Coblation Debridement for Rotator Cuff Repair

(FLOW90 Trial)

Overseen by Ian Lo, MD FRSCS

Age: 18+

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Academic

Recruiting

Sponsor: University of Calgary

Disqualifiers: Previous surgery, Labral repair, Infection, others

No Placebo Group

Approved in 1 Jurisdiction

Trial Summary

What is the purpose of this trial?

Randomized controlled trial comparing coblation debridement to mechanical debridement in rotator cuff repair.

Will I have to stop taking my current medications?

The trial protocol does not specify whether you need to stop taking your current medications. However, it mentions that participants should have failed conservative treatments like physical therapy, steroid injections, or anti-inflammatory medications for more than 3 months, which suggests you may continue these treatments.

What data supports the effectiveness of the treatment Coblation Debridement (FLOW90) for rotator cuff repair?

Research shows that Coblation, a method using plasma energy, effectively reduces bacteria in wounds without spreading them, which suggests it could be beneficial in surgical settings like rotator cuff repair. Additionally, Coblation has been effective in treating other conditions, such as spinal disc issues, indicating its potential versatility and effectiveness in different medical procedures. ^{1 2 3 4 5}

What makes Coblation Debridement (FLOW90) unique for rotator cuff repair?

Coblation Debridement (FLOW90) is unique because it uses a plasma field to remove unwanted tissue with minimal heat, reducing the risk of damaging surrounding tissues and preventing bacterial spread, unlike other methods that may cause significant aerosolization of bacteria. ^{1 2 3 6 7}

Research Team

Ian Lo, MD FRSCS

Principal Investigator

University of Calgary

Eligibility Criteria

This trial is for adults over 18 with a repairable full-thickness rotator cuff tear smaller than 5cm, who have tried other treatments like physical therapy or steroid injections without success. They must be able to get an MRI and commit to follow-up visits. People with partial tears, irreparable tears, high operative risks, severe fatty atrophy of the muscle, or those involved in litigation or compensation cases cannot join.

Inclusion Criteria

The subject has signed the REB approved informed consent form (ICF) specific to this study prior to enrollment

I have had pain and disability for over 3 months despite trying treatments like physical therapy.

I can move on my own and can attend all required follow-up visits.

Exclusion Criteria

I need surgery to fix a tear in the cartilage of my hip.

I have had surgery to repair the rotator cuff in my shoulder.

I have a shoulder injury that cannot be fixed with surgery.

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants undergo surgical repair of the rotator cuff with either coblation or mechanical debridement

1 day (surgery)

1 visit (in-person)

Post-operative Rehabilitation

Standard post-operative rehab program for all patients

12 weeks

Follow-up

Participants are monitored for safety and effectiveness after treatment, with follow-up visits at 3, 6, 12, and 24 months post-operatively

24 months

4 visits (in-person)

Treatment Details

Interventions

• Coblation Debridement (FLOW90) (Other)

Trial Overview The study is testing two methods of preparing the bone before repairing a torn rotator cuff: coblation debridement (using FLOW90) versus mechanical debridement. Participants will be randomly assigned to one of these treatment groups in this controlled trial.

Participant Groups

Group I: Coblation Debridement Experimental Treatment 1 Intervention

FLOW 90 / WEREWOLF debridement of rotator cuff footprint.

Group II: Mechanical Debridement Active Control 1 Intervention

Standard mechanical debridement of rotator cuff footprint.

Who Is Running the Clinical Trial?

University of Calgary

Lead Sponsor

Trials

827

Recruited

902,000+

Dr. Shweta Patel

University of Calgary

Chief Medical Officer since 2020

MD from the University of Baroda Medical College, India

Dr. Edward McCauley

University of Calgary

President and Vice-Chancellor since 2018

PhD in Ecology and Evolutionary Biology from the University of California, Santa Barbara

Findings from Research

Coblation significantly reduced bacterial load in wounds compared to other methods, making it an effective option for wound debridement.

Unlike hydrodebridement (Versajet), which caused significant bacterial aerosolization, Coblation and curette debridement did not spread bacteria into the air, highlighting Coblation's safety in preventing bacterial transmission during treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Bacteria aerosol spread and wound bacteria reduction with different methods for wound debridement in an animal model. Sönnergren, HH., Polesie, S., Strömbeck, L., et al.[2015]

In a study of 16 patients with early postoperative infections following extremity fractures, Coblation debridement effectively treated the infections while retaining internal fixation, leading to complete wound healing without recurrence.

All patients healed successfully within an average of 4.8 months, avoiding complications like nonunion or osteomyelitis, demonstrating that Coblation debridement is a safe and effective method for managing infections in this context.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Application of plasma-mediated bipolar radiofrequency ablation debridement in treatment with retention of internal fixation for early postoperative infection of fractures of extremities]. Lu, Y., Yang, R., Zhu, J., et al.[2021]

Coblation debridement technology uses a focused plasma field to effectively remove unwanted tissues from wounds, offering a safer alternative for patients who may not tolerate traditional surgical debridement due to age or health conditions.

This method minimizes thermal damage to surrounding tissues by keeping local temperatures below 50°C, which helps prevent wound bed renecrosis while still achieving effective tissue dissolution.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Coblation technology for surgical wound debridement: principle, experimental data, and technical data. Trial, C., Brancati, A., Marnet, O., et al.[2015]

A study involving 35 patients with spinal disc herniations showed that percutaneous disc nucleoplasty using coblation resulted in significant immediate pain relief and improved patient satisfaction compared to a non-operated group.

After 3 months and 1 year, 84% and 93% of patients reported good results, indicating that coblation is an effective and modern treatment option for various types and sizes of disc protrusions in the lumbar spine.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Coblation of nucleus pulposus in treatment of military men's lumbar disc protrusions]. Manukovskiĭ, VA., Badalov, VI., Tiulikov, KV., et al.[2012]

In a study of 90 patients with sciatica due to lumbar disc herniation, those treated with plasma disc decompression (PDD) experienced significantly greater reductions in leg pain and improved quality of life compared to those receiving fluoroscopy-guided transforaminal epidural steroid injections (TFESI).

Over a 2-year follow-up, 56% of patients in the PDD group remained free from needing further procedures, compared to only 28% in the TFESI group, indicating that PDD may be a more effective long-term treatment option for this condition.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Plasma disc decompression compared with fluoroscopy-guided transforaminal epidural steroid injections for symptomatic contained lumbar disc herniation: a prospective, randomized, controlled trial. Gerszten, PC., Smuck, M., Rathmell, JP., et al.[2022]

In a study of 47 patients with discogenic back pain, the Nucleoplasty procedure demonstrated significant pain relief, with 80% of patients reporting at least 50% pain reduction one month after treatment, although this percentage decreased over time to 53% at 12 months.

The Nucleoplasty procedure was found to be safe, with no complications reported, and it is considered a minimally invasive technique that effectively improves functional abilities such as sitting, standing, and walking in a substantial number of patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Role of percutaneous disc decompression using coblation in managing chronic discogenic low back pain: a prospective, observational study. Singh, V., Piryani, C., Liao, K.[2006]

In a study involving 58 patients, percutaneous low-power laser discectomy (PLLD) showed a higher rate of clinical improvement at 6 and 12 months post-surgery (92.9%) compared to low-temperature plasma radiofrequency ablation (coblation) (70.0%).

PLLD also significantly reduced the disk herniation index, indicating better radiological outcomes, while coblation did not show changes in disk degeneration, suggesting that PLLD may be more effective for long-term recovery in cervical radiculopathy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Clinical and Radiological Comparisons of Percutaneous Low-Power Laser Discectomy and Low-Temperature Plasma Radiofrequency Ablation for Cervical Radiculopathy: A Prospective, Multicenter, Cohort Study. Lan, X., Wang, Z., Huang, Y., et al.[2022]

References

1. Sweden pubmed.ncbi.nlm.nih.gov

Bacteria aerosol spread and wound bacteria reduction with different methods for wound debridement in an animal model. [2015]

2. China pubmed.ncbi.nlm.nih.gov

[Application of plasma-mediated bipolar radiofrequency ablation debridement in treatment with retention of internal fixation for early postoperative infection of fractures of extremities]. [2021]

3. United States pubmed.ncbi.nlm.nih.gov

Coblation technology for surgical wound debridement: principle, experimental data, and technical data. [2015]

4. Russia (Federation) pubmed.ncbi.nlm.nih.gov

[Coblation of nucleus pulposus in treatment of military men's lumbar disc protrusions]. [2012]

5. United States pubmed.ncbi.nlm.nih.gov

Plasma disc decompression compared with fluoroscopy-guided transforaminal epidural steroid injections for symptomatic contained lumbar disc herniation: a prospective, randomized, controlled trial. [2022]

6. United States pubmed.ncbi.nlm.nih.gov

Role of percutaneous disc decompression using coblation in managing chronic discogenic low back pain: a prospective, observational study. [2006]

7. Switzerland pubmed.ncbi.nlm.nih.gov

Clinical and Radiological Comparisons of Percutaneous Low-Power Laser Discectomy and Low-Temperature Plasma Radiofrequency Ablation for Cervical Radiculopathy: A Prospective, Multicenter, Cohort Study. [2022]