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Musculotendinous Tissue Repair Unit and Reinforcement (MTURR) (MTURR)

Primary Purpose

Traumatic Injury, Muscle Injury, Tendon Injury

Status
Completed
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Extracellular Matrix
Sponsored by
University of Pittsburgh
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Traumatic Injury focused on measuring MTURR, ECM, Muscle Loss, Tendon, Tendon Repair, Muscle Repair, Soft Tissue Repair, Scaffold, Extracellular Matrix

Eligibility Criteria

18 Years - 70 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Patients with the following characteristics will be eligible to participate in the study:

    • Age: 18 to 70 years of age and able to provide informed consent
    • Civilian, and current or former military personnel are eligible to participate
    • Have suffered injury resulting in a structural deficit of a minimum of 20% of the muscle group mass and a functional deficit of a minimum of 25% when compared to the contralateral limb; or if bilateral injury is present to extremities, the potential surgical extremity is to be compared against normal expected values of a sample population of similar age and gender, and evidence of remaining tendon and musculotendinous units that could be surgically repaired with sutures.
    • Injuries may encompass a single muscle belly or compartment. Whether an area is expected to be repaired by sutures will be determined from imaging studies and physical examination.
    • Have suffered traumatic injury within the last 18 months to the upper and/or lower extremity; Target of 18 months or less but subject's may be enrolled with injury outside this range if the principal investigator determines that there is viable muscle in the injured compartment determined by clinical exam and imaging studies.
    • Eligible for study procedures 3 months post injury with stability determined by the Principal Investigator and/ or MD Co-Investigator
    • Willing and able to comply with follow up examinations, radiographic studies, physical therapy, muscle biopsy and laboratory tests.

Exclusion Criteria:

  • Patients with the following characteristics will be excluded from participating in the study:

    • Inability to provide informed consent
    • Poor nutrition (demonstrated by abnormal lab range for serum Albumin and Pre-Albumin values)
    • Chronic disease such as congestive heart failure, liver disease, renal disease, or diabetes
    • Active and unstable disease state or infection anywhere in the body per MD's evaluation and determination (demonstrated by stated or medical record history and abnormal lab range for CBC with Differential and Platelet, and chemistry panel values)
    • Known coagulopathy (demonstrated by stated or medical record history of diagnosis)
    • Pregnancy (demonstrated by a positive result of a urine pregnancy test)
    • Diagnosis of cancer within last 12 months and /or actively receiving chemotherapy or radiation treatment
    • Axis I diagnosis DSM-IV (e.g., Schizophrenia, Bipolar Disorder). Subjects who are found to be stable on medication and receive psychiatric clearance could be eligible for study participation per the Physician's discretion
    • Subjects with complete muscle/tendon gaps greater than 5 cm that are obvious on imaging studies and are unlikely to be reasonably repaired with sutures and reinforcement, and will be excluded.

Sites / Locations

  • Walter Reed National Military Medical Center (WRNMMC)
  • University of Pittsburgh

Arms of the Study

Arm 1

Arm Type

Other

Arm Label

Extracellular Matrix

Arm Description

Implantation of Extracellular Matrix

Outcomes

Primary Outcome Measures

Percent Change From Baseline in the Rectified and Integrated EMG Signal of the Tibialis Anterior Muscle At 24 Weeks Post-Operative
The physical therapy program was designed to promote activation of the dorsiflexor muscles on the operated side, through manual feedback during volitional contractions.

Secondary Outcome Measures

Percentage of Participants With Remodeling Response Approximately 6 Months Post-operative
The secondary objective is to examine the cellular properties of the biopsy tissue material in each subject for future correlation with clinical outcomes. Seven biopsy samples were collected and stained with Hematoxylin and eosin (H&E) and Masson's trichrome stain. Tissue was stained with antibodies against the progenitor cell markers CD146 and NG2 to show evidence of progenitor cell migration into the remodeling injury site.

Full Information

First Posted
February 8, 2011
Last Updated
December 3, 2020
Sponsor
University of Pittsburgh
Collaborators
United States Department of Defense
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1. Study Identification

Unique Protocol Identification Number
NCT01292876
Brief Title
Musculotendinous Tissue Repair Unit and Reinforcement (MTURR)
Acronym
MTURR
Official Title
Musculotendinous Tissue Unit Repair and Reinforcement (MTURR) With the Use of Biologic Scaffolds for Patients Suffering From Severe Skeletal Muscle Injury
Study Type
Interventional

2. Study Status

Record Verification Date
December 2020
Overall Recruitment Status
Completed
Study Start Date
December 2010 (undefined)
Primary Completion Date
May 2015 (Actual)
Study Completion Date
May 2015 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of Pittsburgh
Collaborators
United States Department of Defense

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The objective of the study is to assess mechanical strength and function in subjects undergoing Musculotendinous Tissue Unit Repair and Reinforcement (MTURR) with the use of biologic scaffolds for the restoration of both mechanical strength and function in these subjects. This study formally evaluated healing and return of function after an extracellular matrix device implantation in 17 male and female subjects participating at the University of Pittsburgh under the Department of Plastic and Reconstructive Surgery who suffer from injury with loss of skeletal muscle tissue.
Detailed Description
Loss of musculotendinous tissue as a result of trauma inevitably leads to severe morbidity for the subject and surgical challenges for the caregiver. The reconstruction of tissue following such injuries is often not possible and surgical options are extremely limited. Amputation of the affected limb is not an uncommon outcome. Free muscle grafts, pedicle grafts, and the use of prosthetic materials have all been attempted when primary repair is not possible due to loss of tissue domain. The results of such efforts are typically disheartening. If autologous grafts are used, donor site morbidity compounds the post surgical problems with resultant diminished quality of life. Stated differently, the existing treatment options for treatment of the loss of large amounts of skeletal muscle tissue with scarring are extremely limited because the existing tendon structures are damaged and lack strength. A Repair and Reinforcement approach with a biocompatible device would represent a paradigm shift in the treatment of traumatic tissue injury. This approach involves releasing scar tissue that constricts movement of the existing tendon, repairing damaged tendon and musculotendinous units with suture repair, and reinforcing the repair with a biologic scaffold material. The biologic scaffold is composed of animal derived collagen and the approved by the FDA as devices for reinforcement of soft tissues repaired by sutures or suture anchors, during tendon repair surgery." Additionally, as listed in the FDA 510k approval, these devices" provide a remodelable scaffold that is replaced by the subject's own soft tissues." These biologic materials fall into a category of implantable devices known as extracellular matrix (ECM) because they are composed of proteins that surround the cellular elements in mammals. No living cells are found in these ECM implantable devices. ECM devices are made by many commercial manufacturers and have been used for a variety of reconstructive surgical procedures for years. Because the ECM implant becomes populated with subject cells and blood vessels, the repair may be stronger and the new tissue growing within the device could possibly contribute to improved function by augmenting the tendon structure and allowing ingrowth of adjacent muscle fibers. The objective of the study is to assess mechanical strength and function in subjects undergoing Musculotendinous Tissue Unit Repair and Reinforcement (MTURR) with the use of biologic scaffolds for the restoration of both mechanical strength and function in these subjects. This study evaluated healing and return of function after an extracellular matrix device implantation in 17 male and female subjects participating at the University of Pittsburgh under the Department of Plastic Surgery who suffer from injury with loss of skeletal muscle tissue.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Traumatic Injury, Muscle Injury, Tendon Injury, Soft Tissue Injury, Extremity Injury
Keywords
MTURR, ECM, Muscle Loss, Tendon, Tendon Repair, Muscle Repair, Soft Tissue Repair, Scaffold, Extracellular Matrix

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
17 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Extracellular Matrix
Arm Type
Other
Arm Description
Implantation of Extracellular Matrix
Intervention Type
Device
Intervention Name(s)
Extracellular Matrix
Intervention Description
Extracellular Matrix
Primary Outcome Measure Information:
Title
Percent Change From Baseline in the Rectified and Integrated EMG Signal of the Tibialis Anterior Muscle At 24 Weeks Post-Operative
Description
The physical therapy program was designed to promote activation of the dorsiflexor muscles on the operated side, through manual feedback during volitional contractions.
Time Frame
approximately 24 weeks post-operative
Secondary Outcome Measure Information:
Title
Percentage of Participants With Remodeling Response Approximately 6 Months Post-operative
Description
The secondary objective is to examine the cellular properties of the biopsy tissue material in each subject for future correlation with clinical outcomes. Seven biopsy samples were collected and stained with Hematoxylin and eosin (H&E) and Masson's trichrome stain. Tissue was stained with antibodies against the progenitor cell markers CD146 and NG2 to show evidence of progenitor cell migration into the remodeling injury site.
Time Frame
Approximately 6 months post-operative

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
70 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients with the following characteristics will be eligible to participate in the study: Age: 18 to 70 years of age and able to provide informed consent Civilian, and current or former military personnel are eligible to participate Have suffered injury resulting in a structural deficit of a minimum of 20% of the muscle group mass and a functional deficit of a minimum of 25% when compared to the contralateral limb; or if bilateral injury is present to extremities, the potential surgical extremity is to be compared against normal expected values of a sample population of similar age and gender, and evidence of remaining tendon and musculotendinous units that could be surgically repaired with sutures. Injuries may encompass a single muscle belly or compartment. Whether an area is expected to be repaired by sutures will be determined from imaging studies and physical examination. Have suffered traumatic injury within the last 18 months to the upper and/or lower extremity; Target of 18 months or less but subject's may be enrolled with injury outside this range if the principal investigator determines that there is viable muscle in the injured compartment determined by clinical exam and imaging studies. Eligible for study procedures 3 months post injury with stability determined by the Principal Investigator and/ or MD Co-Investigator Willing and able to comply with follow up examinations, radiographic studies, physical therapy, muscle biopsy and laboratory tests. Exclusion Criteria: Patients with the following characteristics will be excluded from participating in the study: Inability to provide informed consent Poor nutrition (demonstrated by abnormal lab range for serum Albumin and Pre-Albumin values) Chronic disease such as congestive heart failure, liver disease, renal disease, or diabetes Active and unstable disease state or infection anywhere in the body per MD's evaluation and determination (demonstrated by stated or medical record history and abnormal lab range for CBC with Differential and Platelet, and chemistry panel values) Known coagulopathy (demonstrated by stated or medical record history of diagnosis) Pregnancy (demonstrated by a positive result of a urine pregnancy test) Diagnosis of cancer within last 12 months and /or actively receiving chemotherapy or radiation treatment Axis I diagnosis DSM-IV (e.g., Schizophrenia, Bipolar Disorder). Subjects who are found to be stable on medication and receive psychiatric clearance could be eligible for study participation per the Physician's discretion Subjects with complete muscle/tendon gaps greater than 5 cm that are obvious on imaging studies and are unlikely to be reasonably repaired with sutures and reinforcement, and will be excluded.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
J. Peter Rubin, MD
Organizational Affiliation
University of Pittsburgh
Official's Role
Principal Investigator
Facility Information:
Facility Name
Walter Reed National Military Medical Center (WRNMMC)
City
Bethesda
State/Province
Maryland
ZIP/Postal Code
20889
Country
United States
Facility Name
University of Pittsburgh
City
Pittsburgh
State/Province
Pennsylvania
ZIP/Postal Code
15213
Country
United States

12. IPD Sharing Statement

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Musculotendinous Tissue Repair Unit and Reinforcement (MTURR)

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