- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02710682
Tendon Fenestration Versus Surgery for the Treatment of Chronic Lateral Epicondylosis
Ultrasound-guided Tendon Fenestration Versus Open Surgery for the Treatment of Chronic Lateral Epicondylosis of the Elbow: a Prospective, Randomized, Single Blind, Pilot Study.
Lateral epicondylosis, also called tennis elbow or lateral epicondylitis, is a prevalent, painful syndrome of the elbow. It is refractory to conservative treatment measures, including rest, excentric and concentric exercises in approximately 20% of patients after 6 months. Corticosteroid injections can provide relief in the short term. Mini-open surgery may be proposed when the conservative treatment fails and studies have shown an efficacy of 70%. Ultrasound-guided tendon fenestration is a minimally-invasive technique which stimulates the physiological healing mechanisms of the tendon and appears promising for the treatment of chronic tendinopathies. To our knowledge, no studies have compared the US-guided fenestration technique to mini-open surgery for the treatment of chronic lateral epicondylosis.
The primary objective of this pilot study is to compare the efficacy of US-guided fenestration to mini-open surgery to reduce pain and improve functional status in workers suffering from chronic lateral epicondylosis refractory to 6-month conservative treatment.
This is a prospective single-blind randomized pilot study. Sixty-four subjects will be randomized into two intervention groups for treatment either by US-guided fenestration or mini-open surgery. The primary outcome of the study will be the Patient Rated Tennis Elbow Evaluation (PRTEE) score at 6 month post-procedure.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
STUDY DESIGN:
Phase II, prospective, two-arm, single-blind randomized controlled study.
SETTING:
Up to 64 patients (56 + 15% loss to follow-up) suffering from chronic lateral epicondylosis will be recruited by one of two orthopedists working in a specialized outpatient clinic, at the Centre Hospitalier de l'Université de Montréal (CHUM), a tertiary care academic center. Ultrasound examination of the elbow will be performed before the interventions.
RANDOMIZATION:
Using a computerized randomization list, the subjects will be randomized into the 2 treatment arms to be treated either by an US-guided tendon fenestration technique or by mini-open surgery. Randomization will be stratified by block sizes of 8.
FOLLOW UP Subjects' follow-up will extend over a period of 12 months - i.e., at 6 weeks and 3, 6 and 12 months post-intervention. The primary outcome will be the PRTEE score. Secondary outcomes will evaluate the impact of each procedure on: Pain-free grip (dynamometer), Medication Quantitative Scale, working activity (QuickDASH general and work modules; RA-WIS), Patient Global Impression of Change and Patient Satisfaction. The ultrasound examination will be repeated at 6 and 12 months. The predictive value of various B-mode parameters, color Doppler and elastography will be explored.
ANALYSIS:
The primary endpoint will be the proportion of subjects in each intervention arm presenting a reduction of at least 11/100 of the PRTEE score at 6 months post-intervention. The Fisher's exact test will be used to compare the proportion of subjects in each treatment group. The primary analysis will follow the intention-to-treat principle. Regarding the secondary endpoints, an ANOVA for repeated measures with two factors (time and group), a Fisher's exact test or a recursive partitioning analysis will be performed as appropriate.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
Quebec
-
Montréal, Quebec, Canada, H2X 0C1
- Centre Hospitalier de l'Université de Montréal
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Workers
- Ability to read, understand and answer questionnaires in French or English
- Diagnosis of unilateral, lateral epicondylosis established by an orthopaedist, determined by clinical presentation and pain, ≥ 4/10 on a pain numerical rating scale, on palpation of the region slightly anterior and distal to the lateral epicondyle, exacerbated by the extension of the wrist or the middle finger when the elbow is in extension.
- Chronic epicondylosis, refractory to medical treatment conducted for at least six months, which includes rest and implementation of ergonomics to avoid soliciting the extensor tendons, and at least one of: physical therapy, a rehabilitation program with stretching and / or strengthening exercises, injection treatments (corticosteroids, autologous PRP) or extracorporeal shock waves.
Exclusion Criteria:
- Suspected tumor or infectious etiology
- Injection of corticosteroids during the last 3 months
- Hemorrhagic diathesis; anticoagulation (platelets <50,000, International Normalized Ratio (INR) > 2)
- Local infection
- History of elbow surgery or fracture
- History of inflammatory arthropathy
- Neck pain and radiculopathy
- Inability to provide informed consent because of a language problem, dementia or a major psychiatric disorder.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Mini-open surgery
Surgery
|
This treatment will be administered by an orthopedic surgeon specialized in upper limb surgery.
|
Experimental: Ultrasound-guided Tendon fenestration
Tendon fenestration
|
This treatment will be administered by a fellowship-trained MSK radiologist.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Patient Rated Tennis Elbow Evaluation
Time Frame: Baseline and 6 months post-intervention
|
Proportion of patients with a change of at least 11/100 points in the score of the Patient Rated Tennis Elbow Evaluation - 6 months
|
Baseline and 6 months post-intervention
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Patient Rated Tennis Elbow Evaluation
Time Frame: Baseline and 6 weeks, 3 months, 12 months post-intervention
|
Proportion of patients with a change of at least 11/100 points in the score over the time. Mean change in the score over the time. |
Baseline and 6 weeks, 3 months, 12 months post-intervention
|
QuickDASH main module
Time Frame: Baseline and 6 weeks, 3 months, 6 months and 12 months post-intervention
|
Proportion of patients with a change of at least 8/100 points in the score over the time. Mean change in the score over the time. |
Baseline and 6 weeks, 3 months, 6 months and 12 months post-intervention
|
QuickDASH Work module
Time Frame: Baseline and 6 weeks, 3 months, 6 months and 12 months post-intervention
|
Proportion of patients with a change of at least 8/100 points in the score over the time. Mean change in the score over the time. |
Baseline and 6 weeks, 3 months, 6 months and 12 months post-intervention
|
RA-WIS questionnaire
Time Frame: Baseline and 6 weeks, 3 months, 6 months and 12 months post-intervention
|
Proportion of patients with score of at least 17 points over the time.
Mean change in the score over the time.
|
Baseline and 6 weeks, 3 months, 6 months and 12 months post-intervention
|
Grip strength without pain
Time Frame: Baseline and 6 weeks, 3 months, 6 months and 12 months post-intervention
|
Mean change over the time
|
Baseline and 6 weeks, 3 months, 6 months and 12 months post-intervention
|
Medication Quantitative Scale
Time Frame: 6 weeks, 3 months, 6 months and 12 months post-intervention
|
Mean change over the time
|
6 weeks, 3 months, 6 months and 12 months post-intervention
|
Global Perception of Change
Time Frame: 6 weeks, 3 months, 6 months and 12 months post-intervention
|
Proportion of patients reporting that their condition has significantly or moderately improved over the time
|
6 weeks, 3 months, 6 months and 12 months post-intervention
|
Level of satisfaction
Time Frame: 6 weeks, 3 months, 6 months and 12 months post-intervention
|
Proportion of patients reporting that their condition has significantly or moderately satisfied over the time
|
6 weeks, 3 months, 6 months and 12 months post-intervention
|
Common Extensor Tendon Morphometric parameters measured at B-mode ultrasound
Time Frame: Baseline, 6 and 12 months post-intervention
|
Recursive partitioning analysis
|
Baseline, 6 and 12 months post-intervention
|
Common Extensor Tendon Elasticity measured at ultrasound elastography
Time Frame: Baseline, 6 and 12 months post-intervention
|
Recursive partitioning analysis
|
Baseline, 6 and 12 months post-intervention
|
Collaborators and Investigators
Investigators
- Principal Investigator: Nathalie Bureau, MD, MSc, CRCHUM
Publications and helpful links
General Publications
- Lungu E, Grondin P, Tetreault P, Desmeules F, Cloutier G, Choiniere M, Bureau NJ. Ultrasound-guided tendon fenestration versus open-release surgery for the treatment of chronic lateral epicondylosis of the elbow: protocol for a prospective, randomised, single blinded study. BMJ Open. 2018 Jun 9;8(6):e021373. doi: 10.1136/bmjopen-2017-021373.
- Bureau NJ, Tétreault P, Grondin P, Freire V, Desmeules F, Cloutier G, Julien AS, Choinière M. Treatment of chronic lateral epicondylosis: a randomized trial comparing the efficacy of ultrasound-guided tendon dry needling and open-release surgery. Eur Radiol. 2022 Apr 28. doi: 10.1007/s00330-022-08794-4. [Epub ahead of print]
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- CE 15.327
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
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