Comparison of the results of operative versus non-operative management of acute grade III and IV acromioclavicular joint disruption
| ISRCTN | ISRCTN47376242 |
|---|---|
| DOI | https://doi.org/10.1186/ISRCTN47376242 |
| Secondary identifying numbers | 10/S1101/55 |
- Submission date
- 15/06/2013
- Registration date
- 07/11/2013
- Last edited
- 15/10/2020
- Recruitment status
- No longer recruiting
- Overall study status
- Completed
- Condition category
- Injury, Occupational Diseases, Poisoning
Plain English summary of protocol
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
Contact information
Scientific
Department of Trauma and Orthopaedics
Royal Infirmary of Edinburgh
51 Little France Crescent
Edinburgh
EH16 4SA
United Kingdom
| Phone | +44 (0)131 242 3407 |
|---|---|
| c.mike.robinson@ed.ac.uk |
Study information
| Study design | Multicentre randomised controlled trial |
|---|---|
| Primary study design | Interventional |
| Secondary study design | Randomised controlled trial |
| Study setting(s) | Hospital |
| Study type | Treatment |
| Participant information sheet | Not available in web format, please use the contact details to request a patient information sheet |
| 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 |
| Study acronym | ACORN |
| Study objectives | Operative management will not improve the functional outcome over non-operative management for acute grade III and IV acromioclavicular joint disruption. |
| Ethics approval(s) | Lothian Research Ethics Committee, ref: 10/S1101/55 |
| Health condition(s) or problem(s) studied | 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 |
| 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 study start date | 01/02/2011 |
| Completion date | 01/09/2015 |
Eligibility
| Participant type(s) | Patient |
|---|---|
| Age group | Adult |
| Sex | Both |
| Target number of participants | 80 |
| Total final enrolment | 60 |
| Key inclusion criteria | 1. Grade III or IV acromioclavicular joint disruption 2. Acute injury (within last 2 weeks) 3. Age 16-35 years inclusive |
| Key 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 |
| Date of first enrolment | 01/02/2011 |
| Date of final enrolment | 01/09/2015 |
Locations
Countries of recruitment
- Scotland
- United Kingdom
Study participating centres
United Kingdom
United Kingdom
United Kingdom
United Kingdom
Sponsor information
Hospital/treatment centre
c/o Karen Maitland
NHS Lothian Research and Development
51 Little France Crescent
Edinburgh
EH16 4SA
Scotland
United Kingdom
"ROR" |
https://ror.org/009bsy196 |
|---|
Funders
Funder type
Industry
No information available
Results and Publications
| Intention to publish date | |
|---|---|
| Individual participant data (IPD) Intention to share | No |
| IPD sharing plan summary | Not provided at time of registration |
| Publication and dissemination plan | Not provided at time of registration |
| IPD sharing plan |
Study outputs
| Output type | Details | Date created | Date added | Peer reviewed? | Patient-facing? |
|---|---|---|---|---|---|
| Results article | results | 21/11/2018 | 15/10/2020 | Yes | No |
Editorial Notes
15/10/2020: Publication reference and total final enrolment number added.
09/11/2017: No publications found, verifying study status with principal investigator.
