Rotator Cuff Injuries, Rotator Cuff Tendinitis, Syndrome Rotator Cuff, Tendinopathy, Tendinoses, Rotator Cuff
Conditions
Keywords
Collagen Type I, MD-Shoulder Collagen Medical Device, Shoulder, Constant Murley Score, American Shoulder and Elbow Surgeons, Numeric Rating Scale, Simply Shoulder Test, Range of Motion
Brief summary
Rotator Cuff Syndrome is a commonly encountered musculoskeletal disorder in clinical practice, with an incidence ranging from 0.3% to 5.5%, and an annual prevalence of 0.5% to 7.4%. In addition, over time, with a monthly rate of 0.26%, this condition can progress to complete rotator cuff tendon injury resulting in worsening pain and shoulder function. The etiology of Rotator Cuff Syndrome is still controversial. What the investigators know is that in tendinopathies there are histological changes in the structure of the tendons, resulting in a change in the mechanical properties of the tendons and leading to a chronic often disabling pain condition. Although conservative therapy should still be considered the first choice in cuff tendinopathies, The clinical results of the various types of nonsurgical treatments are still mixed and often show poor efficacy. This explains the growing interest of the scientific community in developing new biological therapies that can both improve shoulder function and promote tendon healing. The aim of the study is to evaluate, through the Constant Murley Score (CMS), the performance of intra-articular treatment with a collagen-based medical device (MD-Shoulder Collagen Medical Device) in recovering joint function and reducing pain in Rotator Cuff Syndrome.
Detailed description
This is a pilot monocentric Clinical Investigation based on a one sample design. The purpose of this research is to evaluate, through the CMS functional scale, the performance of intra-articular treatment with a collagen-based medical device in recovering joint function and reducing associated pain. The safety of the treatment will also be assessed. Variables will be assessed at 6 different times points: at baseline (day0), after weeks 2, weeks 4, months 3, months 6, and after months 12. The total duration of the study will be 16 months. There will be a 4-month subject selection and recruitment period and a 12-month treatment and observation period. A total of 24 subjects with painful shoulder in Rotator Cuff Syndrome will be enrolled. The recruitment phase will be closed no sooner than the number of subjects planned in the study has been reached. Enrollment will involve subjects with rotator cuff syndrome who are eligible according to the selection criteria. Diagnosis will be performed by the Principal Investigator through clinical examination and instrumental investigation with shoulder MRI. The investigators will explain the rationale for the investigation plan and the procedures involved to the eligible subjects. Consent to participate in the study will then be sought. Prior or ongoing the treatments of any kind will be documented. In order to monitor analgesic consumption (Celecoxib 200mg / Paracetamol 1000 mg) used during the study in case of pain onset, a clinical diary will be given to the subject in which to indicate the day and dose of medication used.
Interventions
Only one experimental group is scheduled by the Investigation Plan to be treated with 2-mL volume ultrasound-guided infiltrations of MD-Shoulder Collagen Medical Device (GUNA, Milan-Italy). Subjects will be treated with number one ultrasound-guided infiltration at the time of enrollment, 2 weeks after enrollment, and 4 weeks after enrollment. Intra-articular infiltrations will be performed with 5cc syringes and 22-gauge needles. MD-Shoulder Collagen Medical Device will be infiltrated within the scapulohumeral joint under conditions of complete asepsis.
Sponsors
Study design
Intervention model description
one sample study
Eligibility
Inclusion criteria
* Subjects with age \> 18 years. * Subjects with shoulder pain for at least 3 month. * Subjects with a diagnosis of rotator cuff tendinopathy, subacromial conflict syndrome, partial rotator cuff tendon injuries (injuries A and B according to Snyder's Classification). * Subjects with a CMS score between 40 and 75. * Subjects who understood and signed the Informed Consent to Active Participation in the study. * Subjects able to understand the conditions of the study and participate throughout the duration.
Exclusion criteria
* Subjects with complete rotator cuff lesions (C lesions according to Snyder's classification). * Subjects with shoulder instability. * Subjects with adhesive retractile capsulitis. * Subjects undergoing Hyaluronic Acid and/or cortisone infiltration in a period \< 3 months. * Subjects with diabetes mellitus. * Subjects with uncontrolled thyroid disease. * Subjects with coagulopathies. * Subjects on chronic treatment with immunosuppressants. * Subjects with an allergy to porcine collagen. * Subjects in pregnancy or lactation.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change From Baseline in Constant-Murley Score (CMS) at 3 Months | 3 months after baseline (Day 0) | The primary outcome is the change from baseline in the Constant-Murley Score (CMS) at 3 months after the first intra-articular injection. The CMS is a validated clinical scale ranging from 0 to 100 points, where higher scores indicate better shoulder function and less pain. It includes four subdomains: pain (15 points), activities of daily living (20 points), range of motion (40 points), and strength (25 points). An increase of at least 13 points is considered very clinically significant. Results will be analyzed as the mean change in CMS from baseline (Day 0) to Month 3. Unit of Measure: Points on the Constant-Murley Scale (0-100) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Evaluation of MD-Shoulder Collagen Medical Device With Numeric Rating Scale | weeks 2, weeks 4, months 3, months 6, months 12 | Secondary Endpoints will consist of the evaluation of MD-Shoulder Collagen Medical Device, with NRS (Numeric Rating Scale) at weeks 2, weeks 4, months 3, mouth 6, mouth 12 compared to day 0. |
| Evaluation of MD-Shoulder Collagen Medical Device With American Shoulder and Elbow Surgeons (ASES)Scores Range From 0 to 100 With a Score of 0 Indicating a Worse Shoulder Condition and 100 Indicating a Better Shoulder Condition | months 3 months 6, months 12 | Secondary Endpoints will consist of the evaluation of MD-Shoulder Collagen Medical with American Shoulder and Elbow Surgeons (ASES), Simply Shoulder Test (SST) and Range Of Motion (ROM) at months 3, mouth 6, mouth 12 compared to day 0 |
| Evaluation of MD-Shoulder Collagen Medical Device With Simply Shoulder Test (SST), the Items on the Scale Measure the Ability of the Affected Shoulder to Perform Work Duties, Dressing, Bathing, Lifting, Carrying and Throwing. | months 3, months 6, months12 | Secondary Endpoints will consist of the evaluation of MD-Shoulder Collagen Medical Device with simply shoulder test (SST) at months 3, mouth 6, mouth 12 compared to day 0 number of yes/number of completed items 100 = % of yes response. 0 = worst and 100 = best function |
| Evaluation of MD-Shoulder Collagen Medical Device Performance Using the Constant-Murley Score | months 6, months12 | Secondary Endpoints will consist of the evaluation of MD-Shoulder Collagen Medical device through CMS at months 6 and months 12 compared to day 0. |
| Evaluation of MD-Shoulder Collagen Medical With Cuff Integrity at Mouth 12 Compared to Day 0 by Performing With Magnetic Resonance Imaging (MRI) of the Treated Shoulder. | month 12 | Secondary Endpoints will consist of the evaluation of MD-Shoulder Collagen Medical with cuff integrity at mouth 12 compared to day 0 by performing with Magnetic Resonance Imaging (MRI) of the treated shoulder. |
| Evaluation of MD-Shoulder Collagen Medical With Assessment of Analgesic Drug Unit Consumption Based on Clinical Diary at Various Phases of the Study. | months 3, months 6, months 12 | Secondary Endpoints will consist of the evaluation of MD-Shoulder Collagen Medical with Analgesic consumption at various phases of the study with use of clinical diary |
| Safety Evaluation | weeks 2, weeks 4, months 3, months 6, months 12 | Evaluation of Adverse Events. |
| Evaluation of MD-Shoulder Collagen Medical Device With Range of Motion (ROM). | months 3, months 6, months12 | Secondary Endpoints will consist of the evaluation of MD-Shoulder Collagen Medical with Range Of Motion (ROM) at months 3, mouth 6, mouth 12 compared to day 0 |
Countries
Italy
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| MD-Shoulder Medical Device MD-Shoulder Medical Device type I collagen based
MD-Shoulder Collagen Medical Device: Only one experimental group is scheduled by the Investigation Plan to be treated with 2-mL volume ultrasound-guided infiltrations of MD-Shoulder Collagen Medical Device (GUNA, Milan-Italy).
Subjects will be treated with number one ultrasound-guided infiltration at the time of enrollment, 2 weeks after enrollment, and 4 weeks after enrollment.
Intra-articular infiltrations will be performed with 5cc syringes and 22-gauge needles.
MD-Shoulder Collagen Medical Device will be infiltrated within the scapulohumeral joint under conditions of complete asepsis. | 24 |
| Total | 24 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | withdrawn | 1 |
Baseline characteristics
| Characteristic | MD-Shoulder Medical Device |
|---|---|
| Age, Categorical <=18 years | 0 Participants |
| Age, Categorical >=65 years | 0 Participants |
| Age, Categorical Between 18 and 65 years | 24 Participants |
| Ethnicity (NIH/OMB) Hispanic or Latino | 24 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 0 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants |
| Sex: Female, Male Female | 16 Participants |
| Sex: Female, Male Male | 8 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 0 / 24 |
| other Total, other adverse events | 1 / 24 |
| serious Total, serious adverse events | 0 / 24 |
Outcome results
Change From Baseline in Constant-Murley Score (CMS) at 3 Months
The primary outcome is the change from baseline in the Constant-Murley Score (CMS) at 3 months after the first intra-articular injection. The CMS is a validated clinical scale ranging from 0 to 100 points, where higher scores indicate better shoulder function and less pain. It includes four subdomains: pain (15 points), activities of daily living (20 points), range of motion (40 points), and strength (25 points). An increase of at least 13 points is considered very clinically significant. Results will be analyzed as the mean change in CMS from baseline (Day 0) to Month 3. Unit of Measure: Points on the Constant-Murley Scale (0-100)
Time frame: 3 months after baseline (Day 0)
Population: A total of 24 subjects with painful shoulder in rotator cuff tendinopathy have been enrolled.~Only subjects were be included:~* belonging to the U.O.C. 1st Orthopedic Clinic (Gaetano Pini Orthopedic Institute, Milan, Italy);~* who meet the inclusion criteria and have no exclusion criteria.
| Arm | Measure | Value (MEAN) |
|---|---|---|
| MD-Shoulder Medical Device | Change From Baseline in Constant-Murley Score (CMS) at 3 Months | 10.03 units on a scale |
Evaluation of MD-Shoulder Collagen Medical Device Performance Using the Constant-Murley Score
Secondary Endpoints will consist of the evaluation of MD-Shoulder Collagen Medical device through CMS at months 6 and months 12 compared to day 0.
Time frame: months 6, months12
Evaluation of MD-Shoulder Collagen Medical Device With American Shoulder and Elbow Surgeons (ASES)Scores Range From 0 to 100 With a Score of 0 Indicating a Worse Shoulder Condition and 100 Indicating a Better Shoulder Condition
Secondary Endpoints will consist of the evaluation of MD-Shoulder Collagen Medical with American Shoulder and Elbow Surgeons (ASES), Simply Shoulder Test (SST) and Range Of Motion (ROM) at months 3, mouth 6, mouth 12 compared to day 0
Time frame: months 3 months 6, months 12
Evaluation of MD-Shoulder Collagen Medical Device With Numeric Rating Scale
Secondary Endpoints will consist of the evaluation of MD-Shoulder Collagen Medical Device, with NRS (Numeric Rating Scale) at weeks 2, weeks 4, months 3, mouth 6, mouth 12 compared to day 0.
Time frame: weeks 2, weeks 4, months 3, months 6, months 12
Evaluation of MD-Shoulder Collagen Medical Device With Range of Motion (ROM).
Secondary Endpoints will consist of the evaluation of MD-Shoulder Collagen Medical with Range Of Motion (ROM) at months 3, mouth 6, mouth 12 compared to day 0
Time frame: months 3, months 6, months12
Evaluation of MD-Shoulder Collagen Medical Device With Simply Shoulder Test (SST), the Items on the Scale Measure the Ability of the Affected Shoulder to Perform Work Duties, Dressing, Bathing, Lifting, Carrying and Throwing.
Secondary Endpoints will consist of the evaluation of MD-Shoulder Collagen Medical Device with simply shoulder test (SST) at months 3, mouth 6, mouth 12 compared to day 0 number of yes/number of completed items 100 = % of yes response. 0 = worst and 100 = best function
Time frame: months 3, months 6, months12
Evaluation of MD-Shoulder Collagen Medical With Assessment of Analgesic Drug Unit Consumption Based on Clinical Diary at Various Phases of the Study.
Secondary Endpoints will consist of the evaluation of MD-Shoulder Collagen Medical with Analgesic consumption at various phases of the study with use of clinical diary
Time frame: months 3, months 6, months 12
Evaluation of MD-Shoulder Collagen Medical With Cuff Integrity at Mouth 12 Compared to Day 0 by Performing With Magnetic Resonance Imaging (MRI) of the Treated Shoulder.
Secondary Endpoints will consist of the evaluation of MD-Shoulder Collagen Medical with cuff integrity at mouth 12 compared to day 0 by performing with Magnetic Resonance Imaging (MRI) of the treated shoulder.
Time frame: month 12
Safety Evaluation
Evaluation of Adverse Events.
Time frame: weeks 2, weeks 4, months 3, months 6, months 12