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Shoulder DislocationNCT02535585

Arthroscopic Treatment of Anterior Shoulder Dislocation Using Knotted and Knotless Anchors

A study testing knotted anchors (SutureTak biocomposite 3.0 mm) and knotless anchors (PushLock biocomposite 2.9 mm knotless) in people with Shoulder Dislocation, run by University of Sao Paulo at 1 site in Brazil.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The shoulder is the joint that most commonly suffers dislocation, and anterior instability is the most frequent form. Arthroscopic repair is the gold standard for the treatment of recurrent shoulder dislocation. Read more about this study

Who is it for?
Any age
Conditions the study is for
Shoulder Dislocation
What is being tested?
knotted anchors (SutureTak biocomposite 3.0 mm) and knotless anchors (PushLock biocomposite 2.9 mm knotless)
Type of treatment
Medical device
Could I receive a placebo?
No, everyone receives an active treatment
How many people
58 participants
Where
1 siteBrazil
Study dates
27 Feb 2017to 16 Jan 2021
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 Any age
  • All sexes
  • No healthy volunteers
  • Child, Adult, Older adult

Who may be able to join

  • Skeletal maturity;
  • Anterior glenohumeral instability;
  • Previous labral lesion without bone defects or with defects that affect no more than 20% of the anteroposterior diameter of the glenoid, as shown by MRI;
  • Instability severity index score (ISIS) < 4;
  • Non-Inclusion Criteria
  • Epilepsy;
Show all 10Show fewer
  • Associated rotator cuff tear;
  • Proximal humeral fracture;
  • Multidirectional or posterior instability by clinical evaluation;
  • Generalized ligamentous laxity by clinical evaluation;

Who cannot join

  • Irreparable injury to the anterior capsule or injury to the humeral insertion of the inferior glenohumeral ligament;
  • Glenoid bone defect greater than 20% of the anteroposterior diameter measured by arthroscopy;
  • Rotator cuff tear found on arthroscopy;
  • Abandonment of the rehabilitation program and follow-up before the first evaluation of outcomes

Trial locations and contacts

1 site in 1 country.

Brazil1 site
  • Departamento de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo

    São Paulo, São Paulo, 05403-010

Other trials in Brazil

About this study

The shoulder is the joint that most commonly suffers dislocation, and anterior instability is the most frequent form. Arthroscopic repair is the gold standard for the treatment of recurrent shoulder dislocation. The most commonly used technique is the attachment of glenoid labrum-ligament complex (GLLC) with knotted anchors. In 2001, Thal introduced the concept of tissue fixation using knotless anchors and its applicability for GLLC lesions. Some researchers have published studies using knotless anchors and have compared this technique to the use of knotted anchors, demonstrating similar reconstruction of labral height and functional outcomes, while the recurrence rate is still contradictory. To date, there are no prospective randomized controlled clinical trial comparing these two techniques of GLLC repairs.

The researchers aims to compare clinical outcomes and imaging evaluation of patients undergoing GLLC repair arthroscopically with the use of absorbable knotless and knotted anchors.

Read the detailed description

The shoulder is the joint that most commonly suffers dislocation, and anterior instability is the most frequent form. The overall incidence of first-time dislocations requiring closed reduction is 23.1 per 100,000 people/year, with a higher incidence in males and Caucasians. Individuals with a younger age at first dislocation show a higher rate of recurrence.

Arthroscopic repair is the gold standard for the treatment of recurrent shoulder dislocation, with similar outcomes to open repair. The technique is less aggressive because the tendon of the subscapularis does not need to be addressed, leading to shorter hospital stays, less scarring, earlier return to normal activities, and a greater postoperative range of motion.

In this technique, the glenoid labrum-ligament complex (GLLC) is repaired using bone anchors that can be metallic, absorbable, or flexible. Biomechanical studies have shown that these three types of anchors are similar in terms of cyclic loading resistance and bone fixation. Absorbable anchors are most frequently used because metallic anchors can cause postoperative imaging interference in MRI study, can migrate and became loose or break, which can damage the articular cartilage. Flexible anchors when submitted to cyclic stress can produce cystic cavities in bone tissue attachment 21, and probably can lead to a failure of glenoid labrum-ligament complex suture.

The most commonly used technique is the attachment of GLLC with knotted anchors. Studies have shown to perform an arthroscopic knot is challenging and can be technically difficult. The knot volume can produce friction during the shoulder movement, leading joint discomfort and cartilage damage. The quality of the soft tissue healing depend on the knot quality too. The dislocation recurrence rate with this technique ranges from 4% to 19%.

In 2001, Thal introduced the concept of tissue fixation using knotless anchors and its applicability for GLLC lesions. Although this new technique had solved the difficulty of tying knots, the results regarding the GLLC suture shown more gap formation between this complex and the glenoid bone, delayed anchor loosening and postoperative arthropathy. The recurrence rate is high associated with perianchor radiolucency.The recurrence rate with this technique is as high as 23.8%.

Some researchers have published studies using knotless anchors and have compared this technique to the use of knotted anchors, demonstrating similar reconstruction of labral height and functional outcomes, while the recurrence rate is still contradictory. To date, there are no prospective randomized controlled clinical trial comparing these two techniques of GLLC repairs.

Our researchers aims to compare clinical outcomes and imaging evaluation of patients undergoing GLLC repair arthroscopically with the use of absorbable knotless and knotted anchors.

Being tested
knotted anchors (SutureTak biocomposite 3.0 mm), knotless anchors (PushLock biocomposite 2.9 mm knotless)
Medical subject headings
Shoulder Dislocation

What participants receive

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

  • knotted anchors (SutureTak biocomposite 3.0 mm)Device

    Arthroscopic repair of the labral lesion with knotted anchors (SutureTak biocomposite 3.0 mm).

  • knotless anchors (PushLock biocomposite 2.9 mm knotless)Device

    Arthroscopic repair of the labral lesion with knotless anchors (PushLock biocomposite 2.9 mm knotless)

Study groups in NCT02535585
Study groupRoleWhat they receive
knotted anchorsActive comparatorArthroscopic repair of the labral lesion with knotted anchors (SutureTak biocomposite 3.0 mm).
Receives: Device: knotted anchors (SutureTak biocomposite 3.0 mm)
knotless anchorsActive comparatorArthroscopic repair of the labral lesion with knotless anchors (PushLock biocomposite 2.9 mm knotless)
Receives: Device: knotless anchors (PushLock biocomposite 2.9 mm knotless)

What is being measured

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

  1. Rowe scale

    To compare, using the Rowe scale, clinical outcomes, at one year after surgery, of patients undergoing labral lesion suture using knotted anchors with those treated with knotless anchors.

    Measured: 1 year

Secondary outcomes (9)
  1. dislocation recurrence rate

    To evaluate the postoperative dislocation recurrence rate in each group of patients

    Measured: 1 year

  2. intraoperative and postoperative complications

    To ascertain intraoperative (loosening, protrusion, and breaking of material) and postoperative (infection, stiffness, and osteoarthritis) complications

    Measured: 1 year

  3. WOSI

    To compare the clinical outcomes of the two patient groups using the Western Ontario Shoulder Instability Index (WOSI).

    Measured: 1 year

  4. ASES

    To compare the clinical outcomes of the two patient groups using the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES).

    Measured: 1 year

  5. Magnetic resonance imaging - LGHI

    Labrum glenoid height index (LGHI) - ratio of the labral height to the glenoid height

    Measured: 1 year

  6. Magnetic resonance imaging - Labral Slope

    Labral slope - angle between the line perpendicular to the deepest point of the glenoid to the labral glenoid apex

    Measured: 1 year

  7. Magnetic resonance imaging - Labral morphology

    Labral morphology (PDW EXP sequence) with the Rondelli classification

    Measured: 1 year

  8. Magnetic resonance imaging - Anchor resorption

    Anchor resorption (T1 sequence) according to Stein et al.

    Measured: 1 year

  9. Magnetic resonance imaging - Bone reaction

    Bone reaction (T2 sequence) according to Hoffmann et al.

    Measured: 1 year

Timeline

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

  1. First posted28 Aug 2015 (estimated)
  2. Study start27 Feb 2017
  3. Primary completion23 Mar 2020
  4. Study completion16 Jan 2021

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 N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Double blind
Who is masked
Participant, Outcomes assessor
Enrolment
58 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02535585
Sponsor's protocol ID
1134
Status last verified
Apr 2021
First submitted
21 Aug 2015
Last updated
6 Apr 2021
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No

Publications

  • Cutts S, Prempeh M, Drew S. Anterior shoulder dislocation. Ann R Coll Surg Engl. 2009 Jan;91(1):2-7. doi: 10.1308/003588409X359123.

    PubMed 19126329
  • Leroux T, Wasserstein D, Veillette C, Khoshbin A, Henry P, Chahal J, Austin P, Mahomed N, Ogilvie-Harris D. Epidemiology of primary anterior shoulder dislocation requiring closed reduction in Ontario, Canada. Am J Sports Med. 2014 Feb;42(2):442-50. doi: 10.1177/0363546513510391. Epub 2013 Nov 25.

    PubMed 24275862
  • Owens BD, Dawson L, Burks R, Cameron KL. Incidence of shoulder dislocation in the United States military: demographic considerations from a high-risk population. J Bone Joint Surg Am. 2009 Apr;91(4):791-6. doi: 10.2106/JBJS.H.00514.

    PubMed 19339562
  • Harris JD, Gupta AK, Mall NA, Abrams GD, McCormick FM, Cole BJ, Bach BR Jr, Romeo AA, Verma NN. Long-term outcomes after Bankart shoulder stabilization. Arthroscopy. 2013 May;29(5):920-33. doi: 10.1016/j.arthro.2012.11.010. Epub 2013 Feb 5.

    PubMed 23395467
  • Bollier MJ, Arciero R. Management of glenoid and humeral bone loss. Sports Med Arthrosc Rev. 2010 Sep;18(3):140-8. doi: 10.1097/JSA.0b013e3181e88ef9.

    PubMed 20711045
  • Kim SH, Ha KI, Cho YB, Ryu BD, Oh I. Arthroscopic anterior stabilization of the shoulder: two to six-year follow-up. J Bone Joint Surg Am. 2003 Aug;85(8):1511-8.

    PubMed 12925631
  • Carreira DS, Mazzocca AD, Oryhon J, Brown FM, Hayden JK, Romeo AA. A prospective outcome evaluation of arthroscopic Bankart repairs: minimum 2-year follow-up. Am J Sports Med. 2006 May;34(5):771-7. doi: 10.1177/0363546505283259.

    PubMed 16627629
  • Burkhart SS, De Beer JF. Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs: significance of the inverted-pear glenoid and the humeral engaging Hill-Sachs lesion. Arthroscopy. 2000 Oct;16(7):677-94. doi: 10.1053/jars.2000.17715.

    PubMed 11027751
  • Fabbriciani C, Milano G, Demontis A, Fadda S, Ziranu F, Mulas PD. Arthroscopic versus open treatment of Bankart lesion of the shoulder: a prospective randomized study. Arthroscopy. 2004 May;20(5):456-62. doi: 10.1016/j.arthro.2004.03.001.

    PubMed 15122134
  • Hayashida K, Yoneda M, Mizuno N, Fukushima S, Nakagawa S. Arthroscopic Bankart repair with knotless suture anchor for traumatic anterior shoulder instability: results of short-term follow-up. Arthroscopy. 2006 Jun;22(6):620-6. doi: 10.1016/j.arthro.2006.03.006.

    PubMed 16762700
  • Ng C, Bialocerkowski A, Hinman R. Effectiveness of arthroscopic versus open surgical stabilisation for the management of traumatic anterior glenohumeral instability. Int J Evid Based Healthc. 2007 Jun;5(2):182-207. doi: 10.1111/j.1479-6988.2007.00064.x.

    PubMed 21631787
  • Kim SH, Ha KI, Kim SH. Bankart repair in traumatic anterior shoulder instability: open versus arthroscopic technique. Arthroscopy. 2002 Sep;18(7):755-63. doi: 10.1053/jars.2002.31701.

    PubMed 12209434
  • Hobby J, Griffin D, Dunbar M, Boileau P. Is arthroscopic surgery for stabilisation of chronic shoulder instability as effective as open surgery? A systematic review and meta-analysis of 62 studies including 3044 arthroscopic operations. J Bone Joint Surg Br. 2007 Sep;89(9):1188-96. doi: 10.1302/0301-620X.89B9.18467.

    PubMed 17905956
  • Cooke SJ, Starks I, Kathuria V. The results of arthroscopic anterior stabilisation of the shoulder using the bioknotless anchor system. Sports Med Arthrosc Rehabil Ther Technol. 2009 Jan 19;1(1):2. doi: 10.1186/1758-2555-1-2.

    PubMed 19284697
  • Barber FA, Herbert MA. Cyclic loading biomechanical analysis of the pullout strengths of rotator cuff and glenoid anchors: 2013 update. Arthroscopy. 2013 May;29(5):832-44. doi: 10.1016/j.arthro.2013.01.028. Epub 2013 Apr 2.

    PubMed 23561482

Questions about this trial

What is this clinical trial studying?

A study testing knotted anchors (SutureTak biocomposite 3.0 mm) and knotless anchors (PushLock biocomposite 2.9 mm knotless) in people with Shoulder Dislocation, run by University of Sao Paulo at 1 site 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 10 inclusion and 4 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: finished, as of the sponsor's last update on 6 Apr 2021. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site 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?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

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?

Rowe scale (time frame: 1 year). 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 NCT02535585, which also lists 54 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 6 Apr 2021.

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