Articular Cartilage Disorder of Knee
Conditions
Brief summary
The purpose of this study is to evaluate the changes in clinical and imaging outcomes following arthroscopic treatment of chondral lesion(s) by Radiofrequency-Based debridement or Mechanical Debridement in subjects 18-50 years of age.
Detailed description
This is a non-inferiority, prospective, single blinded, randomized, single-center study design with enrollment of 82 randomized subjects (to assure 70 subjects complete the study). The sample size of 82 participants was calculated from a power analysis. The study was powered to detect at least a seven point change in KOOS pain score based on achieving 80% statistical power to detect a non-inferiority margin. Study duration will be until the last subject enrolled reaches 52 weeks post-operative. The 82 randomized subjects will be randomized at a 1:1 ratio into the Werewolf Coblation wand treatment group or mechanical debridement treatment group. Subjects will be blinded to their treatment assignment until they complete all study visits. Upon withdraw from the study, termination from the study, or new or recurrent symptoms requiring a subsequent arthroscopy, the blinded assignment will be revealed to the subject.
Interventions
DEVICERadiofrequency-Based Debridement
In this process, radiofrequency energy is used to excite the water molecules in a conductive medium, such as an electrolyte (saline) solution, to generate excited radicals within precisely focused plasma. The energized particles in the plasma have sufficient energy to break molecular bonds (16-18), excising or dissolving (i.e. ablating) soft tissue at relatively low temperatures (typically 40ºC to 70ºC).
DEVICEMechanical Debridement
Arthroscopic chondroplasty used to remove loose and damaged cartilage which minimizes synovial irritation and mechanical impingement
Sponsors
Smith & Nephew, Inc.
Christopher Kaeding
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Masking description
Study subject will not be made aware of the treatment received until after completion of the research study.
Eligibility
Sex/Gender
ALL
Age
18 Years to 50 Years
Healthy volunteers
No
Inclusion criteria
* Given written informed consent on the IRB approved consent form specific to the study, prior to study participation * 18-50 years old * Male or Female * Suspected chondral damage in the following locations where debridement is indicated: * Medial femoral condyle * Lateral femoral condyle * Trochlea * Patella * \< 30% joint space narrowing as seen on x-ray (merchant view, AP and PA Rosenberg) * 1 or more chondral lesion(s) as noted on MRI
Exclusion criteria
* Previous chondral treatment in the same compartment (prior debridement and lavage performed more than three months prior to baseline are acceptable) * Focal chondral defect indicated for concomitant procedures (i.e., microfracture, ACI, MACI, OATs) * Concomitant procedures that are not allowed: * Lateral retinacular release * Excision of osteophytes * Subchondroplasty * Manipulation under anesthesia * ACL reconstruction * Quad tendon repair * Patellar tendon repair * Patellar tendon debridement * Multiligament reconstruction * Pregnant and/or intending to become pregnant during this study period
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Knee and Osteoarthritis Outcome Scores (KOOS) activity subscale | change from baseline at week 52 post-op | The previous week is the time period considered when answering the questions. Standardized answer options are given (5 Likert boxes) and each question is assigned a score from 0 to 4. A normalized score (100 indicating no symptoms and 0 indicating extreme symptoms) is calculated for each subscale. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| International Knee Documentation Committee (IKDC) subjective knee evaluation | change from baseline at week 52 post-op | — |
| International Knee Documentation Committee (IKDC) objective knee | change from baseline at week 52 post-op | — |
| Visual Analogue Scale (VAS) | change from baseline at week 52 post-op | Using a ruler, the score is determined by mea-suring the distance (mm) on the 10-cm line between the no pain anchor and the patient's mark, providing a range of scores from 0-100. A higher score indicates greater pain intensity. |
| Work Productivity and Activity Impairment (WPAI V2.0) | change from 1 week post op to 6 weeks post-op | Asks about the effect of patient knee injury on their ability to work and perform normal daily activities |
| MRI | change from baseline at week 52 post-op | Baseline MRI will be compared to MRI at 52 weeks to evaluate knee morphology, cartilage signal, osteophytes, bone marrow edema, subarticular cysts, effusions and loose bodies. The international cartilage repair score will be used. |
| Marx Activity Rating Scale (MARS) | change from baseline at week 52 post-op | MARS includes 4 items that assess the frequency of running, cutting, decelerating, and pivoting based on the subjects healthiest and most active state in the past year. A higher score indicates more functional demand on the knee joint and potentially a higher risk of injury. Each item is scored on a 5-point ordinal scale ranging from 0 (less than 1 time in a month) to 4 (4 or more times in a week), and the total scale score is obtained by summing the individual items' scores (range, 0-16). |
Countries
United States
Outcome results
None listed