Rotator Cuff InjuriesNCT04146987
Cost-Effectiveness of Rotator Cuff Repair Methods
A study testing Rotator cuff repair surgery in people with Rotator Cuff Injuries and Shoulder Pain, run by Hospital Israelita Albert Einstein at 2 sites in Brazil.
Trial summary
Shoulder pain is one of the most common musculoskeletal complaints in orthopedic practice. Rotator cuff injuries account for up to 70% of pain in the shoulder girdle. There is no clinical study carried out in Brazil comparing cost effectiveness between the open and arthroscopic methods of rotator cuff repair surgery. Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Rotator Cuff Injuries, Shoulder Pain, Shoulder Impingement
- What is being tested?
- Rotator cuff repair surgery
- Type of treatment
- Surgery or procedure
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 100 participants
- Where
- 2 sitesBrazil
- Study dates
- 1 Aug 2020to 1 Dec 2022
- Phase
- Interventional
- 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 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Patients with complete rotator cuff injury, symptomatic, where there was failure or the patient could not support the non-surgical treatment;
- Patients with high-grade partial rotator cuff injury where therapy failed or the patient did not support non-surgical treatment;
- Patients without medical contraindications for surgery;
- Patients with a good understanding of the Portuguese language and who agree to participate and sign the Informed Consent Form.
Who cannot join
- Patients under 18 years old
- Patients with previous shoulder surgery;
- Patients with limited range of motion of the shoulder (joint stiffness);
- Patients with previous fractures in the affected shoulder;
- Patients with signs of glenohumeral osteoarthritis;
- Patients with neurological injury;
- Patients who opt not to participate and/or are not willing to sign the informed consent form;
- Patients unable to complete the follow-up evaluation (inability to read or complete the forms).
Trial locations and contacts
2 sites in 1 country.
Brazil2 sites, 1 recruiting
- Recruiting
Hospital Alvorada Moema
São Paulo, São Paulo, 04541022
Rafael Pierami, MD, +55 (11) 2186-9809, rafael.pierami@einstein.br
- Active, not recruiting
Hospital Israelita Albert Einstein (HIAE)
São Paulo, São Paulo, 05652900
About this study
Official title: Cost-Effectiveness of Rotator Cuff Repair Surgery by Open and Arthroscopic Techniques. Randomized Clinical Trial
Shoulder pain is one of the most common musculoskeletal complaints in orthopedic practice. Rotator cuff injuries account for up to 70% of pain in the shoulder girdle. There is no clinical study carried out in Brazil comparing cost effectiveness between the open and arthroscopic methods of rotator cuff repair surgery.
The present study aims to determine which method of repair of the rotator cuff, open or arthroscopic, has the best cost effectiveness ratio.
A randomized clinical trial will be carried out in which patients with symptomatic rotator cuff lesion will be submitted to repair surgery by either open or arthroscopic technique and will be subsequently evaluated.
Read the detailed description
Introduction:
Musculoskeletal injuries are a major cost to the healthcare system. In 2004, 30% of the North American population had some kind of musculoskeletal disorder that required medical treatment; between 2002 and 2004, the estimated cost of treating these changes was $ 510 billion. Shoulder diseases represent the third most common cause of these changes, behind only spinal and knee disorders.
An evaluation of the primary health care system in Cambridge, United Kingdom, showed that the average frequency of shoulder pain was 9.5 per 1,000 individuals. Of these, 86% had rotator cuff tendinopathy. North American data estimate that approximately 4.5 million patients annually seek medical attention due to shoulder pain; of these, two million have some symptoms related to the rotator cuff. About 250,000 rotator cuff repair surgeries are performed annually in the United States of America (US), and with the continued increase in life expectancy and aging, there is a tendency to increase this number.
The rotator cuff is composed of the tendons of the subscapularis, supraspinatus, infraspinatus and teres minor muscles. The long portion of the biceps tendon also contributes to cuff function, which is to stabilize the humeral head in the glenoid cavity, preventing superior migration of the humeral head.
The possible lesions range from tendon degeneration (tendinosis/tendinopathy), through partial lesions (articular, interstitial or bursal), to complete lesions. Diagnosis is made by associating history and physical examination along with imaging methods, and magnetic resonance imaging (MRI) is considered the method of choice.
Currently, the indication for surgical treatment is based on the persistence of symptoms and/or the degree of muscle weakness and/or size of the lesion, after a time of conservative treatment. In general, when opting for surgery, imaging can assist in the planning of surgical treatment, since it allows measuring the extent of the lesion (partial or total) and discriminating which tendons are involved (supraspinatus, infraspinatus, etc.).
Treatment of rotator cuff diseases depends on the type of injury, the patient's degree of activity, age, and the presence of symptoms. In general, tendon degeneration and partial lesions are treated non-surgically, with physiotherapy, infiltrations and analgesic medications. Complete and incomplete lesions that did not respond well to conservative treatment, however, should be treated surgically. Among the surgical options, the open method is still considered the gold standard, with good or excellent results in over 90% of cases. With the advent of arthroscopy and the evolution of arthroscopic instruments and implants in the last decade, the arthroscopic repair technique has gained space and is widely used in the investigator's country. Several studies abroad did not demonstrate superiority of one technique over another in terms of clinical outcomes. As the cost of arthroscopic surgery is higher, due to the equipment needed to perform it, it is important to establish which option has the best cost-effectiveness.
Some studies abroad even suggest the superiority of the open method over the arthroscopic method. However, there are no studies comparing cost-effectiveness between open and arthroscopic methods in Brazil. Therefore, the present study aims to compare the open and arthroscopic methods for rotator cuff repair and determine which presents the best cost-effectiveness ratio.
Hypothesis:
The hypothesis of this study is that the open method of rotator cuff repair will be more cost-effective compared to the arthroscopic method.
Justification:
In a systematic literature search, it was observed that there are no studies in the Brazilian literature comparing the cost-effectiveness of open and arthroscopic rotator cuff repair methods. Data from the international literature suggest that the open repair method is more cost-effective than the arthroscopic method (same clinical outcome and lower cost).
Thus, despite the high incidence of rotator cuff injury, there is insufficient evidence from the Brazilian experience to determine the best method for treating these injuries. So, this project proposes to conduct a study to answer the clinical question of which method, open or arthroscopic, has the best cost-effectiveness in the surgical treatment of rotator cuff injury. According to the levels of scientific evidence, the most appropriate study design to answer this clinical question is a randomized clinical trial.
Study Goal:
The present study aims to compare the open and arthroscopic methods for rotator cuff repair and determine which presents the best cost-effectiveness ratio.
- Conditions
- Rotator Cuff Injuries, Shoulder Pain, Shoulder Impingement, Shoulder Injuries, Shoulder Bursitis, Shoulder Tendinitis
- Being tested
- Rotator cuff repair surgery
- Keywords
- Rotator Cuff, Rotator Cuff Tear, Rotator Cuff Tendinopathy, Shoulder Arthroscopy, Rotator Cuff Repair, Open Rotator Cuff Repair
- Medical subject headings
- Rotator Cuff Injuries, Shoulder Pain, Shoulder Impingement Syndrome, Shoulder Injuries
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Rotator cuff repair surgeryProcedure or surgery
Patients will undergo open rotator cuff repair or arthroscopic rotator cuff repair
| Study group | Role | What they receive |
|---|---|---|
| Open rotator cuff repair | Active comparator | Patients will be positioned in a beach chair position with the affected limb pending off the table, allowing manipulation and full range of motion range. After asepsis, antisepsis and placement of sterile surgical fields, anterolateral incision will be made in the shoulder in question; the deltoid muscle belly will be gently divided along its fibers until exposure of the subdeltoid / subacromial bursa, which will be partially excised for exposure of the subacromial space and rotator cuff tendons. After mobilization and release of the ruptured tendons and debridement of the rotator cuff footprint, the tendon repair to the bone will be performed using 5.5m metal anchors, according to the preference and technique chosen by the surgeon. In all cases, the release of the coracoacromial ligament and acromioplasty will be performed. Receives: Procedure: Rotator cuff repair surgery |
| Arthroscopic rotator cuff repair | Active comparator | The patients will be positioned in lateral decubitus position, with the arm to be operated attached to a skin traction device, which trough a traction post and 07 kg, will maintain the shoulder in the following position: abduction of 30 to 60 and flexion of 20 to 30 degrees. After asepsis, antisepsis and placement of impermeable sterile surgical fields, a posterolateral incision will be made in the shoulder for optic introduction, with a 50 mmHg pressure pump and a 0.90 flow, and inspection of the GU joint. After joint inspection, the optic will be introduced into the subacromial space with detachment of the subacromial and subdeltoid. Using shaver blades, partial bursectomy will be performed as well as debridement of the rotator cuff footprint. The tendon will then be reinserted to the bone using metallic 5.5mm anchors. After tendon repair, the coracoacromomial ligament will be released, as well as acromioplasty. Receives: Procedure: Rotator cuff repair surgery |
What is being measured
The primary outcome is the main question the study is designed to answer.
Constant-Murley Score (CM)
The Constant-Murley Score (CM) validated for the Portuguese language. The evaluators will ask the patients to fill in the validated CM form for the Portuguese language and measure the range of motion with a goniometer. The CM scale covers different domains of shoulder function (pain, activities of daily living, range of motion and power), punctuating each of them; it ranges from 0 to 100, with higher scores indicating better function.
Measured: Measured continuously for 48 weeks after the intervention
EuroQol-5D-3L (European Quality of Life)
EuroQol-5D-3L (European Quality of Life), a generic score developed to describe health-related quality of life will also be assessed preoperatively, at 6, 24 and 48 weeks postoperatively. This score includes five health domains: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression; each domain has 3 levels: no problem; some problems and extreme problems. In addition, the EuroQol-5D-3L has a visual analog scale where the participant assigns a value between zero and one hundred to his or her own health condition. At the end of its application, EuroQol-5D-3L will provide a unique numerical value that can be used for longitudinal comparison between two time periods (pre and postoperative, for example).
Measured: Measured continuously for 48 weeks after the intervention
Secondary outcomes (2)
Simple Shoulder Test (SST)
SST is a simple, quick and widely used questionnaire for shoulder function measurement; it consists of 12 dichotomous questions answered by the patient himself. Each positive answer (yes) is given a score; at the end of the questionnaire the percentage of positive answers (score) is made, and the higher the percentage, the better the shoulder function.
Measured: Measured continuously for 48 weeks after the intervention
Visual Analogue Pain Scale (VAS)
This scale allows pain intensity to be measured with maximum interobserver reproducibility; it consists of a 10 cm straight line with the ends determining the limits of pain sensation (no pain; worst pain ever experienced); the distance between zero (no pain) and the patient's demarcation defines the intensity of pain.
Measured: Measured continuously for 48 weeks after the intervention
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted31 Oct 2019
- Study start1 Aug 2020
- Primary completion1 Nov 2022 (estimated)
- Study completion1 Dec 2022 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (43)Papers the sponsor has linked to this study.
- Other trials for Rotator Cuff InjuriesStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
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 N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- Patients will undergo a clinical evaluation, plain radiography, and magnetic resonance imaging to confirm the diagnosis of rotator cuff injury. At this moment, the type of lesion will be evaluated, as well as its size, retraction and the degree of fatty infiltration of the muscular belly, according to the Goutallier classification. The lesions will be classified as small (\<1cm); moderate (1-3cm); large (3-5cm) or very large (\> 5cm). All patients will undergo examinations and preoperative clinical evaluation. Patients will be consecutively allocated to one of two proposed treatment methods: open rotator cuff repair or arthroscopic rotator cuff repair.
- Masking
- Quadruple blind
- Who is masked
- Participant, Care provider, Investigator, Outcomes assessor
- Enrolment
- 100 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Hospital Israelita Albert Einstein
- Sponsor type
- University, hospital or other
- Collaborators
- Hospital Alvorada, Fundação de Amparo à Pesquisa do Estado de São Paulo
- Responsible party
- Sponsor
- Investigators
- Rafael Pierami, MD, Principal investigator, SOCIEDADE BENEF ISRAELITABRAS HOSPITAL ALBERT EINSTEIN
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT04146987
- Sponsor's protocol ID
- 032019
- Status last verified
- Jul 2020
- First submitted
- 14 Oct 2019
- Last updated
- 14 Oct 2020
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Mather RC 3rd, Koenig L, Acevedo D, Dall TM, Gallo P, Romeo A, Tongue J, Williams G Jr. The societal and economic value of rotator cuff repair. J Bone Joint Surg Am. 2013 Nov 20;95(22):1993-2000. doi: 10.2106/JBJS.L.01495.
PubMed 24257656Kuye IO, Jain NB, Warner L, Herndon JH, Warner JJ. Economic evaluations in shoulder pathologies: a systematic review of the literature. J Shoulder Elbow Surg. 2012 Mar;21(3):367-75. doi: 10.1016/j.jse.2011.05.019. Epub 2011 Aug 23.
PubMed 21865060Ostor AJ, Richards CA, Prevost AT, Speed CA, Hazleman BL. Diagnosis and relation to general health of shoulder disorders presenting to primary care. Rheumatology (Oxford). 2005 Jun;44(6):800-5. doi: 10.1093/rheumatology/keh598. Epub 2005 Mar 15.
PubMed 15769790Favard L, Bacle G, Berhouet J. Rotator cuff repair. Joint Bone Spine. 2007 Dec;74(6):551-7. doi: 10.1016/j.jbspin.2007.08.003. Epub 2007 Oct 12.
PubMed 17993287Tempelaere C, Pierrart J, Lefevre-Colau MM, Vuillemin V, Cuenod CA, Hansen U, Mir O, Skalli W, Gregory T. Dynamic Three-Dimensional Shoulder Mri during Active Motion for Investigation of Rotator Cuff Diseases. PLoS One. 2016 Jul 19;11(7):e0158563. doi: 10.1371/journal.pone.0158563. eCollection 2016.
PubMed 27434235Sela Y, Eshed I, Shapira S, Oran A, Vogel G, Herman A, Perry Pritsch M. Rotator cuff tears: correlation between geometric tear patterns on MRI and arthroscopy and pre- and postoperative clinical findings. Acta Radiol. 2015 Feb;56(2):182-9. doi: 10.1177/0284185114520861. Epub 2014 Jan 20.
PubMed 24445094Teefey SA, Rubin DA, Middleton WD, Hildebolt CF, Leibold RA, Yamaguchi K. Detection and quantification of rotator cuff tears. Comparison of ultrasonographic, magnetic resonance imaging, and arthroscopic findings in seventy-one consecutive cases. J Bone Joint Surg Am. 2004 Apr;86(4):708-16.
PubMed 15069134Jason E. Hsu Steven B. Lippitt, Frederick A. Matsen III AOG. Rockwood and Matsen's The Shoulder, 5th Edition: The Rotator Cuff. In: Rockwood and Matsen's The Shoulder, 5th Edition. 5th ed. Elsevier; 2016. p. 651-719.
Yamakawa S, Hashizume H, Ichikawa N, Itadera E, Inoue H. Comparative studies of MRI and operative findings in rotator cuff tear. Acta Med Okayama. 2001 Oct;55(5):261-8. doi: 10.18926/AMO/32019.
PubMed 11688948Roy JS, Braen C, Leblond J, Desmeules F, Dionne CE, MacDermid JC, Bureau NJ, Fremont P. Diagnostic accuracy of ultrasonography, MRI and MR arthrography in the characterisation of rotator cuff disorders: a systematic review and meta-analysis. Br J Sports Med. 2015 Oct;49(20):1316-28. doi: 10.1136/bjsports-2014-094148. Epub 2015 Feb 11.
PubMed 25677796Lenza M, Buchbinder R, Takwoingi Y, Johnston RV, Hanchard NC, Faloppa F. Magnetic resonance imaging, magnetic resonance arthrography and ultrasonography for assessing rotator cuff tears in people with shoulder pain for whom surgery is being considered. Cochrane Database Syst Rev. 2013 Sep 24;2013(9):CD009020. doi: 10.1002/14651858.CD009020.pub2.
PubMed 24065456Handoll HH, Hanchard NC, Lenza M, Buchbinder R. Rotator cuff tears and shoulder impingement: a tale of two diagnostic test accuracy reviews. Cochrane Database Syst Rev. 2013 Oct 7;2013(10):ED000068. doi: 10.1002/14651858.ED000068. No abstract available.
PubMed 24475489Hanchard NC, Lenza M, Handoll HH, Takwoingi Y. Physical tests for shoulder impingements and local lesions of bursa, tendon or labrum that may accompany impingement. Cochrane Database Syst Rev. 2013 Apr 30;2013(4):CD007427. doi: 10.1002/14651858.CD007427.pub2.
PubMed 23633343Seida JC, LeBlanc C, Schouten JR, Mousavi SS, Hartling L, Vandermeer B, Tjosvold L, Sheps DM. Systematic review: nonoperative and operative treatments for rotator cuff tears. Ann Intern Med. 2010 Aug 17;153(4):246-55. doi: 10.7326/0003-4819-153-4-201008170-00263. Epub 2010 Jul 5.
PubMed 20621893Ainsworth R, Lewis JS. Exercise therapy for the conservative management of full thickness tears of the rotator cuff: a systematic review. Br J Sports Med. 2007 Apr;41(4):200-10. doi: 10.1136/bjsm.2006.032524. Epub 2007 Jan 30.
PubMed 17264144
Study at a glance
From the registry record, last updated by the sponsor on 14 Oct 2020. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Cost-Effectiveness of Rotator Cuff Repair Surgery by Open and Arthroscopic Techniques. Randomized Clinical Trial
- ClinicalTrials.gov ID
- NCT04146987
- Acronym / sponsor ID
- 032019
- Conditions
- Rotator Cuff Injuries, Shoulder Pain, Shoulder Impingement, Shoulder Injuries, Shoulder Bursitis, Shoulder Tendinitis
- Keywords
- Rotator Cuff, Rotator Cuff Tear, Rotator Cuff Tendinopathy, Shoulder Arthroscopy, Rotator Cuff Repair, Open Rotator Cuff Repair
- Study type
- Interventional
- Recruitment status
- Unknown status
- Enrolment
- 100 participants (estimated)
- Lead sponsor
- Hospital Israelita Albert EinsteinUniversity, hospital or other
- Collaborators
- Hospital Alvorada, Fundação de Amparo à Pesquisa do Estado de São Paulo
- Study start
- 1 Aug 2020 (actual)
- Primary completion
- 1 Nov 2022 (estimated)
- Study completion
- 1 Dec 2022 (estimated)
- First posted
- 31 Oct 2019 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Shoulder pain is one of the most common musculoskeletal complaints in orthopedic practice. Rotator cuff injuries account for up to 70% of pain in the shoulder girdle. There is no clinical study carried out in Brazil comparing cost effectiveness between the open and arthroscopic methods of rotator cuff repair surgery.
The present study aims to determine which method of repair of the rotator cuff, open or arthroscopic, has the best cost effectiveness ratio.
A randomized clinical trial will be carried out in which patients with symptomatic rotator cuff lesion will be submitted to repair surgery by either open or arthroscopic technique and will be subsequently evaluated.
Detailed description
Introduction:
Musculoskeletal injuries are a major cost to the healthcare system. In 2004, 30% of the North American population had some kind of musculoskeletal disorder that required medical treatment; between 2002 and 2004, the estimated cost of treating these changes was $ 510 billion. Shoulder diseases represent the third most common cause of these changes, behind only spinal and knee disorders.
An evaluation of the primary health care system in Cambridge, United Kingdom, showed that the average frequency of shoulder pain was 9.5 per 1,000 individuals. Of these, 86% had rotator cuff tendinopathy. North American data estimate that approximately 4.5 million patients annually seek medical attention due to shoulder pain; of these, two million have some symptoms related to the rotator cuff. About 250,000 rotator cuff repair surgeries are performed annually in the United States of America (US), and with the continued increase in life expectancy and aging, there is a tendency to increase this number.
The rotator cuff is composed of the tendons of the subscapularis, supraspinatus, infraspinatus and teres minor muscles. The long portion of the biceps tendon also contributes to cuff function, which is to stabilize the humeral head in the glenoid cavity, preventing superior migration of the humeral head.
The possible lesions range from tendon degeneration (tendinosis/tendinopathy), through partial lesions (articular, interstitial or bursal), to complete lesions. Diagnosis is made by associating history and physical examination along with imaging methods, and magnetic resonance imaging (MRI) is considered the method of choice.
Currently, the indication for surgical treatment is based on the persistence of symptoms and/or the degree of muscle weakness and/or size of the lesion, after a time of conservative treatment. In general, when opting for surgery, imaging can assist in the planning of surgical treatment, since it allows measuring the extent of the lesion (partial or total) and discriminating which tendons are involved (supraspinatus, infraspinatus, etc.).
Treatment of rotator cuff diseases depends on the type of injury, the patient's degree of activity, age, and the presence of symptoms. In general, tendon degeneration and partial lesions are treated non-surgically, with physiotherapy, infiltrations and analgesic medications. Complete and incomplete lesions that did not respond well to conservative treatment, however, should be treated surgically. Among the surgical options, the open method is still considered the gold standard, with good or excellent results in over 90% of cases. With the advent of arthroscopy and the evolution of arthroscopic instruments and implants in the last decade, the arthroscopic repair technique has gained space and is widely used in the investigator's country. Several studies abroad did not demonstrate superiority of one technique over another in terms of clinical outcomes. As the cost of arthroscopic surgery is higher, due to the equipment needed to perform it, it is important to establish which option has the best cost-effectiveness.
Some studies abroad even suggest the superiority of the open method over the arthroscopic method. However, there are no studies comparing cost-effectiveness between open and arthroscopic methods in Brazil. Therefore, the present study aims to compare the open and arthroscopic methods for rotator cuff repair and determine which presents the best cost-effectiveness ratio.
Hypothesis:
The hypothesis of this study is that the open method of rotator cuff repair will be more cost-effective compared to the arthroscopic method.
Justification:
In a systematic literature search, it was observed that there are no studies in the Brazilian literature comparing the cost-effectiveness of open and arthroscopic rotator cuff repair methods. Data from the international literature suggest that the open repair method is more cost-effective than the arthroscopic method (same clinical outcome and lower cost).
Thus, despite the high incidence of rotator cuff injury, there is insufficient evidence from the Brazilian experience to determine the best method for treating these injuries. So, this project proposes to conduct a study to answer the clinical question of which method, open or arthroscopic, has the best cost-effectiveness in the surgical treatment of rotator cuff injury. According to the levels of scientific evidence, the most appropriate study design to answer this clinical question is a randomized clinical trial.
Study Goal:
The present study aims to compare the open and arthroscopic methods for rotator cuff repair and determine which presents the best cost-effectiveness ratio.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Quadruple blind (participant, care provider, investigator, outcomes assessor)
- Number of arms
- 2
- Model description
- Patients will undergo a clinical evaluation, plain radiography, and magnetic resonance imaging to confirm the diagnosis of rotator cuff injury. At this moment, the type of lesion will be evaluated, as well as its size, retraction and the degree of fatty infiltration of the muscular belly, according to the Goutallier classification. The lesions will be classified as small (<1cm); moderate (1-3cm); large (3-5cm) or very large (> 5cm). All patients will undergo examinations and preoperative clinical evaluation. Patients will be consecutively allocated to one of two proposed treatment methods: open rotator cuff repair or arthroscopic rotator cuff repair.
| Arm | Type | Receives |
|---|---|---|
| Open rotator cuff repair | Active comparator | Procedure: Rotator cuff repair surgeryPatients will be positioned in a beach chair position with the affected limb pending off the table, allowing manipulation and full range of motion range. After asepsis, antisepsis and placement of sterile surgical fields, anterolateral incision will be made in the shoulder in question; the deltoid muscle belly will be gently divided along its fibers until exposure of the subdeltoid / subacromial bursa, which will be partially excised for exposure of the subacromial space and rotator cuff tendons. After mobilization and release of the ruptured tendons and debridement of the rotator cuff footprint, the tendon repair to the bone will be performed using 5.5m metal anchors, according to the preference and technique chosen by the surgeon. In all cases, the release of the coracoacromial ligament and acromioplasty will be performed. |
| Arthroscopic rotator cuff repair | Active comparator | Procedure: Rotator cuff repair surgeryThe patients will be positioned in lateral decubitus position, with the arm to be operated attached to a skin traction device, which trough a traction post and 07 kg, will maintain the shoulder in the following position: abduction of 30 to 60 and flexion of 20 to 30 degrees. After asepsis, antisepsis and placement of impermeable sterile surgical fields, a posterolateral incision will be made in the shoulder for optic introduction, with a 50 mmHg pressure pump and a 0.90 flow, and inspection of the GU joint. After joint inspection, the optic will be introduced into the subacromial space with detachment of the subacromial and subdeltoid. Using shaver blades, partial bursectomy will be performed as well as debridement of the rotator cuff footprint. The tendon will then be reinserted to the bone using metallic 5.5mm anchors. After tendon repair, the coracoacromomial ligament will be released, as well as acromioplasty. |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (4 listed)
- Patients with complete rotator cuff injury, symptomatic, where there was failure or the patient could not support the non-surgical treatment;
- Patients with high-grade partial rotator cuff injury where therapy failed or the patient did not support non-surgical treatment;
- Patients without medical contraindications for surgery;
- Patients with a good understanding of the Portuguese language and who agree to participate and sign the Informed Consent Form.
Key exclusion criteria (8 listed)
- Patients under 18 years old
- Patients with previous shoulder surgery;
- Patients with limited range of motion of the shoulder (joint stiffness);
- Patients with previous fractures in the affected shoulder;
- Patients with signs of glenohumeral osteoarthritis;
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Rotator cuff repair surgeryPatients will undergo open rotator cuff repair or arthroscopic rotator cuff repair | Procedure or surgery | Arthroscopic rotator cuff repair, Open rotator cuff repair |
Primary outcome
Constant-Murley Score (CM)
Time frame: Measured continuously for 48 weeks after the intervention
The Constant-Murley Score (CM) validated for the Portuguese language. The evaluators will ask the patients to fill in the validated CM form for the Portuguese language and measure the range of motion with a goniometer. The CM scale covers different domains of shoulder function (pain, activities of daily living, range of motion and power), punctuating each of them; it ranges from 0 to 100, with higher scores indicating better function.
EuroQol-5D-3L (European Quality of Life)
Time frame: Measured continuously for 48 weeks after the intervention
EuroQol-5D-3L (European Quality of Life), a generic score developed to describe health-related quality of life will also be assessed preoperatively, at 6, 24 and 48 weeks postoperatively. This score includes five health domains: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression; each domain has 3 levels: no problem; some problems and extreme problems. In addition, the EuroQol-5D-3L has a visual analog scale where the participant assigns a value between zero and one hundred to his or her own health condition. At the end of its application, EuroQol-5D-3L will provide a unique numerical value that can be used for longitudinal comparison between two time periods (pre and postoperative, for example).
2 secondary outcomes
Simple Shoulder Test (SST)
Time frame: Measured continuously for 48 weeks after the intervention
Visual Analogue Pain Scale (VAS)
Time frame: Measured continuously for 48 weeks after the intervention
Results and safety
Results are not available in the source record.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 14 Oct 2020.
- Results publication: PubMed 24257656Mather RC 3rd, Koenig L, Acevedo D, Dall TM, Gallo P, Romeo A, Tongue J, Williams G Jr. The societal and economic value of rotator cuff repair. J Bone Joint Surg Am. 2013 Nov 20;95(22):1993-2000. doi: 10.2106/JBJS.L.01495.
- Results publication: PubMed 21865060Kuye IO, Jain NB, Warner L, Herndon JH, Warner JJ. Economic evaluations in shoulder pathologies: a systematic review of the literature. J Shoulder Elbow Surg. 2012 Mar;21(3):367-75. doi: 10.1016/j.jse.2011.05.019. Epub 2011 Aug 23.
- Results publication: PubMed 15769790Ostor AJ, Richards CA, Prevost AT, Speed CA, Hazleman BL. Diagnosis and relation to general health of shoulder disorders presenting to primary care. Rheumatology (Oxford). 2005 Jun;44(6):800-5. doi: 10.1093/rheumatology/keh598. Epub 2005 Mar 15.
- Results publication: PubMed 17993287Favard L, Bacle G, Berhouet J. Rotator cuff repair. Joint Bone Spine. 2007 Dec;74(6):551-7. doi: 10.1016/j.jbspin.2007.08.003. Epub 2007 Oct 12.
- Results publication: PubMed 27434235Tempelaere C, Pierrart J, Lefevre-Colau MM, Vuillemin V, Cuenod CA, Hansen U, Mir O, Skalli W, Gregory T. Dynamic Three-Dimensional Shoulder Mri during Active Motion for Investigation of Rotator Cuff Diseases. PLoS One. 2016 Jul 19;11(7):e0158563. doi: 10.1371/journal.pone.0158563. eCollection 2016.
- Results publication: PubMed 24445094Sela Y, Eshed I, Shapira S, Oran A, Vogel G, Herman A, Perry Pritsch M. Rotator cuff tears: correlation between geometric tear patterns on MRI and arthroscopy and pre- and postoperative clinical findings. Acta Radiol. 2015 Feb;56(2):182-9. doi: 10.1177/0284185114520861. Epub 2014 Jan 20.
- Results publication: PubMed 15069134Teefey SA, Rubin DA, Middleton WD, Hildebolt CF, Leibold RA, Yamaguchi K. Detection and quantification of rotator cuff tears. Comparison of ultrasonographic, magnetic resonance imaging, and arthroscopic findings in seventy-one consecutive cases. J Bone Joint Surg Am. 2004 Apr;86(4):708-16.
- Results publicationJason E. Hsu Steven B. Lippitt, Frederick A. Matsen III AOG. Rockwood and Matsen's The Shoulder, 5th Edition: The Rotator Cuff. In: Rockwood and Matsen's The Shoulder, 5th Edition. 5th ed. Elsevier; 2016. p. 651-719.
- Results publication: PubMed 11688948Yamakawa S, Hashizume H, Ichikawa N, Itadera E, Inoue H. Comparative studies of MRI and operative findings in rotator cuff tear. Acta Med Okayama. 2001 Oct;55(5):261-8. doi: 10.18926/AMO/32019.
- Results publication: PubMed 25677796Roy JS, Braen C, Leblond J, Desmeules F, Dionne CE, MacDermid JC, Bureau NJ, Fremont P. Diagnostic accuracy of ultrasonography, MRI and MR arthrography in the characterisation of rotator cuff disorders: a systematic review and meta-analysis. Br J Sports Med. 2015 Oct;49(20):1316-28. doi: 10.1136/bjsports-2014-094148. Epub 2015 Feb 11.
- Results publication: PubMed 24065456Lenza M, Buchbinder R, Takwoingi Y, Johnston RV, Hanchard NC, Faloppa F. Magnetic resonance imaging, magnetic resonance arthrography and ultrasonography for assessing rotator cuff tears in people with shoulder pain for whom surgery is being considered. Cochrane Database Syst Rev. 2013 Sep 24;2013(9):CD009020. doi: 10.1002/14651858.CD009020.pub2.
- Results publication: PubMed 24475489Handoll HH, Hanchard NC, Lenza M, Buchbinder R. Rotator cuff tears and shoulder impingement: a tale of two diagnostic test accuracy reviews. Cochrane Database Syst Rev. 2013 Oct 7;2013(10):ED000068. doi: 10.1002/14651858.ED000068. No abstract available.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Rafael Pierami, MD principal investigator
SOCIEDADE BENEF ISRAELITABRAS HOSPITAL ALBERT EINSTEIN
2 sites in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Rotator cuff repair surgery in people with Rotator Cuff Injuries and Shoulder Pain, run by Hospital Israelita Albert Einstein at 2 sites in Brazil.
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 4 inclusion and 8 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: status not confirmed, as of the sponsor's last update on 14 Oct 2020. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 2 sites in Brazil. 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.
Are results available for this study?
Results are not available in the source record.
How can a doctor refer a patient or contact the research team?
Contact Rafael Pierami, MD (+55 (11)982325308, rafael.pierami@einstein.br), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Constant-Murley Score (CM) (time frame: Measured continuously for 48 weeks after the intervention). The study lists 2 primary outcomes in all. 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 NCT04146987, which also lists 43 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 14 Oct 2020.