BioBrace® Implant for Arthroscopic Repair of Full Thickness Rotator Cuff Tears (REinForce)

REinForce: A Prospective, Single Blind, Multi-Center, Randomized, Controlled, Pivotal Study to Evaluate the Safety and Effectiveness of the BioBrace® Implant During Arthroscopic Repair of Full Thickness Rotator Cuff Tears

This study aims to evaluate the safety and effectiveness of arthroscopic rotator cuff repair augmented with the BioBrace® Implant vs. arthroscopic rotator cuff repair alone in subjects requiring surgical intervention for a full-thickness rotator cuff tear.

Study Overview

• Status: Enrolling by invitation
• Conditions: Rotator Cuff Tears
• Intervention / Treatment: Device: Arthroscopic rotator cuff repair with BioBrace® Implant augmentation.; Procedure: Arthroscopic rotator cuff repair

Detailed Description

This is a prospective, single blind, multi-center, randomized, controlled, pivotal clinical study investigating the treatment of full thickness tears of the rotator cuff. Tears must involve the supraspinatus and/or infraspinatus tendons and measure ≥ 2 cm and < 5 cm. Subjects meeting the inclusion/exclusion criteria will be enrolled and will undergo either arthroscopic rotator cuff repair augmented with the BioBrace® Implant or arthroscopic rotator cuff repair alone. Clinical evaluations will be conducted at baseline (pre-operatively) and at 6 weeks, 3-, 6-, and 12-months post-operatively using various patient-reported outcome measures and MRI to assess repair integrity and re-tear rate.

• Study Type: Interventional
• Enrollment (Estimated): 268
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Connecticut
    • New Haven, Connecticut, United States, 06513
      • ConMed

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

1. Male or female 40 to 70 years old

2. Positive diagnostic imaging by MRI within 6 months of enrollment of the index shoulder indicating a full thickness rotator cuff tear (RCT):

   1. Tear of the supraspinatus and/or infraspinatus tendons
   2. Tear size ≥ 2 cm and < 5 cm
3. Chronic shoulder pain ≥ 3 months

4. Failed non-operative treatment of the index shoulder to include one or all of the following:

   1. Oral analgesics
   2. Nonsteroidal anti-inflammatory medications (NSAIDs)
   3. Corticosteroid injections
   4. Activity modifications
   5. Physical therapy or home-guided exercises
5. Able to read and understand the study REB/IRB approved Informed Consent Form (ICF)
6. Willing to be available to attend each protocol-required follow-up examination

Intraoperative Inclusion Criteria:

1. Full thickness tear of the supraspinatus and/or infraspinatus tendons
2. Tear size ≥ 2 cm and < 5 cm
3. Able to reapproximate the tendons to cover > 50% of the footprint on the greater tuberosity

Exclusion Criteria:

1. Previous surgery of the index shoulder one year prior to the study surgery excluding diagnostic arthroscopy
2. Fatty infiltration of the index shoulder rotator cuff muscle ≥ Grade 3 (Goutallier Score)
3. Major medical condition that could affect quality of life and influence the results of the study as determined by the Investigator
4. Oral steroid use or steroid injection within 6 weeks prior to surgery
5. Active smoker
6. History of insulin-dependent diabetes
7. Documented evidence of a history (e.g., liver testing) of drug/alcohol abuse within 12 months of enrollment
8. Hypersensitivity to any investigational device materials including collagen of animal origin (bovine type-I), poly-L-lactic acid (PLLA) or polyethylene glycol (PEG)
9. Presence of an implanted metallic device or other implants that would contraindicate acquisition or inhibit radiologist review of an MRI of the index shoulder
10. History of claustrophobia that would prevent an MRI of the index shoulder
11. Females of child-bearing potential who are either pregnant or breastfeeding or plan to become pregnant during the course of the study
12. Currently participating, or plans to enroll in another clinical trial during this study that would affect the outcomes of this study as determined by the Investigator
13. History of non-compliance with medical treatment or clinical trial participation
14. The subject is physically or mentally compromised (e.g., currently being treated for a psychiatric disorder, senile dementia, Alzheimer's disease, etc.), to the extent that the Investigator judges the subject to be unable or unlikely to remain compliant with protocol required follow-up
15. Any comorbidity or condition that renders the patient a poor surgical candidate as determined by the Investigator
16. The subject is receiving prescription narcotic pain medication
17. The subject currently has an acute infection in the area surrounding the surgical site
18. Contralateral shoulder condition where rotator cuff repair is scheduled or to be scheduled over the course of this study
19. The subject's condition represents a worker's compensation case

Intraoperative Exclusion Criteria:

1. Subject requires subscapularis repair other than a repair with a single anchor

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: BioBrace Augment Group; An arthroscopic rotator cuff repair is performed with the BioBrace Implant fixed on top of the repaired tendon using anchors.	Device: Arthroscopic rotator cuff repair with BioBrace® Implant augmentation.; An arthroscopic rotator cuff repair will be performed and augmented with the BioBrace® Implant. The BioBrace® Implant is intended for use in surgical procedures for reinforcement of soft tissue where weakness exists. It is a bioresorbable, biocomposite scaffold composed of a highly porous collagen sponge and reinforced with poly-L-lactic-acid (PLLA). When used in rotator cuff repairs, it is placed on top of the tendons to augment and reinforce the underlying repair. The BioBrace® is designed to mechanically and biologically augment weakened or torn soft tissue and can be integrated into surgeons' standard of care rotator cuff repair techniques.
Sham Comparator: Repair Only Group; An arthroscopic rotator cuff repair is performed using standard surgical procedure.	Procedure: Arthroscopic rotator cuff repair; An arthroscopic rotator cuff repair is performed using standard surgical procedure.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
6 Month Retear Rate	The between-group difference in radiological incidence (MRI) of a Sugaya Type IV or V full-thickness discontinuity at postoperative Month 6.	6 months post-op

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
12 Month Retear Rate	The between-group difference in radiological incidence (MRI) of Sugaya Type IV or V full-thickness discontinuity at postoperative Month 12.	12 months post-op
Single Assessment Numeric Evaluation (SANE)	Adjusted mean between-group difference in SANE score from baseline to 6 weeks, 3-, 6-, and 12-months post-op	Baseline, 6 weeks, 3-, 6-, and 12-months post-op
Western Ontario Rotator Cuff Index (WORC)	Adjusted mean between-group difference in WORC score from baseline to 6 weeks, 3-, 6-, and 12-months post-op	Baseline, 6 weeks, 3-, 6-, and 12-months post-op
EuroQOL Five Dimensions Questionnaire (EQ-5D-5L)	Adjusted mean between-group difference in health-related, quality of life from baseline to 6 weeks, 3-, 6-, and 12-months post-op	Baseline, 6 weeks, 3-, 6-, and 12-months post-op

Collaborators and Investigators

• Sponsor: CONMED Corporation

Study record dates

Study Major Dates

• Study Start (Actual): January 5, 2024
• Primary Completion (Estimated): June 1, 2025
• Study Completion (Estimated): December 1, 2025

Study Registration Dates

• First Submitted: August 10, 2023
• First Submitted That Met QC Criteria: August 10, 2023
• First Posted (Actual): August 18, 2023

Study Record Updates

• Last Update Posted (Actual): May 7, 2024
• Last Update Submitted That Met QC Criteria: May 6, 2024
• Last Verified: May 1, 2024

More Information

Terms related to this study

• Keywords: Rotator cuff tear; Full thickness tear; BioBrace
• Additional Relevant MeSH Terms: Wounds and Injuries; Rupture; Shoulder Injuries; Tendon Injuries; Rotator Cuff Injuries
• Other Study ID Numbers: CSP-BB0003

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: Yes
• product manufactured in and exported from the U.S.: Yes