Suture Anchor Comparison in Rotator Cuff Repairs

• Suture Anchor HEALOCOIL (Device): Rotator cuff tears will be repaired intraoperatively using suture anchors
• Suture anchor Twinfix Ultra HA (Device)

Primary outcomes

• Ossification Quality Score (Bony Ingrowth Assessed Via CT) [2 years]: The ossification quality score is an ordinal measure of quality of bone reabsorption that is divided into four progressive groups. Quality score 1 reflects "little or no bone ossification", Quality score 2 reflects "Some ossification; discontinuous or with a wide lucent rim", Quality score 3 reflects "Ossification with a thin lucent rim", and Quality score 4 reflects "Good ossification; border of tract vague". For this study, Quality scores 1 and 2 will be merged (defined as low quality ossification) as will Quality scores 3 and 4 (defined as high quality ossification). The proportion of suture anchors graded as having high quality ossification versus low quality ossification will be compared between the two groups to determine if there is a significant difference between Healicoil and Twinfix anchors in regards to quality of ossification.

Secondary outcomes

• Number of Participants With a Rotator Cuff Re-tear [6 months]: Repair failure rate (Defined as number of subjects with a re-tear) determined by ultrasound 6 months after surgery.
• Visual Analogue Pain Scale [2 years]: The Visual Analogue Pain Scale (VAS) measures the patient-reported level of pain at the two-year follow-up. The scale runs from 0 to 10, with "0" indicating no pain and "10" indicating extreme pain. The lower the VAS Pain level, the better the outcome in regards to level of pain.
• Function at Two Years as Measured by Western Ontario Rotator Cuff Index (WORC), PENN Shoulder Score (PENN), Single Assessment Numeric Evaluation (SANE), and EuroQol-5D (EQ-5D) [2 years]: Outcomes at Two Years on the following: * Western Ontario Rotator Cuff Index (WORC): developed to help understand the particular signs, symptoms, and functional limitations associated with rotator cuff tendinopathy. The outcome is measured on a scale of 0 to 100, with 100 being the best outcome and 0 being the worst. * PENN Shoulder Score (PENN): The PENN is a 100-point shoulder-specific self-report questionnaire evaluating pain, satisfaction, and shoulder function. The outcome is measured on a scale of 0 to 100, with 100 being the best outcome and 0 being the worst. * Single Assessment Numeric Evaluation (SANE): A single question that asks "How would you rate your shoulder today as a percentage of normal (0% to 100% scale with 100% being normal)?" 0 indicates an abnormal shoulder, whereas 100% indicates a perfectly normal shoulder. * Euroqol-5D (EQ-5D): The EQ-5D is a patient-reported overall health questionnaire, with 100 indicating "The best health you can imagine" and

Sex: All, ages: 35 Years to 75 Years

Inclusion Criteria:

* Male or female, aged 35 to 75 years at the time of surgery.
* Willing and able to give voluntary informed consent to participate in this investigation.
* Full thickness tear of the rotator cuff
* Tear requires repair within one year of initial diagnosis.
* Tear must be anatomically repairable (must be able to get tendon back to the medial position on the footprint and at least back to the tuberosity).
* Willing and able, in the opinion of the Investigator, to cooperate with study procedures, and willing to return to study site for all required post-operative study visits.

Exclusion Criteria:

* Evidence of acute trauma including fracture or dislocation of the shoulder joint.
* Chronic retraction.
* Evidence of active infection, osteomyelitis, sepsis or distant infection, which could spread to the index joint.
* Subject has had previous rotator cuff, arthroplasty or fracture procedures on the operative shoulder.
* Subject has had acromioplasty or diagnostic arthroscopy on the operative shoulder within one (1) year prior to scheduled surgery date.
* Evidence of osteomalacia or other metabolic bone disorder(s), which may impair bone or soft tissue function.
* Evidence of other significant shoulder pathology including (Type II-IV lesion, Bankart lesion, Hill Sachs lesion).
* Patient has grade 4 changes to articular cartilage in operative shoulder
* Inflammatory arthropathies.
* Significant muscle paralysis of the shoulder girdle.
* Painful pathologies of the cervical spine.
* Comminuted bone surface, which would compromise secure anchor fixation.
* Non-surgical rotator cuff associated treatment, such as corticosteroid injection, within one (1) month prior to scheduled surgery date.
* Participating in another investigational trial or ongoing study that would interfere with the assessment of the primary and secondary outcomes.
* Female patient who is pregnant, nursing, or of childbearing potential while not practicing effective contraceptive methods.
* Major psychiatric illness, developmental handicap or inability to read and understand the English language.
* Major medical illness that would preclude undergoing surgery.
* Known to be involved in any active injury litigation claims relating to the study shoulder.
* Unwilling or unable to be assessed according to study protocol for two years following surgery.
* Patient requires a concomitant SLAP repair procedure in operative shoulder.
* Surgeon plans to use a Platelet Rich Plasma product or another therapy intended to augment healing of the rotator cuff in the study procedure.
* Protocol specified surgical technique cannot be followed for this subject.
* Rotator cuff repair will be done via open (as opposed to arthroscopic) procedure.
* Any other reason (in the judgment of the investigator).

Participant flow

Outcome results

• Ossification Quality Score (Bony Ingrowth Assessed Via CT) (Primary), Count of units, Suture Anchors: HEALICOIL Regenesorb 42; Twinfix Ultra HA 36
• Number of Participants With a Rotator Cuff Re-tear (Secondary), Count of participants, Participants: HEALICOIL Regenesorb 6; Twinfix Ultra HA 2
• Visual Analogue Pain Scale (Secondary), Mean, score on a scale: HEALICOIL Regenesorb 1.2 +/- 1.3; Twinfix Ultra HA 1.8 +/- 1.9
• Function at Two Years as Measured by Western Ontario Rotator Cuff Index (WORC), PENN Shoulder Score (PENN), Single Assessment Numeric Evaluation (SANE), and EuroQol-5D (EQ-5D) (Secondary), Mean, score on a scale: HEALICOIL Regenesorb 84.2 +/- 20.9; Twinfix Ultra HA 86.7 +/- 13.9

Adverse events

Time frame: Adverse events were collected and assessed from time of surgery to two year final study follow-up

Other adverse events by term

• Study Protocol and Statistical Analysis Plan (PDF, 2016-02-16)

• Stefan Tolan, MD, Principal investigator, Steadman Hawkins Clinic of the Carolinas - Greenville Health System