- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04299802
Percutaneous Ultrasonic Tenotomy Versus Platelet Rich Plasma for Gluteal Tendinopathy
A Prospective Randomized Comparison Study on the Effects of Percutaneous Ultrasonic Tenotomy Versus Leukocyte-Rich Platelet Rich Plasma for Refractory Gluteal Tendinopathy
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Aim of the Study:
To investigate the safety and effectiveness of a single percutaneous ultrasonic tenotomy procedure versus a single injection of autologous leukocyte-rich platelet rich plasma (LR-PRP) in subjects with symptomatic gluteal tendinopathy which has been refractory to conservative treatment
Hypothesis of the Study:
The hypothesis of this study is that subjects with symptomatic gluteal tendinopathy (defined as <50% partial-thickness tear of either the gluteus medius or gluteus minimus tendons on MRI or US) who receive either a single percutaneous ultrasonic tenotomy or a single injection of LR-PRP will demonstrate less pain and improved hip function compared to pre-treatment baseline.
Primary Objective:
The primary objective of this study is to evaluate safety and effectiveness of both a single percutaneous ultrasonic tenotomy or a single injection of LR-PRP in gluteal tendinopathy. Effectiveness will be demonstrated in a superiority trial design by comparing improvement in pain and function after a single percutaneous ultrasonic tenotomy versus a single injection of LR-PRP in refractory gluteal tendinopathy that has failed conservative management.
Randomization:
Subjects will be randomly assigned to the single percutaneous ultrasonic tenotomy procedure or single injection of LR-PRP arms in a 1:1 ratio.
Enrollment:
The providers from the Andrews Institute will enroll subjects into the study. 60 subjects assigned to two randomization arms will be enrolled: a single percutaneous ultrasonic tenotomy procedure arm and a single LR-PRP injection arm.
Study Duration:
Estimated Subject Enrollment Period: 36 weeks Treatment and Follow-up Period per Subject: 48 weeks
Follow-up Schedule:
Follow-up visits will occur at 2 weeks, 6 weeks, 12 weeks, 24 weeks and 48 weeks post-procedure. Visits will include physical examinations, patient-reported outcome questionnaires, medication usage, adverse event monitoring and MRIs. Follow-up phone calls will occur at 24 and 48 weeks post-procedure. Phone calls will include patient-reported outcome questionnaires, medication usage, and adverse event monitoring.
Study Type
Phase
- Not Applicable
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Males and Females 18 - 70 years of age (inclusive)
- Clinical symptoms for a minimum of three months
- Subjects have a baseline pain score of > 3
- Partial-thickness gluteal tendon tear (gluteus medius or gluteus minimus) defined as <50% partial-thickness tear of either tendon or imaging abnormalities consistent with tendinosis on a 3 Tesla MRI or diagnostic ultrasound within the last 3 months, as determined by the Investigator
Exclusion Criteria:
- Age < 18 or > 70
- Corticosteroid injection in the index gluteal bursae within the last 3 months
- Subjects who have received more than one (1) previous corticosteroid injections or percutaneous tenotomy procedure or any biologic treatment in the index gluteal bursae at any point in the past.
- Severe arthrosis of the femoral-acetabular joint
- A high-grade gluteal tendon tear (>50% partial-thickness tear)
- Previous hip surgery on the affected side
- Previous or current history of labral pathology on the affected side
- Lumbar radiculopathy impacting the index hip
- History of systemic malignant neoplasms within the last 5 years
- Malignant or local neoplasm within the last 6 months or any history of local neoplasm at the site of administration (on the affected side)
- Receiving immunosuppressive therapy
- Active regimen of chemotherapy or radiation-based treatment
- Allergy to sodium citrate or any "caine" type of local anesthetic
- Pregnancy
- Subject is currently participating in another clinical trial that has not yet completed its primary endpoint. (Non-interventional observational studies are not exclusionary.)
- Active workman's compensation case in progress
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Leukocyte-Rich Platelet-Rich Plasma (LR-PRP)
LR-PRP will be administered via usual protocol with venous blood draw and concentration via centrifugation.
The LR-PRP will be injected under ultrasound guidance into the gluteus minimus and gluteus medius tendons, enthesis and surrounding bursae.
|
LR-PRP will be a concentration of PRP with the addition of leukocytes.
Studies have shown that LR-PRP is more effective in treating tendinopathy than leukocyte-poor platelet-rich plasma.
Other Names:
|
Active Comparator: Percutaneous Ultrasonic Tenotomy
Percutaneous Ultrasonic Tenotomy will be administered via usual protocol within an outpatient surgical setting or in-office procedure.
Patient will be anesthetized with local anesthetic and a <5mm incision will be made along the lateral hip with an #11 scalpel.
A 14-G angiocath will be introduced through the defective area of the tendon down to the enthesis.
Multiple passes will be made and then the percutaneous ultrasonic tenotomy device will be introduced to the defective area.
No more than 5 minutes of energy cutting time will be used to address the defective area down to the enthesis, which will debride abnormal tissue but leave normal healthy tissue intact.
|
Discussed in Percutaneous Ultrasonic Tenotomy Arm section
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in Numeric Pain Rating Scale
Time Frame: Baseline, 12 weeks post treatment, 48 weeks post treatment, 1 year post treatment
|
Pain rating scale with a minimum score of 0 (No pain) and a maximum score of 10 (worst pain imaginable).
|
Baseline, 12 weeks post treatment, 48 weeks post treatment, 1 year post treatment
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in Victorian Institute for Sport Assessment for Gluteal Tendinopathy Score
Time Frame: Baseline, 12 weeks post treatment, 48 weeks post treatment, 1 year post treatment
|
Scores range from 0-100.
Higher scores indicate less pain and better function.
|
Baseline, 12 weeks post treatment, 48 weeks post treatment, 1 year post treatment
|
Change in Hip Disability and Osteoarthritis Outcome Score
Time Frame: Baseline, 12 weeks post treatment, 48 weeks post treatment, 1 year post treatment
|
Scores range from 0-100.
0 indicating the worst possible hip symptoms and 100 indicating no hip symptoms.
|
Baseline, 12 weeks post treatment, 48 weeks post treatment, 1 year post treatment
|
Change in Gluteal Muscle Strength
Time Frame: Baseline, 12 weeks post treatment, 48 weeks post treatment
|
Manual muscle strength will be assessed by an investigator.
The scale used will range from 0-5.
Lower scores indicate less strength.
|
Baseline, 12 weeks post treatment, 48 weeks post treatment
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in Visual Analog Scale for Procedure Satisfaction
Time Frame: Baseline, 24 weeks post treatment, 48 weeks post treatment
|
A VAS for satisfaction is a horizontal line of 100-mm long.
At the beginning and at the end, there are two descriptors representing extremes of satisfaction (i.e.
no satisfaction and extreme satisfaction).
The patient will make a vertical mark on the 100-mm line.
The measurement in millimetres will be converted to the same number of points ranging from 0 to 100 points.
|
Baseline, 24 weeks post treatment, 48 weeks post treatment
|
Collaborators and Investigators
Investigators
- Study Chair: James Andrews, MD, Andrews Research & Education Foundation
Publications and helpful links
General Publications
- Jacobson JA, Yablon CM, Henning PT, Kazmers IS, Urquhart A, Hallstrom B, Bedi A, Parameswaran A. Greater Trochanteric Pain Syndrome: Percutaneous Tendon Fenestration Versus Platelet-Rich Plasma Injection for Treatment of Gluteal Tendinosis. J Ultrasound Med. 2016 Nov;35(11):2413-2420. doi: 10.7863/ultra.15.11046. Epub 2016 Sep 23.
- Borg-Stein J, Osoria HL, Hayano T. Regenerative Sports Medicine: Past, Present, and Future (Adapted From the PASSOR Legacy Award Presentation; AAPMR; October 2016). PM R. 2018 Oct;10(10):1083-1105. doi: 10.1016/j.pmrj.2018.07.003. Epub 2018 Jul 19.
- Wu PI, Diaz R, Borg-Stein J. Platelet-Rich Plasma. Phys Med Rehabil Clin N Am. 2016 Nov;27(4):825-853. doi: 10.1016/j.pmr.2016.06.002.
- Fitzpatrick J, Bulsara MK, O'Donnell J, McCrory PR, Zheng MH. The Effectiveness of Platelet-Rich Plasma Injections in Gluteal Tendinopathy: A Randomized, Double-Blind Controlled Trial Comparing a Single Platelet-Rich Plasma Injection With a Single Corticosteroid Injection. Am J Sports Med. 2018 Mar;46(4):933-939. doi: 10.1177/0363546517745525. Epub 2018 Jan 2.
- Fitzpatrick J, Bulsara M, Zheng MH. The Effectiveness of Platelet-Rich Plasma in the Treatment of Tendinopathy: A Meta-analysis of Randomized Controlled Clinical Trials. Am J Sports Med. 2017 Jan;45(1):226-233. doi: 10.1177/0363546516643716. Epub 2016 Jul 21.
- Lee JJ, Harrison JR, Boachie-Adjei K, Vargas E, Moley PJ. Platelet-Rich Plasma Injections With Needle Tenotomy for Gluteus Medius Tendinopathy: A Registry Study With Prospective Follow-up. Orthop J Sports Med. 2016 Nov 9;4(11):2325967116671692. doi: 10.1177/2325967116671692. eCollection 2016 Nov.
- Neph A, Onishi K, Wang JH. Myths and Facts of In-Office Regenerative Procedures for Tendinopathy. Am J Phys Med Rehabil. 2019 Jun;98(6):500-511. doi: 10.1097/PHM.0000000000001097.
- Morrey, Bernard F.
- Barnes DE, Beckley JM, Smith J. Percutaneous ultrasonic tenotomy for chronic elbow tendinosis: a prospective study. J Shoulder Elbow Surg. 2015 Jan;24(1):67-73. doi: 10.1016/j.jse.2014.07.017. Epub 2014 Oct 8.
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 (Actual)
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
- 112233
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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