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Clinical Trial Details — Status: Completed

Administrative data

NCT number NCT00128076
Other study ID # MCT-82335
Secondary ID
Status Completed
Phase Phase 3
First received August 5, 2005
Last updated May 26, 2016
Start date August 2006
Est. completion date December 2015

Study information

Verified date May 2016
Source McMaster University
Contact n/a
Is FDA regulated No
Health authority Canada: Health Canada
Study type Interventional

Clinical Trial Summary

This study will compare two different surgical techniques for repairing a tear in the muscles of the shoulder (rotator cuff). The investigators will determine whether an arthroscopic or mini-open technique provides better quality of life and repair integrity.


Description:

Background:

Rotator cuff tears are the most common source of shoulder pain and disability. Only poor quality studies have compared mini-open to arthroscopic repair, leaving surgeons with inadequate evidence to support optimal, minimally-invasive repair.

Methods/Design:

This randomized, multi-centre, national trial will determine whether an arthroscopic or mini-open repair provides better quality of life for patients with small or moderate sized rotator cuff tears. A national consensus meeting of investigators in Joints Orthopaedic Initiative for Shoulder Trials (JOINTS) identified this question as the top priority for shoulder surgeons across Canada. The primary outcome measure is a valid quality-of-life scale (Western Ontario Rotator Cuff (WORC) that addresses 5 domains of health affected by rotator cuff disease. Secondary outcomes will assess rotator cuff functionality (ROM, strength, constant score), secondary dimensions of health (general health status (SF-12) and work limitations) and repair integrity (MRI). Outcomes are measured at baseline, at 6 weeks, 3, 6, 12 and 24 months postoperatively by blinded research assistants and musculoskeletal radiologists. Patients (n=250) with small or medium-sized cuff tears identified by clinical examination and MRI who meet eligibility criteria will be recruited. This sample size will provide 80% power to detect (statistically) a clinically important difference of 20% in WORC scores between procedures after controlling for baseline WORC score ("=0.05). A central methods centre will manage randomization, data management and monitoring under supervision of experienced epidemiologists. Surgeons will participate in either conventional or expertise-based designs according to defined criteria, to avoid biases from differential surgeon expertise. Mini-open or all-arthroscopic repair procedures, will be performed according to a standardized protocol. Central Adjudication (of cases), Trial Oversight and Safety Committees will monitor trial conduct. The investigators will use an analysis of covariance (ANCOVA), where the baseline WORC score is used as a covariate, to compare the quality of life (WORC score) at 2-years post-operatively. As a secondary analysis the investigators will conduct the same statistical test but will include age and tear size as covariates with the baseline score. Enrollment will require 2 years and follow-up an additional 2-years.


Recruitment information / eligibility

Status Completed
Enrollment 275
Est. completion date December 2015
Est. primary completion date August 2014
Accepts healthy volunteers No
Gender Both
Age group 18 Years to 75 Years
Eligibility Inclusion Criteria:

- The investigators will recruit patients with small or medium rotator cuff tears as determined by clinical examination and diagnostic imaging (magnetic resonance imaging [MRI]) prior to surgery.

- The full-thickness rotator cuff tears of supraspinatus and infraspinatus will be classified into 2 categories based on area of longest dimension.

- SMALL= 0-1 cm;

- MODERATE =1-3 cm.

- Definitive measurement of tear size will be made in surgery and used as a covariate in analysis. (JOINTS measurement protocol will be used)

Exclusion Criteria:

Pre-Operative Exclusion Criteria

- Evidence of major joint trauma, infection, avascular necrosis, chronic dislocation, inflammatory or degenerative glenohumeral arthropathy, frozen shoulder or previous surgery of the affected shoulder,

- Evidence of significant cuff arthropathy with superior humeral translation and acromial erosion diagnosed by x-ray or other investigations,

- Major medical illness (life expectancy less then 2 years or unacceptably high operative risk),

- Unable to speak or read English,

- Psychiatric illness that precludes informed consent,

- Unwilling to be followed for 2 years.

Intra-Operative Exclusion Criteria

- Large, massive or irreparable cuff tears, extending into the subscapularis or teres minor, which cannot be mobilized to the articular margin or repaired using one or both of the techniques (all arthroscopic or mini-open),

- Teres minor or subscapularis tears,

- Inelastic and immobile tendon, which cannot be advanced to articular margin,

- Co-existing labral pathologies requiring repair with sutures (superior labral anterior posterior [SLAP] II-IV), Bankart lesions requiring repair, partial tears of biceps (more than 60% of thickness) requiring tenodesis or release.

Study Design

Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Outcomes Assessor), Primary Purpose: Treatment


Related Conditions & MeSH terms


Intervention

Procedure:
All-Arthroscopic repair
joint techniques and repair are both performed entirely through the arthroscope
Mini-open repair
repair is performed though a small incision and the arthroscope can be used to address problems within the joint (as per traditional diagnostic procedures)

Locations

Country Name City State
Canada University of Calgary Sport Medicine Centre Calgary Alberta
Canada Walter Mackenzie Centre Edmonton Alberta
Canada St. Joseph's Healthcare Hamilton Hamilton Ontario
Canada Kingston General Hospital Kingston Ontario
Canada Fowler Kennedy Sports Medicine Clinic London Ontario
Canada St. Joseph's Health Care London London Ontario
Canada Royal Columbian Hospital New Westminster British Columbia
Canada Orthopaedic and Arthritic Hospital Toronto Ontario
Canada PanAm Clinic Winnipeg Manitoba

Sponsors (3)

Lead Sponsor Collaborator
McMaster University Canadian Institutes of Health Research (CIHR), The Physicians' Services Incorporated Foundation

Country where clinical trial is conducted

Canada, 

References & Publications (1)

MacDermid JC, Holtby R, Razmjou H, Bryant D; JOINTS Canada. All-arthroscopic versus mini-open repair of small or moderate-sized rotator cuff tears: a protocol for a randomized trial [NCT00128076]. BMC Musculoskelet Disord. 2006 Mar 10;7:25. — View Citation

Outcome

Type Measure Description Time frame Safety issue
Primary Quality of life measure specific to rotator cuff disease (Western Ontario Rotator Cuff Questionnaire (WORC) within 2 years No
Secondary SF-12 within 2 years No
Secondary Work Limitations Scale within 2 years No
Secondary Cuff integrity on imaging within 1 year post-operative No
Secondary Strength within 2 years No
Secondary Range of Motion within 2 years No
Secondary American Shoulder and Elbow Surgeons (ASES) shoulder scale within 2 years No
Secondary Shoulder and Pain Disability Index (SPADI) Within 2 years No
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