Acute Cuff Tear Repair Trial (ACCURATE): protocol for a multicentre, randomised, placebo-controlled trial on the efficacy of arthroscopic rotator cuff repair

Anssi Ryösä, Juha Kukkonen, Hanna Cecilia Björnsson Hallgren, Stefan Moosmayer, Teresa Holmgren, Mats Ranebo, Berte Bøe, Ville Äärimaa, ACCURATE study group, Kaisa Lehtimäki, Sanna Johansson, Päivi Lampinen, Kimmo Mattila, Tommi Kauko, Tapio Flinkkilä, Kai Sirniö, Antti Joukainen, Simo Miettinen, Inka Vlasov, Inka Papponen, Janne Lehtinen, Kari Kanto, Hanna-Mari Laiho, Juha Paloneva, Antti Tuominen, Saara-Maija Hinkkanen, Tuomas Lähdeoja, Miia Mäntysaari, Leena Caravitis, Pauli Sjöblom, Erno Lehtonen-Smeds, Pirjo Takalalaukkanen, Marja Berg, Johan Scheer, Anne Dettmer, Annika Hjortenkrans, Carina Nilsson Skånevård Sund, Region Skåne, Knut Aagaard, Anders Olofsson, Karl Lunsjo, Anne Lönnberg, Frida Jönsson, Ingerid Baksaas Aasen, Ove Bjørnstad, Birgitte Holt Olsen, Sigurd Liavaag, Gunnar Kristiansen, Arild Ege, Linda Hansen, Ragnhild Ø Støen, Martine Enger, Ingrid Trøan, Anssi Ryösä, Juha Kukkonen, Hanna Cecilia Björnsson Hallgren, Stefan Moosmayer, Teresa Holmgren, Mats Ranebo, Berte Bøe, Ville Äärimaa, ACCURATE study group, Kaisa Lehtimäki, Sanna Johansson, Päivi Lampinen, Kimmo Mattila, Tommi Kauko, Tapio Flinkkilä, Kai Sirniö, Antti Joukainen, Simo Miettinen, Inka Vlasov, Inka Papponen, Janne Lehtinen, Kari Kanto, Hanna-Mari Laiho, Juha Paloneva, Antti Tuominen, Saara-Maija Hinkkanen, Tuomas Lähdeoja, Miia Mäntysaari, Leena Caravitis, Pauli Sjöblom, Erno Lehtonen-Smeds, Pirjo Takalalaukkanen, Marja Berg, Johan Scheer, Anne Dettmer, Annika Hjortenkrans, Carina Nilsson Skånevård Sund, Region Skåne, Knut Aagaard, Anders Olofsson, Karl Lunsjo, Anne Lönnberg, Frida Jönsson, Ingerid Baksaas Aasen, Ove Bjørnstad, Birgitte Holt Olsen, Sigurd Liavaag, Gunnar Kristiansen, Arild Ege, Linda Hansen, Ragnhild Ø Støen, Martine Enger, Ingrid Trøan

Abstract

Introduction: Rotator cuff tear is a very common and disabling condition that can be related to acute trauma. Rotator cuff tear surgery is a well-established form of treatment in acute rotator cuff tears. Despite its widespread use and almost a gold standard position, the efficacy of an arthroscopic rotator cuff repair is still unknown. The objective of this trial is to investigate the difference in outcome between arthroscopic rotator cuff repair and inspection of the shoulder joint defined as placebo surgery in patients 45-70 years of age with an acute rotator tear related to trauma.

Methods and analysis: Acute Cuff Tear Repair Trial (ACCURATE) is a randomised, placebo-controlled, multicentre efficacy trial with sample size of 180 patients. Concealed allocation is done in 1:1 ratio. The randomisation is stratified according to participating hospital, gender and baseline Western Ontario Rotator Cuff Index (WORC). Both groups receive the same standardised postoperative treatment and physiotherapy. The primary outcome measure is the change in WORC score from baseline to 2-year follow-up. Secondary outcome measures include Constant-Murley Score, the Numerical Rating Scale for pain, subjective patient satisfaction and the health-related quality of life instrument 15 dimensions (15D). Patients and outcome assessors are blinded from the allocated intervention. The primary analysis of results will be conducted according to intention-to-treat analysis.

Ethics and dissemination: The study protocol for this clinical trial has been approved by the Ethics Committee of the Hospital District of Southwest Finland and Regional Ethics Committee in Linköping Sweden and Regional Committees for Medical and Health Research Ethics South East in Norway. Every recruiting centre will apply local research approvals. The results of this study will be submitted for publication in peer-reviewed journals.

Trial registration number: NCT02885714; Pre-results.

Keywords: adult orthopaedics; orthopaedic sports trauma; shoulder.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Flow chart of the trial.

References

    1. Sørensen AK, Bak K, Krarup AL, et al. . Acute rotator cuff tear: do we miss the early diagnosis? A prospective study showing a high incidence of rotator cuff tears after shoulder trauma. J Shoulder Elbow Surg 2007;16:174–80. 10.1016/j.jse.2006.06.010
    1. Kukkonen J, Joukainen A, Itälä A, et al. . Operatively treated traumatic versus non-traumatic rotator cuff ruptures: a registry study. Ups J Med Sci 2013;118:29–34. 10.3109/03009734.2012.715597
    1. Braune C, von Eisenhart-Rothe R, Welsch F, et al. . Mid-term results and quantitative comparison of postoperative shoulder function in traumatic and non-traumatic rotator cuff tears. Arch Orthop Trauma Surg 2003;123:419–24. 10.1007/s00402-003-0548-2
    1. Björnsson HC, Norlin R, Johansson K, et al. . The influence of age, delay of repair, and tendon involvement in acute rotator cuff tears: structural and clinical outcomes after repair of 42 shoulders. Acta Orthop 2011;82:187–92. 10.3109/17453674.2011.566144
    1. Aagaard KE, Abu-Zidan F, Lunsjo K. High incidence of acute full-thickness rotator cuff tears. Acta Orthop 2015;86:558–62. 10.3109/17453674.2015.1022433
    1. Mall NA, Lee AS, Chahal J, et al. . An evidenced-based examination of the epidemiology and outcomes of traumatic rotator cuff tears. Arthroscopy 2013;29:366–76. 10.1016/j.arthro.2012.06.024
    1. Tashjian RZ. Epidemiology, natural history, and indications for treatment of rotator cuff tears. Clin Sports Med 2012;31:589–604. 10.1016/j.csm.2012.07.001
    1. Lähteenmäki HE, Virolainen P, Hiltunen A, et al. . Results of early operative treatment of rotator cuff tears with acute symptoms. J Shoulder Elbow Surg 2006;15:148–53. 10.1016/j.jse.2005.07.006
    1. Petersen SA, Murphy TP. The timing of rotator cuff repair for the restoration of function. J Shoulder Elbow Surg 2011;20:62–8. 10.1016/j.jse.2010.04.045
    1. Butler BR, Byrne AN, Higgins LD, et al. . Results of the repair of acute rotator cuff tears is not influenced by tear retraction. Int J Shoulder Surg 2013;7:91–9. 10.4103/0973-6042.118906
    1. Duncan NS, Booker SJ, Gooding BW, et al. . Surgery within 6 months of an acute rotator cuff tear significantly improves outcome. J Shoulder Elbow Surg 2015;24:1876–80. 10.1016/j.jse.2015.05.043
    1. Colvin AC, Egorova N, Harrison AK, et al. . National trends in rotator cuff repair. J Bone Joint Surg Am 2012;94:227–33. 10.2106/JBJS.J.00739
    1. Judge A, Murphy RJ, Maxwell R, et al. . Temporal trends and geographical variation in the use of subacromial decompression and rotator cuff repair of the shoulder in England. Bone Joint J 2014;96-B:70–4. 10.1302/0301-620X.96B1.32556
    1. Ensor KL, Kwon YW, Dibeneditto MR, et al. . The rising incidence of rotator cuff repairs. J Shoulder Elbow Surg 2013;22:1628–32. 10.1016/j.jse.2013.01.006
    1. Paloneva J, Lepola V, Äärimaa V, et al. . Increasing incidence of rotator cuff repairs-A nationwide registry study in Finland. BMC Musculoskelet Disord 2015;16:189 10.1186/s12891-015-0639-6
    1. Ernst E, Resch KL. Concept of true and perceived placebo effects. BMJ 1995;311:551–3. 10.1136/bmj.311.7004.551
    1. Wartolowska K, Judge A, Hopewell S, et al. . Use of placebo controls in the evaluation of surgery: systematic review. BMJ 2014;348:g3253 10.1136/bmj.g3253
    1. Tenery R, Rakatansky H, Riddick FA, et al. . Surgical "placebo" controls. Ann Surg 2002;235:303–7.
    1. Colagiuri B, Schenk LA, Kessler MD, et al. . The placebo effect: From concepts to genes. Neuroscience 2015;307:171–90. 10.1016/j.neuroscience.2015.08.017
    1. Savulescu J, Wartolowska K, Carr A. Randomised placebo-controlled trials of surgery: ethical analysis and guidelines. J Med Ethics 2016;42:776–83. 10.1136/medethics-2015-103333
    1. Ryösä A, Laimi K, Äärimaa V, et al. . Surgery or conservative treatment for rotator cuff tear: a meta-analysis. Disabil Rehabil 2017;39:1357–63. 10.1080/09638288.2016.1198431
    1. Chan AW, Tetzlaff JM, Altman DG, et al. . SPIRIT 2013 statement: defining standard protocol items for clinical trials. Ann Intern Med 2013;158:200–7. 10.7326/0003-4819-158-3-201302050-00583
    1. Schulz KF, Altman DG, Moher D, et al. . CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMJ 2010;340:c332 10.1136/bmj.c332
    1. Hamada K, Yamanaka K, Uchiyama Y, et al. . A radiographic classification of massive rotator cuff tear arthritis. Clin Orthop Relat Res 2011;469:2452–60. 10.1007/s11999-011-1896-9
    1. Samilson RL, Prieto V. Dislocation arthropathy of the shoulder. J Bone Joint Surg Am 1983;65:456–60. 10.2106/00004623-198365040-00005
    1. Hamada K, Fukuda H, Mikasa M, et al. . Roentgenographic findings in massive rotator cuff tears. A long-term observation. Clin Orthop Relat Res 1990;254:92–6. 10.1097/00003086-199005000-00014
    1. Fuchs B, Weishaupt D, Zanetti M, et al. . Fatty degeneration of the muscles of the rotator cuff: assessment by computed tomography versus magnetic resonance imaging. J Shoulder Elbow Surg 1999;8:599–605. 10.1016/S1058-2746(99)90097-6
    1. Henn RF, Kang L, Tashjian RZ, et al. . Patients' preoperative expectations predict the outcome of rotator cuff repair. J Bone Joint Surg Am 2007;89:1913–9. 10.2106/JBJS.F.00358
    1. Oh JH, Yoon JP, Kim JY, et al. . Effect of expectations and concerns in rotator cuff disorders and correlations with preoperative patient characteristics. J Shoulder Elbow Surg 2012;21:715–21. 10.1016/j.jse.2011.10.017
    1. Dunn WR, Kuhn JE, Sanders R, et al. . 2013 Neer Award: predictors of failure of nonoperative treatment of chronic, symptomatic, full-thickness rotator cuff tears. J Shoulder Elbow Surg 2016;25:1303–11. 10.1016/j.jse.2016.04.030
    1. Colagiuri B. Participant expectancies in double-blind randomized placebo-controlled trials: potential limitations to trial validity. Clin Trials 2010;7:246–55. 10.1177/1740774510367916
    1. Frisaldi E, Shaibani A, Benedetti F. Why we should assess patients' expectations in clinical trials. Pain Ther 2017;6:107–10. 10.1007/s40122-017-0071-8
    1. Younger J, Gandhi V, Hubbard E, et al. . Development of the stanford expectations of treatment scale (sets): a tool for measuring patient outcome expectancy in clinical trials. Clin Trials 2012;9:767–76. 10.1177/1740774512465064
    1. Cho CH, Seo HJ, Bae KC, et al. . The impact of depression and anxiety on self-assessed pain, disability, and quality of life in patients scheduled for rotator cuff repair. J Shoulder Elbow Surg 2013;22:1160–6. 10.1016/j.jse.2013.02.006
    1. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983;67:361–70. 10.1111/j.1600-0447.1983.tb09716.x
    1. Outerbridge RE, Dunlop JA. The problem of chondromalacia patellae. Clin Orthop Relat Res 1975;110:177–96. 10.1097/00003086-197507000-00024
    1. Holmgren T, Björnsson Hallgren H, Öberg B, et al. . Effect of specific exercise strategy on need for surgery in patients with subacromial impingement syndrome: randomised controlled study. BMJ 2012;344:e787 10.1136/bmj.e787
    1. Harris JD, Pedroza A, Jones GL, et al. . Predictors of pain and function in patients with symptomatic, atraumatic full-thickness rotator cuff tears: a time-zero analysis of a prospective patient cohort enrolled in a structured physical therapy program. Am J Sports Med 2012;40:359–66. 10.1177/0363546511426003
    1. Kluczynski MA, Nayyar S, Marzo JM, et al. . Early versus delayed passive range of motion after rotator cuff repair: a systematic review and meta-analysis. Am J Sports Med 2015;43:2057–63. 10.1177/0363546514552802
    1. Thigpen CA, Shaffer MA, Gaunt BW, et al. . The American Society of shoulder and elbow therapists' consensus statement on rehabilitation following arthroscopic rotator cuff repair. J Shoulder Elbow Surg 2016;25:521–35. 10.1016/j.jse.2015.12.018
    1. Klintberg IH, Cools AM, Holmgren TM, et al. . Consensus for physiotherapy for shoulder pain. Int Orthop 2015;39:715–20. 10.1007/s00264-014-2639-9
    1. Edwards P, Ebert J, Joss B, et al. . Exercise rehabilitation in the non-operative management of rotator cuff tears: a review of the literature. Int J Sports Phys Ther 2016;11:279–301.
    1. Kirkley A, Alvarez C, Griffin S. The development and evaluation of a disease-specific quality-of-life questionnaire for disorders of the rotator cuff: The Western Ontario Rotator Cuff Index. Clin J Sport Med 2003;13:84–92. 10.1097/00042752-200303000-00004
    1. Huang H, Grant JA, Miller BS, et al. . A Systematic review of the psychometric properties of patient-reported outcome instruments for use in patients with rotator cuff disease. Am J Sports Med 2015;43:2572–82. 10.1177/0363546514565096
    1. Ekeberg OM, Bautz-Holter E, Keller A, et al. . A questionnaire found disease-specific WORC index is not more responsive than SPADI and OSS in rotator cuff disease. J Clin Epidemiol 2010;63:575–84. 10.1016/j.jclinepi.2009.07.012
    1. Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 1987;214:160–4.
    1. Henseler JF, Kolk A, van der Zwaal P, et al. . The minimal detectable change of the constant score in impingement, full-thickness tears, and massive rotator cuff tears. J Shoulder Elbow Surg 2015;24:376–81. 10.1016/j.jse.2014.07.003
    1. Constant CR, Gerber C, Emery RJ, et al. . A review of the constant score: modifications and guidelines for its use. J Shoulder Elbow Surg 2008;17:355–61. 10.1016/j.jse.2007.06.022
    1. Kirkley A, Griffin S, Dainty K. Scoring systems for the functional assessment of the shoulder. Arthroscopy 2003;19:1109–20. 10.1016/j.arthro.2003.10.030
    1. Kukkonen J, Kauko T, Vahlberg T, et al. . Investigating minimal clinically important difference for Constant score in patients undergoing rotator cuff surgery. J Shoulder Elbow Surg 2013;22:1650–5. 10.1016/j.jse.2013.05.002
    1. Holmgren T, Oberg B, Adolfsson L, et al. . Minimal important changes in the Constant-Murley score in patients with subacromial pain. J Shoulder Elbow Surg 2014;23:1083–90. 10.1016/j.jse.2014.01.014
    1. Williamson A, Hoggart B. Pain: a review of three commonly used pain rating scales. J Clin Nurs 2005;14:798–804. 10.1111/j.1365-2702.2005.01121.x
    1. Farrar JT, Young JP, LaMoreaux L, et al. . Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain 2001;94:149–58. 10.1016/S0304-3959(01)00349-9
    1. Michener LA, Snyder AR, Leggin BG. Responsiveness of the numeric pain rating scale in patients with shoulder pain and the effect of surgical status. J Sport Rehabil 2011;20:115–28. 10.1123/jsr.20.1.115
    1. Sintonen H. The 15D instrument of health-related quality of life: properties and applications. Ann Med 2001;33:328–36. 10.3109/07853890109002086
    1. Alanne S, Roine RP, Räsänen P, et al. . Estimating the minimum important change in the 15D scores. Qual Life Res 2015;24:599–606. 10.1007/s11136-014-0787-4
    1. Sugaya H, Maeda K, Matsuki K, et al. . Functional and structural outcome after arthroscopic full-thickness rotator cuff repair: single-row versus dual-row fixation. Arthroscopy 2005;21:1307–16. 10.1016/j.arthro.2005.08.011
    1. Bang H, Ni L, Davis CE. Assessment of blinding in clinical trials. Control Clin Trials 2004;25:143–56. 10.1016/j.cct.2003.10.016
    1. Wessel J, Razmjou H, Mewa Y, et al. . The factor validity of the western ontario rotator cuff index. BMC Musculoskelet Disord 2005;6:22 10.1186/1471-2474-6-22
    1. Järvinen TL, Sihvonen R, Bhandari M, et al. . Blinded interpretation of study results can feasibly and effectively diminish interpretation bias. J Clin Epidemiol 2014;67:769–72. 10.1016/j.jclinepi.2013.11.011
    1. Raman J, Walton D, MacDermid JC, et al. . Predictors of outcomes after rotator cuff repair-A meta-analysis. J Hand Ther 2017;30:276–92. 10.1016/j.jht.2016.11.002
    1. Wade R, Salgar S. Clinico-radiological evaluation of retear rate in arthroscopic double row versus single row repair technique in full thickness rotator cuff tear. J Orthop 2017;14:313–8. 10.1016/j.jor.2017.01.001
    1. Pennington WT, Gibbons DJ, Bartz BA, et al. . Comparative analysis of single-row versus double-row repair of rotator cuff tears. Arthroscopy 2010;26:1419–26. 10.1016/j.arthro.2010.03.013
    1. Sobhy MH, Khater AH, Hassan MR, et al. . Do functional outcomes and cuff integrity correlate after single- versus double-row rotator cuff repair? A systematic review and meta-analysis study. Eur J Orthop Surg Traumatol 2018;28:593–605. 10.1007/s00590-018-2145-7
    1. Spiegl UJ, Euler SA, Millett PJ, et al. . Summary of meta-analyses dealing with single-row versus double-row repair techniques for rotator cuff tears. Open Orthop J 2016;10:330–8. 10.2174/1874325001610010330
    1. Mascarenhas R, Chalmers PN, Sayegh ET, et al. . Is double-row rotator cuff repair clinically superior to single-row rotator cuff repair: a systematic review of overlapping meta-analyses. Arthroscopy 2014;30:1156–65. 10.1016/j.arthro.2014.03.015
    1. Millett PJ, Warth RJ, Dornan GJ, et al. . Clinical and structural outcomes after arthroscopic single-row versus double-row rotator cuff repair: a systematic review and meta-analysis of level I randomized clinical trials. J Shoulder Elbow Surg 2014;23:586–97. 10.1016/j.jse.2013.10.006
    1. Maman E, Harris C, White L, et al. . Outcome of nonoperative treatment of symptomatic rotator cuff tears monitored by magnetic resonance imaging. J Bone Joint Surg Am 2009;91:1898–906. 10.2106/JBJS.G.01335
    1. Safran O, Schroeder J, Bloom R, et al. . Natural history of nonoperatively treated symptomatic rotator cuff tears in patients 60 years old or younger. Am J Sports Med 2011;39:710–4. 10.1177/0363546510393944
    1. Ranebo MC, Björnsson Hallgren HC, Norlin R, et al. . Clinical and structural outcome 22 years after acromioplasty without tendon repair in patients with subacromial pain and cuff tears. J Shoulder Elbow Surg 2017;26:1262–70. 10.1016/j.jse.2016.11.012
    1. Choi S, Kim MK, Kim GM, et al. . Factors associated with clinical and structural outcomes after arthroscopic rotator cuff repair with a suture bridge technique in medium, large, and massive tears. J Shoulder Elbow Surg 2014;23:1675–81. 10.1016/j.jse.2014.02.021
    1. Boileau P, Brassart N, Watkinson DJ, et al. . Arthroscopic repair of full-thickness tears of the supraspinatus: does the tendon really heal? J Bone Joint Surg Am 2005;87:1229–40. 10.2106/JBJS.D.02035
    1. Heuberer PR, Smolen D, Pauzenberger L, et al. . Longitudinal long-term magnetic resonance imaging and clinical follow-up after single-row arthroscopic rotator cuff repair: clinical superiority of structural tendon integrity. Am J Sports Med 2017;45:1283–8. 10.1177/0363546517689873
    1. Russell RD, Knight JR, Mulligan E, et al. . Structural integrity after rotator cuff repair does not correlate with patient function and pain: a meta-analysis. J Bone Joint Surg Am 2014;96:265–71. 10.2106/JBJS.M.00265
    1. Fucentese SF, von Roll AL, Pfirrmann CW, et al. . Evolution of nonoperatively treated symptomatic isolated full-thickness supraspinatus tears. J Bone Joint Surg Am 2012;94:801–8. 10.2106/JBJS.I.01286
    1. Yamamoto A, Takagishi K, Osawa T, et al. . Prevalence and risk factors of a rotator cuff tear in the general population. J Shoulder Elbow Surg 2010;19:116–20. 10.1016/j.jse.2009.04.006
    1. Fukuda H. Partial-thickness rotator cuff tears: a modern view on Codman’s classic. J Shoulder Elbow Surg 2000;9:163–8. 10.1067/mse.2000.101959
    1. Loew M, Magosch P, Lichtenberg S, et al. . How to discriminate between acute traumatic and chronic degenerative rotator cuff lesions: an analysis of specific criteria on radiography and magnetic resonance imaging. J Shoulder Elbow Surg 2015;24:1685–93. 10.1016/j.jse.2015.06.005
    1. Teefey SA, Middleton WD, Bauer GS, et al. . Sonographic differences in the appearance of acute and chronic full-thickness rotator cuff tears. J Ultrasound Med 2000;19:377–8. 10.7863/jum.2000.19.6.377
    1. Buirski G. Magnetic resonance imaging in acute and chronic rotator cuff tears. Skeletal Radiol 1990;19:109–11. 10.1007/BF00197615
    1. Randelli P, Spennacchio P, Ragone V, et al. . Complications associated with arthroscopic rotator cuff repair: a literature review. Musculoskelet Surg 2012;96:9–16. 10.1007/s12306-011-0175-y
    1. Yeranosian MG, Arshi A, Terrell RD, et al. . Incidence of acute postoperative infections requiring reoperation after arthroscopic shoulder surgery. Am J Sports Med 2014;42:437–41. 10.1177/0363546513510686
    1. Lenza M, Buchbinder R, Takwoingi Y, et al. . Magnetic resonance imaging, magnetic resonance arthrography and ultrasonography for assessing rotator cuff tears in people with shoulder pain for whom surgery is being considered. Cochrane Database Syst Rev 2013;9:CD009020 10.1002/14651858.CD009020.pub2
    1. Stock G. If the goal is relief, what’s wrong with a placebo? Am J Bioeth 2003;3:53–4. 10.1162/152651603322614616
    1. Wartolowska KA, Gerry S, Feakins BG, et al. . A meta-analysis of temporal changes of response in the placebo arm of surgical randomized controlled trials: an update. Trials 2017;18:323 10.1186/s13063-017-2070-9

Source: PubMed

3
Abonnere