Remplissage Versus Latarjet Coracoid Transfer for Recurrent Shoulder Instability
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|ClinicalTrials.gov Identifier: NCT03453710|
Recruitment Status : Not yet recruiting
First Posted : March 5, 2018
Last Update Posted : March 12, 2018
|Condition or disease||Intervention/treatment||Phase|
|Shoulder Dislocation||Procedure: Bankart Repair plus Remplissage Procedure: Latarjet coracoid transfer||Not Applicable|
Presently, consensus guidelines for the surgical management of anterior glenohumeral instability are lacking. While there has been continual evolution in available arthroscopic instrumentation, this has not translated to improvements in patient outcomes. Isolated arthroscopic bankart repair is often associated with unacceptably high rates of failure, with a recent systematic review identifying continued recurrence rates of 14.2%. Improved recognition of bone defects and identification of critical defect sizes that contribute to recurrent instability and failed stabilization have lead to improvements in treatment algorithms. It has been widely accepted that glenoid defects exceeding 20% of anteroposterior (AP) width and humeral head defects exceeding 30% of the humeral head width contribute to recurrent instability. For defects of this magnitude, isolated arthroscopic Bankart repair is insufficient in restoring joint stability, and more extensive procedures are required. This can include adding a remplissage to the arthroscopic Bankart repair or open allograft reconstruction for humeral defects; or Latarjet coracoid transfer for glenoid defects.
However, often patients present with combined 'bipolar' bone loss, where individual defects are subcritical in size. There is increasing recognition that the presence of this combined bone loss may lead to increased rates of failure with an isolated arthroscopic bankart repair. Currently, accepted treatment options for bipolar bone loss include a combined arthroscopic Bankart repair and remplissage, or a Latarjet coracoid transfer. While there is supportive biomechanical data for each procedure, and limited case series in the literature, there remains a paucity of high-quality evidence to guide treatment for this complex clinical scenario. Consequently, we aim to perform a pilot study designed as a prospective, randomized controlled trial comparing arthroscopic Bankart repair and Remplissage with an open Latarjet coracoid transfer.
|Study Type :||Interventional (Clinical Trial)|
|Estimated Enrollment :||30 participants|
|Intervention Model:||Parallel Assignment|
|Intervention Model Description:||Prospective, randomized controlled trial|
|Masking:||Single (Outcomes Assessor)|
|Masking Description:||Patients will be evaluated by a blinded study nurse, unaware of treatment allocation, for administration of baseline questionnaires, as well as subsequent post-operative questionnaires.|
|Official Title:||Arthroscopic Bankart Repair and Remplissage Versus Latarjet Coracoid Transfer for Recurrent Anterior Glenohumeral Instability With Subcritical Bone Loss - A Randomized Controlled Trial|
|Estimated Study Start Date :||June 2018|
|Estimated Primary Completion Date :||July 2019|
|Estimated Study Completion Date :||June 2020|
Active Comparator: Bankart Repair and Remplissage
Patients randomized to the all-arthroscopic group (Bankart repair and remplissage) will undergo a standard arthroscopic anterior labral repair with a minimum of 3 suture anchors, followed by remplissage with 1 or 2 anchors, at the discretion of the treating surgeon.
Procedure: Bankart Repair plus Remplissage
Arthroscopic Bankart repair with a minimum of 3 anchors
1 or 2 anchor Remplissage subsequently performed with percutaneous anchor insertion in the base of the Hill-Sachs defect, and sutures passed in a horizontal mattress configuration 1 cm apart, tied in the subacromial space.
Active Comparator: Latarjet Coracoid Transfer
Patients randomized to the open Latarjet coracoid transfer will undergo a Latarjet coracoid transfer through a deltopectoral approach and horizontal split in the subscapularis at the superior 2/3, inferior 1/3 junction. The coracoid process will be oriented in the conventional manner, with the inferior surface against the glenoid vault, secured with two cannulated screws
Procedure: Latarjet coracoid transfer
Coracoid transfer performed via deltopectoral approach with horizontal subscapularis split. Graft placed in the conventional orientation, secured with 2 screws, ensuring the graft is not lateral to the glenoid rim.
- Western Ontario Shoulder Instability (WOSI) Score [ Time Frame: 24 months ]
Western Ontario Shoulder Instability (WOSI) questionnaire is a tool designed for self-assessment of shoulder function for patients with instability problems. Difference between study arm outcomes will be assessed using pre-op and post-op WOSI score as a covariate.
This questionnaire has 21 questions, each scored on a scale from 0 to 100, with 0 being the best score (no limitations related to the shoulder) and 100 representing the worst score.
Overall, the questionnaire is scored as a percentage of the maximum score of 2100 points.
There are subscale components reporting on: physical symptoms (questions 1 through 10; maximum score of 1000); sports/recreation/work (questions 11 through 14; maximum score 400); lifestyle (questions 15 through 18; maximum score 400); and emotion (questions 19-21; maximum score 300).
Subscale scores are added to determine the total score out of a possible 2100 points, with 2100, or 100%, representing the worst possible score.
- Pain numeric rating scale (NRS) [ Time Frame: 24 months ]This tool is designed to evaluate pain. The Scale is from 0-100 to determine shoulder pain pre and post-operatively; 0=extreme pain, 100=no pain
- Simple Shoulder Test (SST) [ Time Frame: 24 months ]Simple Shoulder Test (SST) is a series of 12 "yes" or "no" questions the patient answers about the function of the involved shoulder. The answers to these questions provides a standardized way of recording the function of a shoulder before and after treatment. Differences between study arm outcomes will be assessed using pre-op SST scores as a covariate
- American Shoulder and Elbow Society (ASES) assessment [ Time Frame: 24 months ]The ASES assessment (patient report section) is a region-specific questionnaire designed for self-assessment of aspects of pain and function. Difference between study arm outcomes will be assessed using pre-op ASES score as a covariate
- Range of motion [ Time Frame: 24 months ]Range of motion will be evaluated using a goniometer to calculate: forward flexion, abduction, external rotation and internal rotation
- Post-operative complications [ Time Frame: 24 months ]Post-surgical complications will be collected including: neurologic injury (neuropraxia); superficial wound infection; deep surgical site infection; coracoid non-union or malunion; posterior shoulder pain; stiffness; recurrent instability
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03453710
|Contact: Stacey Wanlin||519-661-3111 ext firstname.lastname@example.org|
|Pan Am Clinic||Not yet recruiting|
|Winnipeg, Manitoba, Canada, R3M 3E4|
|Contact: Peter MacDonald, MD (204) 925-1550 email@example.com|
|Principal Investigator: Peter MacDonald, MD|
|Fowler Kennedy Sport Medicine Clinic||Not yet recruiting|
|London, Ontario, Canada, N6A 3K7|
|Contact: Ryan M Degen, MD 519-661-2171 firstname.lastname@example.org|
|Contact: Stacey Wanlin email@example.com|
|Principal Investigator: Ryan M Degen, MD|
|Principal Investigator: Robert Litchfield, MD|