fracture, scapular notching, and conjoint tendinitis.
Conjoint tendinitis is a condition where the tendon that connects the coracoid process to the upper arm bone, called the conjoint tendon, becomes inflamed and painful. The conjoint tendon is part of the biceps muscle and the coracobrachialis muscle, and it plays a role in shoulder flexion and internal rotation. Conjoint tendinitis may occur after RSA due to the increased tension and compression on the anterior shoulder caused by the shift in the center of rotation of the joint. Conjoint tendinitis may manifest as anterior shoulder pain, tenderness over the coracoid process, and decreased range of motion and strength.
Conjoint tendon lengthening (CTL) is a surgical procedure that involves cutting or lengthening the conjoint tendon, which may relieve the pain by reducing the tension and compression on the anterior shoulder. CTL can be performed as a primary procedure during RSA, or as a secondary procedure after RSA. The rationale for performing CTL as a primary procedure is to prevent the development of conjoint tendinitis and anterior shoulder pain after RSA. The rationale for performing CTL as a secondary procedure is to treat the patients who have failed conservative treatments, such as physical therapy, injections, or medications, and have persistent anterior shoulder pain after RSA.
The literature on CTL for anterior shoulder pain after RSA is scarce and mostly consists of case reports and case series. There is no randomized controlled trial or systematic review on this topic. The existing studies have reported favorable results of CTL, with improvement in pain, function, and patient-reported outcomes. However, the studies have also acknowledged the limitations of their methods, such as small sample size, lack of control group, short follow-up, and potential bias. Therefore, the evidence for the effectiveness of CTL for anterior shoulder pain after RSA is weak and inconclusive.
The gap or problem that this research aims to address is the lack of high-quality evidence on the effectiveness of prophylactic CTL during RSA for preventing or reducing anterior shoulder pain at one year after surgery. The investigators hypothesize that patients who undergo prophylactic CTL during RSA will have less anterior shoulder pain at one year after surgery than those who do not. The investigators will test this hypothesis by conducting a randomized controlled trial with two groups: CTL group and control group. The investigators will compare the pain intensity, range of motion, strength, activity level, and patient-reported outcomes of the two groups at 6 months and 12 months after RSA. The investigators will also identify the factors that predict the response to CTL, such as age, gender, body mass index, comorbidities, duration of pain, and severity of arthritis. This research will contribute to the knowledge in the field of shoulder surgery by providing high-quality evidence on the effectiveness of prophylactic CTL during RSA for anterior shoulder pain. This research will also have practical implications for the field of shoulder surgery by providing a viable option for patients who suffer from anterior shoulder pain after RSA, and enhancing their function and quality of life.
Conditions
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Study Design
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RANDOMIZED
PARALLEL
TREATMENT
SINGLE
Study Groups
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Control
Standard reverse shoulder arthroplasty
Standard Reverse Shoulder Arthroplasty
A standard reverse shoulder arthroplasty procedure will be performed
Treatment
Prophylactic conjoint tendon lengthening in addition to reverse shoulder arthroplasty
Prophylactic Conjoint Tendon Lengthening
During a standard reverse shoulder arthroplasty procedure, the conjoint tendon will be incised and lengthened prophylactically
Interventions
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Prophylactic Conjoint Tendon Lengthening
During a standard reverse shoulder arthroplasty procedure, the conjoint tendon will be incised and lengthened prophylactically
Standard Reverse Shoulder Arthroplasty
A standard reverse shoulder arthroplasty procedure will be performed
Eligibility Criteria
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Inclusion Criteria
* Operations that occur at Loyola University Medical Center (Maywood, IL), Loyola Ambulatory Surgery Center (Maywood, IL), or Gottlieb Memorial Hospital
Exclusion Criteria
* Patients who had prior coracoid transfer procedure
* Patients who are undergoing revision surgery from a prior arthroplasty
* Current pregnancy As per standard protocol with all surgeries, a urine pregnancy test is performed prior to surgery. If positive, the surgery will be cancelled and the patient will be excluded from the research study.
18 Years
ALL
No
Sponsors
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Loyola University School of Medicine
UNKNOWN
Nickolas Garbis
OTHER
Responsible Party
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Nickolas Garbis
Chief of Shoulder/Elbow Division
Principal Investigators
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Nickolas G Garbis, MD
Role: PRINCIPAL_INVESTIGATOR
Loyola University
Locations
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Loyola Outpatient Center
Maywood, Illinois, United States
Countries
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Central Contacts
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Facility Contacts
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References
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Werner BC, Chang B, Nguyen JT, Dines DM, Gulotta LV. What Change in American Shoulder and Elbow Surgeons Score Represents a Clinically Important Change After Shoulder Arthroplasty? Clin Orthop Relat Res. 2016 Dec;474(12):2672-2681. doi: 10.1007/s11999-016-4968-z. Epub 2016 Jul 8.
Vij N, Tummala S, Shahriary E, Tokish J, Martin S. Total Shoulder Arthroplasty Versus Reverse Shoulder Arthroplasty in Primary Glenohumeral Osteoarthritis With Intact Rotator Cuffs: A Meta-Analyses. Cureus. 2024 Apr 8;16(4):e57866. doi: 10.7759/cureus.57866. eCollection 2024 Apr.
Gomez GV, Huffman GR. Conjoint tendon lengthening for recalcitrant anterior shoulder pain after reverse shoulder arthroplasty: a technique article. JSES Rev Rep Tech. 2022 Jan 13;2(2):164-167. doi: 10.1016/j.xrrt.2021.12.005. eCollection 2022 May.
Tashjian RZ, Frandsen JJ, Christensen GV, Chalmers PN. Conjoint tendon release for persistent anterior shoulder pain following reverse total shoulder arthroplasty. JSES Int. 2020 Jul 31;4(4):975-978. doi: 10.1016/j.jseint.2020.07.005. eCollection 2020 Dec.
Boileau P, Melis B, Duperron D, Moineau G, Rumian AP, Han Y. Revision surgery of reverse shoulder arthroplasty. J Shoulder Elbow Surg. 2013 Oct;22(10):1359-70. doi: 10.1016/j.jse.2013.02.004. Epub 2013 May 22.
Black EM, Roberts SM, Siegel E, Yannopoulos P, Higgins LD, Warner JJ. Failure after reverse total shoulder arthroplasty: what is the success of component revision? J Shoulder Elbow Surg. 2015 Dec;24(12):1908-14. doi: 10.1016/j.jse.2015.05.029. Epub 2015 Jul 7.
Anakwenze OA, Kancherla VK, Carolan GF, Abboud J. Coracoid fracture after reverse total shoulder arthroplasty: a report of 2 cases. Am J Orthop (Belle Mead NJ). 2015 Nov;44(11):E469-72.
Schwartz DG, Kang SH, Lynch TS, Edwards S, Nuber G, Zhang LQ, Saltzman M. The anterior deltoid's importance in reverse shoulder arthroplasty: a cadaveric biomechanical study. J Shoulder Elbow Surg. 2013 Mar;22(3):357-64. doi: 10.1016/j.jse.2012.02.002. Epub 2012 May 19.
Schairer WW, Nwachukwu BU, Lyman S, Craig EV, Gulotta LV. National utilization of reverse total shoulder arthroplasty in the United States. J Shoulder Elbow Surg. 2015 Jan;24(1):91-7. doi: 10.1016/j.jse.2014.08.026. Epub 2014 Oct 29.
Kim SH, Wise BL, Zhang Y, Szabo RM. Increasing incidence of shoulder arthroplasty in the United States. J Bone Joint Surg Am. 2011 Dec 21;93(24):2249-54. doi: 10.2106/JBJS.J.01994.
Grammont PM, Baulot E. The classic: Delta shoulder prosthesis for rotator cuff rupture. 1993. Clin Orthop Relat Res. 2011 Sep;469(9):2424. doi: 10.1007/s11999-011-1960-5. No abstract available.
Drake GN, O'Connor DP, Edwards TB. Indications for reverse total shoulder arthroplasty in rotator cuff disease. Clin Orthop Relat Res. 2010 Jun;468(6):1526-33. doi: 10.1007/s11999-009-1188-9.
Other Identifiers
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218607
Identifier Type: -
Identifier Source: org_study_id
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