Plain English Summary
Background and study aims
Injuries to the shoulder joint are common and often result in long-term pain, reduced function and an unsightly deformity over the shoulder. It is widely accepted that sprains and minor disclocations of the shoulder joint are best treated conservatively, but there is growing debate about the most appropriate treatment of complete dislocations. The aim of this study is to compare the results of non-operative and operative treatment for complete shoulder joint dislocations to guide future treatment.
Who can participate?
Men and women aged 16-35 years who have sustained a complete dislocation of the shoulder joint within the last two weeks
What does the study involve?
Participants are randomly allocated to one of two groups. Those allocated to the non-operative group are treated with an initial three-week period of immobilisation in a collar and cuff followed by physiotherapy. Participants allocated to the operative treatment group undergo surgery to stabilise the joint within two weeks of injury. The procedure is done through the open or keyhole method and involves reconstruction of the injured ligaments around the injured joint. After surgery, patients are then treated with immobilisation in a collar and cuff for three weeks followed by physiotherapy. All patients are seen at three weeks, six weeks, three months, six months and one year, when they may be asked to complete a questionnaire and undergo an examination. X-rays are also routinely taken during return visits.
What are the possible benefits and risks of participating?
The major benefit of having surgery is that they have a stable shoulder joint after the surgery, with less of a visible bump. This may allow an earlier return to work and sports. All the surgical procedures are performed under general anaesthetic. Although anaesthesia is extremely safe with modern techniques, there are still very small risks involved. Some patients experience nausea, vomiting and/or dizziness. These are reduced with modern drugs. It is important that participants tell the research team about any medical problems. For those that are allocated to have an operation, the main risk is that the surgery fails to stabilise the injured joint and further instability is experienced (5% risk). There is a small chance of developing wound infection. This may require treatment with antibiotics. There is also a small risk of damage to the adjacent nerves and vessels in the shoulder.
Where is the study run from?
The study is being run from multiple orthopaedic centres who are experienced in both the management of these injuries and conducting studies of this kind including:
1. The Royal Infirmary of Edinburgh (UK) (main centre)
2. Glasgow Victoria Hospital (UK)
3. Glasgow Western Infirmary (UK)
4. Glasgow Royal Infirmary (UK)
When is study starting and how long is it expected to run for?
February 2011 to September 2015
Who is funding the study?
Arthrex (USA)
Who is the main contact?
Mr C M Robinson
c.mike.robinson@ed.ac.uk
Trial website
Contact information
Type
Scientific
Primary contact
Mr Michael Robinson
ORCID ID
Contact details
Department of Trauma and Orthopaedics
Royal Infirmary of Edinburgh
51 Little France Crescent
Edinburgh
EH16 4SA
United Kingdom
+44 (0)131 242 3407
c.mike.robinson@ed.ac.uk
Additional identifiers
EudraCT number
ClinicalTrials.gov number
Protocol/serial number
10/S1101/55
Study information
Scientific title
A multicentre prospective randomised controlled trial to compare the results of AcromioClavicular Open Reduction versus Nonoperative treatment for the management of acute grade III and IV acromioclavicular joint disruption
Acronym
ACORN
Study hypothesis
Operative management will not improve the functional outcome over non-operative management for acute grade III and IV acromioclavicular joint disruption.
Ethics approval
Lothian Research Ethics Committee, ref: 10/S1101/55
Study design
Multicentre randomised controlled trial
Primary study design
Interventional
Secondary study design
Randomised controlled trial
Trial setting
Hospitals
Trial type
Treatment
Patient information sheet
Not available in web format, please use the contact details to request a patient information sheet
Condition
Orthopaedic trauma
Intervention
A total of 80 participants will be randomised using the closed envelope technique into a control (non-operative management) group or treatment (operative management) group each containing 40 participants. All patients will be initially evaluated with a complete history and physical examination. Information regarding the mode of injury and timing of initial symptoms, any previous surgical procedures performed, and current type, level and frequency of symptoms including pain, instability and level of function will be specifically sought in addition to routine demographic details. Preoperative imaging including standardised plain film evaluation of the affected shoulder will be taken.
Control group: non-operative management
Following randomisation into the control group, participants will be treated with immobilisation in a collar and cuff for three weeks. Patients will return for clinical assessment 3 weeks following initial injury and will then begin a course of physiotherapy. Further clinical assessments will be scheduled at 6 weeks, 3 months, 6 months and 12 months.
Treatment group: operative treatment
Following randomisation into the treatment group, participants will be undergo open stabilisation with coracoclavicular ligamentous substitution within two weeks of the initial injury.
Open stabilisation with coracoclavicular ligamentous substitution
The following steps will performed through an open approach. The disrupted acromioclavicular joint will be visualized and reduced with no excision of lateral clavicle or acrion. Repair of existing acromioclavicular and coracoclavicular ligaments will be performed. Stabilization will be achieved using the AC-Tightrope Technique, with the Tightrope spanning between the coracoid and lateral clavicle. In all centres, the operative procedure will be carried out by a specialist shoulder surgeon. The potential risks of operative stabilisation will be explained by the operating surgeon. These include risk of recurrent instability (5%), infection (1%) and death under general anaesthetic (1 in 200,000).
Postoperative protocol and follow-up
Patients will be immobilised for 3 weeks postoperatively in a collar and cuff. These patients will be routinely discharged on day 1 postoperatively. Patients will return for clinical assessment 3 weeks following initial injury and will then begin a course of physiotherapy. Active strengthening will commence at 6 weeks. Further clinical assessments will be scheduled at 6 weeks, 3 months, 6 months and 12 months
Intervention type
Other
Phase
Not Applicable
Drug names
Primary outcome measure
Functional assessment with use of the short-form health survey (SF-12), Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and Oxford score will be carried out for all patients preoperatively, at 6 weeks and at 12 months postoperatively. In addition SF-12 and DASH scores will be assessed at 3 and 6 months.
Secondary outcome measures
1. Shoulder ROM will be assessed at 6 months and 12 months postoperatively. The contralateral shoulder will be assessed for comparison
2. Any complications occurring in patients in either group will be documented at the time of procedure and throughout follow-up
3. Radiographic evidence of recurrent dislocation
Overall trial start date
01/02/2011
Overall trial end date
01/09/2015
Reason abandoned (if study stopped)
Eligibility
Participant inclusion criteria
1. Grade III or IV acromioclavicular joint disruption
2. Acute injury (within last 2 weeks)
3. Age 16-35 years inclusive
Participant type
Patient
Age group
Adult
Gender
Both
Target number of participants
80
Total final enrolment
60
Participant exclusion criteria
1. Grade I or II acromioclavicular joint disruptions
2. Patients who are not local residents and unable to attend for follow-up
3. Coexisting clavicle or proximal humeral fractures
4. Multiple medical co-morbidities
Recruitment start date
01/02/2011
Recruitment end date
01/09/2015
Locations
Countries of recruitment
United Kingdom
Trial participating centre
Royal Infirmary of Edinburgh
EH16 4SA
United Kingdom
Trial participating centre
Glasgow Victoria Hospital
G42 9LF
United Kingdom
Trial participating centre
Glasgow Western Infirmary
G11 6NT
United Kingdom
Trial participating centre
Glasgow Royal Infirmary
G4 0SF
United Kingdom
Funders
Funder type
Industry
Funder name
Arthrex (USA)
Alternative name(s)
Funding Body Type
Funding Body Subtype
Location
Results and Publications
Publication and dissemination plan
Not provided at time of registration
Intention to publish date
Participant level data
Not provided at time of registration
Basic results (scientific)
Publication list
2018 results in https://pubmed.ncbi.nlm.nih.gov/30480595/ (added 15/10/2020)