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Sponsors and Collaborators: |
University of Calgary Calgary Health Region Calgary Orthopaedic Research and Education Fund (COREF) Hip Hip Hooray |
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Information provided by: | University of Calgary |
ClinicalTrials.gov Identifier: | NCT00251264 |
The purpose of this study is to compare arthroscopic and open shoulder stabilization procedures by measuring the disease-specific quality of life outcome in patients with traumatic unidirectional anterior instability of the shoulder at 2 and 5 years.
Hypothesis: There is no difference in disease-specific quality of life outcomes in patients with traumatic unidirectional anterior shoulder instability, undergoing an arthroscopic versus an open stabilization procedure.
Condition | Intervention |
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Joint Instability Shoulder Dislocation |
Procedure: Open stabilization Procedure: Arthroscopic stabilization |
Study Type: | Interventional |
Study Design: | Treatment, Randomized, Single Blind (Outcomes Assessor), Active Control, Parallel Assignment, Efficacy Study |
Official Title: | Arthroscopic Versus Open Stabilization of Traumatic Unidirectional Anterior Shoulder Instability: A Randomized Clinical Trial |
Estimated Enrollment: | 194 |
Study Start Date: | November 2001 |
Estimated Study Completion Date: | February 2011 |
Estimated Primary Completion Date: | February 2011 (Final data collection date for primary outcome measure) |
Arms | Assigned Interventions |
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Open: Active Comparator |
Procedure: Open stabilization
Following examination under anesthesia, a 5cm standard deltopectoral incision is made. Dissection is continued exploiting the deltopectoral internervous plane. The conjoined tendon is retracted medially. The underlying subscapularis tendon is identified and incised horizontally or split vertically in its midsubstance. If required for adequate exposure, the subscapularis split may be extended by incising the inferior component of the subscapularis tendon near its insertion on the lesser tuberosity. The shoulder is entered by performing a "T" shaped arthrotomy with retractors for full exposure of the glenoid. Shoulder pathology is addressed with suture anchor repair of any capsulolabral detachment (ie.Bankart lesion) and/ or a capsular plication for repair of capsular redundancy.
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Arthroscopic: Active Comparator |
Procedure: Arthroscopic stabilization
With the examination under anesthesia completed the arthroscope is introduced through a standard posterior arthroscopy portal. A diagnostic arthroscopy is performed and the intrarticular pathology identified and documented. Any labral detachment (i.e. Bankart lesion) is repaired using suture anchor fixation and arthroscopic tying techniques. Capsular redundancy is addressed with the use of thermal electrocapsulorrhaphy or arthroscopic suture repair of the redundant capsule. With the repair complete 40 cc of 0.5% Bupivicaine is introduced into the joint. A sterile dressing is applied over the wounds and the operated shoulder placed in a shoulder immobilizer.
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Shoulder instability most commonly affects people in the late teens to mid thirties, which are the most active years, recreational and vocational. The resulting disability, time lost from work, as well as the effect on an individual's quality of life represent a significant clinical problem for the population and for the healthcare system.
The normal anatomy in the unstable shoulder can be restored using arthroscopic or open surgical stabilization techniques. There is considerable controversy surrounding the issue of arthroscopic versus open shoulder stabilization. Advocates of arthroscopic procedures cite the following as advantages: faster recovery, less post operative pain, decreased operative time, improved cosmetics, greater return of shoulder motion and the more accurate identification of intraarticular pathology. Those in favor of an open procedure cite superior long term results showing fewer recurrences with an open stabilization.
There are few published reports directly comparing arthroscopic versus open shoulder stabilization repairs. It is also difficult to compare the results of existing studies as they report on heterogeneous patient populations, using a variety of techniques on mixed pathologies, using different outcome scales and variable definitions of success and failure. This study will address this controversial issue by comparing the disease-specific quality of life outcomes in patients with traumatic unidirectional anterior shoulder instability undergoing an arthroscopic versus an open stabilization procedure.
This study is designed as a prospective randomized clinical trial with a second prospective analytical cohort study arm. In the randomized arm, patients are assigned to arthroscopic or open surgery based on varied block, computer-generated randomization. The expertise-based randomization method is used in this study, whereby the surgeons perform either arthroscopic or open surgery, but not both. Therefore, a patient is not only randomized to a treatment group, but is also assigned to the expert surgeon for that treatment.
Patients in the prospective analytical cohort study arm of the trial undergo shoulder stabilization (open or arthroscopic) with any surgeon and complete the same follow-up visits, however they have not been randomized. The outcomes of the prospective cohort will be compared to those of the randomized arm to determine if the expertise-based randomization method has an effect on patient outcome.
Disease-specific quality of life is assessed using the validated Western Ontario Shoulder Instability (WOSI) Index. The index has 21 questions divided into 4 categories: physical symptoms, sport/recreation/work, lifestyle and emotions. This self-administered questionnaire utilizes a 100mm visual analog scale format to provide an overall score out of 100. A lower score reflects a better quality of life.
Ages Eligible for Study: | 14 Years and older |
Genders Eligible for Study: | Both |
Accepts Healthy Volunteers: | No |
Inclusion Criteria:
Clinical:
Diagnosis of traumatic anterior shoulder instability, made by meeting all of the following:
Radiological:
Exclusion Criteria:
Clinical:
Diagnosis of multidirectional instability (MDI) or multidirectional laxity with anteroinferior instability (MDL-AII), made by two or more of:
Canada, Alberta | |
University of Calgary Sport Medicine Centre | |
Calgary, Alberta, Canada, T2N 1N4 |
Principal Investigator: | Nicholas Mohtadi, MD, FRCSC | University of Calgary Sport Medicine Centre |
Principal Investigator: | Robert Hollinshead, MD, FRCSC | University of Calgary Sport Medicine Centre |
Responsible Party: | University of Calgary ( Denise Chan, Orthopaedic Research Coordinator ) |
Study ID Numbers: | 15740 |
Study First Received: | November 8, 2005 |
Last Updated: | July 9, 2008 |
ClinicalTrials.gov Identifier: | NCT00251264 |
Health Authority: | Canada: Health Canada |
Shoulder instability Traumatic Anterior Unidirectional Open stabilization |
Arthroscopic Bankart repair Shoulder instability, traumatic Anterior, unidirectional instability Bankart |
Musculoskeletal Diseases Dislocations Joint Diseases Wounds and Injuries Shoulder Dislocation |
Disorders of Environmental Origin Bupivacaine Joint Instability Arm Injuries |