Musculotendinous Tissue Unit Repair and Reinforcement (MTURR) Coordinating Center (MTURR)
Primary Purpose
Traumatic Injury, Muscle Injury, Tendon Injury
Status
Withdrawn
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Extracellular Matrix
Sponsored by
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
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
- 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
Mechanical strength and function
The primary objective of the study is to assess mechanical strength and function of surgical extremity in patients 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 patients. Physical therapy evaluations of strength and active/passive range of motion and self-reported measures of ability to perform activities of daily living.
Secondary Outcome Measures
Pathology Evaluation
The secondary objective is to examine the cellular properties of the biopsy tissue material from the Extracellular Matrix surgical site for reabsorption and replacement by the subjects own soft tissue with pathological findings to be correlated with clinical outcomes.
Full Information
NCT ID
NCT01497678
First Posted
August 9, 2011
Last Updated
October 19, 2016
Sponsor
University of Pittsburgh
Collaborators
United States Naval Medical Center, Portsmouth, United States Naval Medical Center, San Diego
1. Study Identification
Unique Protocol Identification Number
NCT01497678
Brief Title
Musculotendinous Tissue Unit Repair and Reinforcement (MTURR) Coordinating Center
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 (Coordinating Center Protocol)
Study Type
Interventional
2. Study Status
Record Verification Date
October 2016
Overall Recruitment Status
Withdrawn
Why Stopped
Funding issues. 0 subjects enrolled
Study Start Date
March 2013 (undefined)
Primary Completion Date
November 2014 (Actual)
Study Completion Date
November 2014 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of Pittsburgh
Collaborators
United States Naval Medical Center, Portsmouth, United States Naval Medical Center, San Diego
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 will formally evaluate healing and return of function after an extracellular matrix device implantation in 40 male and female subjects participating at 4-5 military sites who suffer from injury with loss of skeletal muscle tissue. The University of Pittsburgh under the Department of Plastic and Reconstructive Surgery is the Coordinating Center for this multi-site study.
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 will formally evaluate healing and return of function after an extracellular matrix device implantation in 40 male and female subjects participating at 4-5 military sties who suffer from injury with loss of skeletal muscle tissue. The University of Pittsburgh under the Department of Plastic Surgery is the Coordinating Center for this multi-site study.
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
0 (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
Mechanical strength and function
Description
The primary objective of the study is to assess mechanical strength and function of surgical extremity in patients 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 patients. Physical therapy evaluations of strength and active/passive range of motion and self-reported measures of ability to perform activities of daily living.
Time Frame
Approximately 6 months post-operative
Secondary Outcome Measure Information:
Title
Pathology Evaluation
Description
The secondary objective is to examine the cellular properties of the biopsy tissue material from the Extracellular Matrix surgical site for reabsorption and replacement by the subjects own soft tissue with pathological findings to be correlated with clinical outcomes.
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
University of Pittsburgh
City
Pittsburgh
State/Province
Pennsylvania
ZIP/Postal Code
15213
Country
United States
12. IPD Sharing Statement
Citations:
PubMed Identifier
17142418
Citation
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Results Reference
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PubMed Identifier
18837648
Citation
Beattie AJ, Gilbert TW, Guyot JP, Yates AJ, Badylak SF. Chemoattraction of progenitor cells by remodeling extracellular matrix scaffolds. Tissue Eng Part A. 2009 May;15(5):1119-25. doi: 10.1089/ten.tea.2008.0162.
Results Reference
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PubMed Identifier
16508502
Citation
Holcomb JB, Stansbury LG, Champion HR, Wade C, Bellamy RF. Understanding combat casualty care statistics. J Trauma. 2006 Feb;60(2):397-401. doi: 10.1097/01.ta.0000203581.75241.f1.
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PubMed Identifier
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Citation
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Results Reference
background
PubMed Identifier
17003177
Citation
Noe A. Extremity injury in war: a brief history. J Am Acad Orthop Surg. 2006;14(10 Spec No.):S1-6. doi: 10.5435/00124635-200600001-00002.
Results Reference
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PubMed Identifier
16263981
Citation
Hostetler SG, Schwartz L, Shields BJ, Xiang H, Smith GA. Characteristics of pediatric traumatic amputations treated in hospital emergency departments: United States, 1990-2002. Pediatrics. 2005 Nov;116(5):e667-74. doi: 10.1542/peds.2004-2143.
Results Reference
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PubMed Identifier
18786417
Citation
Crisan M, Yap S, Casteilla L, Chen CW, Corselli M, Park TS, Andriolo G, Sun B, Zheng B, Zhang L, Norotte C, Teng PN, Traas J, Schugar R, Deasy BM, Badylak S, Buhring HJ, Giacobino JP, Lazzari L, Huard J, Peault B. A perivascular origin for mesenchymal stem cells in multiple human organs. Cell Stem Cell. 2008 Sep 11;3(3):301-13. doi: 10.1016/j.stem.2008.07.003.
Results Reference
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PubMed Identifier
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Citation
Reing JE, Zhang L, Myers-Irvin J, Cordero KE, Freytes DO, Heber-Katz E, Bedelbaeva K, McIntosh D, Dewilde A, Braunhut SJ, Badylak SF. Degradation products of extracellular matrix affect cell migration and proliferation. Tissue Eng Part A. 2009 Mar;15(3):605-14. doi: 10.1089/ten.tea.2007.0425.
Results Reference
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PubMed Identifier
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Citation
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Results Reference
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Links:
URL
http://clinicaltrials.gov
Description
Musclotendinous Tissue Repair Unit and Reinforcement (MTURR)
Learn more about this trial
Musculotendinous Tissue Unit Repair and Reinforcement (MTURR) Coordinating Center
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