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Torn MeniscusPhase 4MILENCT00613535

Knee Articular Cartilage Debridement in Conjunction With Partial Meniscectomy

A Phase 4 study testing Mechanical debridement, Paragon T2 and Lavage debridement in people with Torn Meniscus, run by Smith & Nephew, Inc. at 10 sites in United States.

Terminated

Stopped early. The study ended before it was planned to and will not resume.

Official record
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Trial summary

The aim of this study is to describe changes at the site of the study patient's articular cartilage lesion on the femoral condyle with multiple magnetic resonance imaging (MRI) outcomes 6 months after treatment using one of three standard surgical treatment methods: 1) lavage debridement; 2) mechanical debridement; 3)… Read more about this study

Who is it for?
Ages 18 to 60 years
Conditions the study is for
Torn Meniscus
What is being tested?
Mechanical debridement, Paragon T2 and Lavage debridement
Could I receive a placebo?
No, everyone receives an active treatment
How many people
165 participants
Where
10 sitesUnited States
Study dates
Apr 2008to Jun 2012
Phase
Phase 4
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 60 years
  • All sexes
  • No healthy volunteers
  • Adult

Who may be able to join

  • Age between 18 and 60 years
  • BMI <35
  • Meniscal tear (medial or lateral) diagnosed by H+P exam and/or imaging in the index knee
  • No severe joint space narrowing (IKDC Classification) seen on weight-bearing AP X-ray in the index knee
  • No avascular necrosis in the index knee as evidenced by preop MRI obtained within 6 months prior to randomization
  • No Varus (>10 degrees) or Valgus (>15 degrees)knee deformities as seen by AP X-ray in the index knee
Show all 15Show fewer
  • Minimal or no abnormality of contralateral knee as shown by clinical exam and/or imaging
  • Candidate for unilateral arthroscopic treatment of the knee
  • Visual Analog Scale (VAS) pain score of 30 mm or greater in the index knee at the time of screening
  • Must be able to undergo MRI at required time points per appendix D
  • Physically and mentally willing and able to comply with study requirements
  • Must be willing and able to follow the standardized rehabilitation protocol (Appendix C)
  • Subject must sign IRB approved informed consent form
  • Arthroscopy Inclusion Criteria:
  • Arthroscopic confirmation of ICRS Grade II or III chondral lesion on the medial or lateral femoral condyle

Who cannot join

  • Knee instability, malalignment, or patellar tracking dysfunction in the index knee
  • Inflammatory rheumatoid arthritis or other systemic inflammatory arthritis in the index knee or contralateral knee
  • Previous total meniscectomy in the index knee
  • Previous surgical treatment of the index knee by arthroscopy less than 2 years prior to treatment by this study
  • Previous total meniscectomy
  • Previous knee tendon and/or ligament repair or patellar surgery of index knee
Show all 24Show fewer
  • Previous microfracture or bone marrow stimulation of the index knee
  • Previous unsuccessful osteotomy in the index knee
  • Presence of fractures, osteocysts or osteolysis in the index knee
  • Presence of osteoarthritis in the index knee
  • Pre-existent osteoarthritis of weight-bearing joints (e.g. hips or contralateral knee) that adversely affects gait
  • Participation in another clinical study
  • Terminally ill
  • Drug therapy for the index knee with systemic steroid therapy, steroid intra-articular therapy or intra-articular hyaluronic acid therapy within 2 months of enrollment into this study
  • Receiving narcotic pain medication by prescription for other conditions unrelated to knee injury
  • Contralateral knee involvement causing abnormal ambulation and non-compliance with rehabilitation
  • Pregnant or suspected pregnant
  • Coagulation disorder or patient is receiving anti-coagulants, which cannot be safely stopped for 14 days (7 days prior to surgery and 7 days post-surgery)
  • Arthroscopy Exclusion Criteria:
  • Presence of Grade IV chondromalacia anywhere in the index knee
  • ACL, PCL or MCL tear of the index knee
  • Osteochondritis dissecans (OCD)of the index knee
  • Meniscal tear requiring total meniscectomy
  • Evidence of osteoarthritis in the index knee

Trial locations and contacts

10 sites in 1 country.

10 sites in 1 country

United States10 sites
  • Commonwealth Orthopaedics

    Arlington, Virginia, 22205

  • Anderson Clinic

    Arlington, Virginia, 22206

  • JDP Medical Research

    Aurora, Colorado, 80014

  • Colorado Orthopedic Consultants, P.C.

    Englewood, Colorado, 80110

  • Shrock Orthopedic Research, LLC

    Fort Lauderdale, Florida, 33316

  • Kerlan Jobe Orthopaedic Foundation

    Los Angeles, California, 90045

  • Basin Orthopedic Surgical Specialists

    Odessa, Texas, 79761

  • HOPE Research Institute

    Phoenix, Arizona, 85050

  • University of Rochester Medical Center Department of Musculoskeletal Research

    Rochester, New York, 14642

  • University of Mass. Memorial Medical Center

    Worcester, Massachusetts, 01685

Other trials in United States

About this study

Official title: Magnetic Resonance Imaging and Clinical Outcomes After Three Different Treatments for Articular Cartilage Lesions Concomitant With Partial Meniscectomy

The aim of this study is to describe changes at the site of the study patient's articular cartilage lesion on the femoral condyle with multiple magnetic resonance imaging (MRI) outcomes 6 months after treatment using one of three standard surgical treatment methods: 1) lavage debridement; 2) mechanical debridement; 3) mechanical and radiofrequency-based debridement.

Read the detailed description

Fibrillated articular cartilage are commonly detected during arthroscopy when treating knee pathologies such as a torn meniscus or a damaged anterior cruciate ligament (ACL). The severity of these lesions is graded using a scheme such as the International Cartilage Research Society (ICRS) classification system. Grade I lesions are often left untreated, while Grade IV lesions require dedicated surgical intervention. Grade II and III lesions are frequently treated when they are encountered arthroscopically.

Currently, it is not known whether treatment of fibrillated articular cartilage is beneficial or whether one procedure is superior to another. Magnetic resonance imaging is the best technique currently available for non-invasive assessment of chondral lesions. The primary aim of the proposed study is to compare post-procedure MR imaging characteristics of fibrillated articular cartilage treated using one of the three standard of care measures: 1) Washing of the knee joint with saline solution to clear blood, fluid or loose tissue (also known as lavage); 2) Lavage in addition to mechanical shaver (a manual surgical tool used by the study doctor); and 3)Lavage in addition to the Paragon device (RF-based microdebridement), which may also be used with a mechanical (or manual) surgical tool. The secondary aim is to determine the association between imaging features and clinical outcomes.

Conditions
Torn Meniscus
Being tested
Mechanical debridement, Paragon T2, Lavage debridement, RF- based Debridement
Keywords
Partial Meniscectomy, Partial Thickness Knee Tear, MR Imaging, Mechanical Debridement, Crepitus, Stability, Coblation, Bipolar Radiofrequency, Debridement, Recurrent Knee Pain, meniscectomy, meniscus, cartilage lesion, articular cartilage lesion, articular cartilage, knee

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Mechanical debridementDevice

    Mechanical shaver will be used to remove large chondral flaps and loose fragments

  • Paragon T2Device

    Use Paragon device to debride after removal of larger chondral lesion flaps with mechanical shaver.

  • Lavage debridementProcedure or surgery

    Remove loose chondral fragments

  • Mechanical DebridementDevice

    Use of a mechanical device such as a shaver, punch, or biter to remove large chondral flaps and loose fragments

  • RF- based DebridementDevice

    Use of debridement device to remove large fragments followed by use of RF-based debridement to smooth the base of the shoulder of the tear.

Study groups in NCT00613535
Study groupRoleWhat they receive
Lavage debridement to remove loose fragmentsActive comparatorArticular cartilage defect left untreated by surgical tool during partial meniscectomy
Receives: Procedure: Lavage debridement
Mechanical DebridementActive comparatorRemove large chondral flaps and loose fragments
Receives: Device: Mechanical debridement
RF based DebridementActive comparatorDebridement to remove loose fragments followed by use of Paragon T-2 RF wand to smooth the base of the shoulder of the tear
Receives: Device: Paragon T2; Device: RF- based Debridement

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. In vivo magnetic resonance imaging (MRI) features of the femoral condyle chondral lesion

    Measured: 6 months after arthroscopy

Secondary outcomes (1)
  1. To determine whether recovery from recurrent pain, effusion, localized mechanical symptoms, and quality of life are equivalent for treatment groups

    Measured: Up to 24 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted13 Feb 2008 (estimated)
  2. Study startApr 2008
  3. Primary completionJun 2012
  4. Study completionJun 2012

Why it stopped: The correlation coefficient at the interim analysis with results for all three groups pooled, did not reach the level of statistical significance of (p\<0.05).

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 4
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Participant
Enrolment
165 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT00613535
Sponsor's protocol ID
A-706-DHH
Other IDs
1093528
Acronym
MILE
Status last verified
May 2015
First submitted
31 Jan 2008
Last updated
19 May 2015
Results posted
No
Data monitoring committee
No

Publications

  • Figueroa D, Calvo R, Vaisman A, Carrasco MA, Moraga C, Delgado I. Knee chondral lesions: incidence and correlation between arthroscopic and magnetic resonance findings. Arthroscopy. 2007 Mar;23(3):312-5. doi: 10.1016/j.arthro.2006.11.015.

    PubMed 17349476
  • Hjelle K, Solheim E, Strand T, Muri R, Brittberg M. Articular cartilage defects in 1,000 knee arthroscopies. Arthroscopy. 2002 Sep;18(7):730-4. doi: 10.1053/jars.2002.32839.

    PubMed 12209430
  • Widuchowski W, Widuchowski J, Trzaska T. Articular cartilage defects: study of 25,124 knee arthroscopies. Knee. 2007 Jun;14(3):177-82. doi: 10.1016/j.knee.2007.02.001. Epub 2007 Apr 10.

    PubMed 17428666
  • Sgaglione NA, Miniaci A, Gillogly SD, Carter TR. Update on advanced surgical techniques in the treatment of traumatic focal articular cartilage lesions in the knee. Arthroscopy. 2002 Feb;18(2 Suppl 1):9-32. doi: 10.1053/jars.2002.31783.

    PubMed 11828343
  • Brittberg M, Winalski CS. Evaluation of cartilage injuries and repair. J Bone Joint Surg Am. 2003;85-A Suppl 2:58-69. doi: 10.2106/00004623-200300002-00008. No abstract available.

    PubMed 12721346
  • Shelbourne KD, Jari S, Gray T. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J Bone Joint Surg Am. 2003;85-A Suppl 2:8-16. doi: 10.2106/00004623-200300002-00002.

    PubMed 12721340
  • Alford JW, Cole BJ. Cartilage restoration, part 1: basic science, historical perspective, patient evaluation, and treatment options. Am J Sports Med. 2005 Feb;33(2):295-306. doi: 10.1177/0363546504273510.

    PubMed 15701618
  • Messner K, Maletius W. The long-term prognosis for severe damage to weight-bearing cartilage in the knee: a 14-year clinical and radiographic follow-up in 28 young athletes. Acta Orthop Scand. 1996 Apr;67(2):165-8. doi: 10.3109/17453679608994664.

    PubMed 8623573
  • Fowler P. Arthroscopic lavage or debridement did not reduce pain more than placebo did in patients with osteoarthritis. J Bone Joint Surg Am. 2003 Feb;85(2):387. doi: 10.2106/00004623-200302000-00038. No abstract available.

    PubMed 12571328
  • Owens BD, Stickles BJ, Balikian P, Busconi BD. Prospective analysis of radiofrequency versus mechanical debridement of isolated patellar chondral lesions. Arthroscopy. 2002 Feb;18(2):151-5. doi: 10.1053/jars.2002.29906.

    PubMed 11830808
  • Barber FA, Iwasko NG. Treatment of grade III femoral chondral lesions: mechanical chondroplasty versus monopolar radiofrequency probe. Arthroscopy. 2006 Dec;22(12):1312-7. doi: 10.1016/j.arthro.2006.06.008.

    PubMed 17157730
  • Mithoefer K, Williams RJ 3rd, Warren RF, Potter HG, Spock CR, Jones EC, Wickiewicz TL, Marx RG. The microfracture technique for the treatment of articular cartilage lesions in the knee. A prospective cohort study. J Bone Joint Surg Am. 2005 Sep;87(9):1911-20. doi: 10.2106/JBJS.D.02846.

    PubMed 16140804
  • Henderson IJ, Tuy B, Connell D, Oakes B, Hettwer WH. Prospective clinical study of autologous chondrocyte implantation and correlation with MRI at three and 12 months. J Bone Joint Surg Br. 2003 Sep;85(7):1060-6. doi: 10.1302/0301-620x.85b7.13782.

    PubMed 14516048
  • Voloshin I, Morse KR, Allred CD, Bissell SA, Maloney MD, DeHaven KE. Arthroscopic evaluation of radiofrequency chondroplasty of the knee. Am J Sports Med. 2007 Oct;35(10):1702-7. doi: 10.1177/0363546507304328. Epub 2007 Jul 20.

    PubMed 17644661
  • Yetkinler DN, Greenleaf JE, Sherman OH. Histologic analysis of radiofrequency energy chondroplasty. Clin Sports Med. 2002 Oct;21(4):649-61, viii. doi: 10.1016/s0278-5919(02)00015-7.

    PubMed 12489295

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing Mechanical debridement, Paragon T2 and Lavage debridement in people with Torn Meniscus, run by Smith & Nephew, Inc. at 10 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 15 inclusion and 24 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: stopped early, as of the sponsor's last update on 19 May 2015. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 10 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study was stopped early (reason given: The correlation coefficient at the interim analysis with results for all three groups pooled, did not reach the level of statistical significance of (p\<0.05).). Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

In vivo magnetic resonance imaging (MRI) features of the femoral condyle chondral lesion (time frame: 6 months after arthroscopy). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT00613535, which also lists 15 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 19 May 2015.

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