Clinical Trials Logo

Clinical Trial Details — Status: Recruiting

Administrative data

NCT number NCT05658289
Other study ID # LatarjetAGR
Secondary ID
Status Recruiting
Phase N/A
First received
Last updated
Start date April 24, 2023
Est. completion date January 2026

Study information

Verified date April 2023
Source Nova Scotia Health Authority
Contact Ivan Wong, MD
Phone 9024737626
Email research@drivanwong.com
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

Anterior shoulder dislocations occur when the humeral head translates anterior to the glenoid cause pain, stiffness, and glenoid bone loss. If left untreated, the risk of recurrence can be up to or greater than 90%. The only surgically modifiable factor to reduce the risk of recurrence is the glenoid bone loss (GBL), where surgeons have the ability to recreate the shape of the glenoid and reduce the risk of recurrent shoulder dislocations. Established boney procedures for shoulder instability include the Latarjet and free bone block procedures, such as the Anatomic Glenoid Reconstruction (AGR). The Latarjet is well known for its lower rate of recurrent instability, but raises concerns due to under-appreciated complications rates. The AGR is a newer surgical approach that has garnered attention for its low rate of recurrent instability and complication profile. Both treatments can reduce pain, increase function following surgery and reduce the risk of recurrent instability. However, these two established approaches have yet to be directly compared and studied on a larger scale. The purpose of this randomized control trial is to compare clinical and radiographic outcomes pre- and post-operatively between the Latarjet to the AGR.


Description:

Anterior shoulder dislocations are painful and highly prevalent. If left untreated, rates of recurrence can be up to and greater than 90%. The risk of recurrence room is increased with younger age (< 40), male sex, hyperlaxity, participation in contact sports, and GBL. From these factors, GBL is the only modifiable factor and surgical intervention is required. Managing the bone deficiency for instances of shoulder instability has proven to be a surgical challenge. Established boney procedures for shoulder instability include the open and arthroscopic Latarjet and open and arthroscopic free bone block interventions. Latarjet is considered the gold standard for treating anterior shoulder instability with bone loss, where the coracoid process is cut and transferred with the conjoin tendon through the subscapularis. The coracoid process is then fixed to the anterior glenoid increasing glenohumeral surface area and stability by the addition of the sling effect. Latarjet has proven to result in low recurrent instability but raises concerns due to underappreciated complication rates (15-30%). The arthroscopic glenoid reconstruction (AGR) with distal tibia allograft is an arthroscopic bone block procedure that has recently garnered attention for its low rate of recurrent instability and complications, high levels of patient satisfaction and avoidance of splitting the subscapularis tendon. AGR with a distal tibia uses a new far medial portal, (i.e., Halifax portal) to avoid damaging the neurovascular or musculature while allowing for anatomic repair of the glenoid. This randomized control trial will compare the gold standard Latarjet to the AGR. This study aims to randomize 68 individuals who experience anterior shoulder instability with GBL. Through a series of clinical and radiographic outcome measures, the study investigators hypothesize the AGR group will demonstrate smaller complication rates, but remain a similar post-operative recurrence rate, and patient reported outcomes. This trial will be the first multi-centre control trial evaluating the Latarjet to the AGR for patients with critical bone loss (>20%). This research has the potential to demonstrate clinical efficacy of a procedure that is safer, more anatomic, with less damage to the subscapular muscle, and an easier revision surgery.


Recruitment information / eligibility

Status Recruiting
Enrollment 68
Est. completion date January 2026
Est. primary completion date December 2023
Accepts healthy volunteers Accepts Healthy Volunteers
Gender All
Age group 16 Years to 40 Years
Eligibility Inclusion Criteria: - Patients with one or more instances of anterior shoulder dislocation; pre-operative CT scan illustrating >20% bone loss. Exclusion Criteria: - posterior shoulder instability; multidirectional shoulder instability; massive rotator cuff teats (MRI proven); history of substance abuse, patients unable to provide informed consent, patients refusing randomization.

Study Design


Related Conditions & MeSH terms


Intervention

Procedure:
Coracoid Transfer
For patients randomized to the active comparator group, the coracoid process and conjoined tendon will be cut and transferred to the anterior rim of the glenoid through an incision in the subscapularis muscle.
Distal Tibia Allograft with Bankart repair
For the experimental group, a distal tibia allograft will be prepped, cut (20mm x 10mm x 15mm), and inserted into the anterior aspect of the shoulder through a far medial portal. The distal tibia allograft will be attached to the anterior glenoid using cannulated screws. A soft tissue repair, Bankart repair, is performed above the graft.

Locations

Country Name City State
Canada Nova Scotia Health QEII Halifax Infirmary Halifax Nova Scotia

Sponsors (1)

Lead Sponsor Collaborator
Nova Scotia Health Authority

Country where clinical trial is conducted

Canada, 

Outcome

Type Measure Description Time frame Safety issue
Primary Complication reporting Complications reported any time from surgery to post-surgery will be compared. 2 years
Secondary Recurrent Instability The rate of recurrent instability, dislocation and/or subluxation will be compared up until 2 years following surgery. 2 years
Secondary American Shoulder and Elbow Surgeon (ASES) Assessment Form Pain and function questionnaire for patients with shoulder injury. The scores will be out of 100, and a higher score equates to a better score. 1 and 2 years
Secondary Western Ontario Shoulder Instability (WOSI) Index Physical symptoms, emotions, and lifestyle questionnaire specific to patients with shoulder instability. The scores will be out of 100 and a lower score equates to a better outcome. 1 and 2 years
Secondary EQ5D-5L Includes 5 questions on mobility, self care, pain, usual activities and psychological status, a summary index is used to derive the outcomes, where a score of 1 indicates the best health. This questionnaire includes a visual analog scale, to indicate overall health out of 100. A score of 100 indicates the best health. 1 and 2 years
Secondary Radiographic measure - subscapularis muscle volume Subscapularis muscle volume will be measured radiographically before and after surgery in millilitres. 1 year
Secondary Radiographic measure - graft resorption Radiographic analysis of the amount of resorption seen by the graft will be analyzed. This will be measured as a percentage of the original graft size. 1 year
Secondary Radiographic measure - glenoid size This will be the graft size before and after insertion of the graft measured in millimetres. 1 year
See also
  Status Clinical Trial Phase
Completed NCT04043286 - The Effects of Dis/Reconnection of Implant Abutments on Peri-implant Bone Levels N/A
Recruiting NCT03046147 - The Effect of Roux-en-Y Gastric Bypass on Bone Turnover N/A
Completed NCT01292395 - Effects of Dietary Protein on Musculoskeletal Health During Calorie Deficiency N/A
Completed NCT00485953 - Effect of Bisphosphonate on Bone Loss in Postmenopausal Women With Breast Cancer Initiating Aromatase Inhibitor Therapy Phase 4
Completed NCT00674453 - The Prevention Of Postmenopausal Osteoporosis With Lasofoxifene And Cytokine Evaluation Phase 2
Completed NCT00181584 - Zoledronic Acid to Prevent Bone Loss During Androgen Deprivation Therapy for Prostate Cancer Phase 2
Withdrawn NCT04380155 - Cycling Duration and Bone Markers in in Active Young Adults N/A
Active, not recruiting NCT04779216 - Effects of Romosozumab on Bone Density in Women With Anorexia Nervosa Phase 3
Completed NCT05371418 - Comparative Clinical and Radiographical Evaluation of Treatment of Angular Bone Defect Related to Over Erupted Tooth Using GTR Followed by Orthodontic Intrusion Versus Orthodontic Intrusion Followed by GTR N/A
Not yet recruiting NCT04345250 - Bone Response to Exercise and Energy Restriction in Young Adults N/A
Active, not recruiting NCT05405894 - Efficacy of Zoledronic Acid to Prevent Bone Loss Following Denosumab Discontinuation
Active, not recruiting NCT05301400 - Marginal Bone Loss in Single Implant Restaurations With Different Methods N/A
Recruiting NCT04983758 - 20-year Implant Survival in Periodontally Healthy and Compromised Patients
Recruiting NCT04713774 - Bone Density and Vascular Calcifications Evolution After Renal Transplant
Completed NCT04279392 - Healthy Body, Healthy Bones After Bariatric Surgery Trial Phase 1/Phase 2
Completed NCT04332679 - Non-resorbable Membranes Versus Titanium Meshes and Resorbable Membranes N/A
Completed NCT05721014 - Effects of OsteoStrong vs. Individually Adapted and Combined Training on Bone Health N/A
Recruiting NCT04883502 - Study of the Role of the Induced Membrane in the Reconstruction of Bone Loss in the Limbs
Not yet recruiting NCT05066815 - Evaluation of Crestal Bone Loss Around Short Dental Implants As Affected By Two Suprastructure Materials N/A
Completed NCT03292146 - Effects of Denosumab on Bone Mineral Density in Women With Anorexia Nervosa: A Pilot Study Phase 3