Clin Orthop Surg.  2019 Sep;11(3):332-336. 10.4055/cios.2019.11.3.332.

Collagenase Clostridium Histolyticum Injection for Dupuytren Contracture: 2-Year Follow-up

• Nayar SK
• Pfisterer
• Ingari JV

• KMID: 2462563
• DOI: http://doi.org/10.4055/cios.2019.11.3.332

Abstract

BACKGROUND
Dupuytren disease is characterized by the development of palmar fibrous tissue that can lead to fixed flexion contracture (FFC) and contribute to functional loss of the involved digits. Our goal was to investigate rates of contracture resolution and recurrence in patients who underwent enzymatic fasciotomy for Dupuytren contracture consisting of collagenase clostridium histolyticum (CCH) injection followed by passive manipulation combined with splinting and home-based therapy.
METHODS
We prospectively enrolled 34 patients (44 metacarpophalangeal [MCP] and 33 proximal interphalangeal [PIP] joints) treated by one orthopaedic hand surgeon between November 2010 and November 2014. On day 1, CCH was injected into a palpable fibrous cord of the involved fingers. The next day, the finger was passively extended to its maximal corrective position. FFC was measured for each joint before injection and immediately after manipulation. Patients were instructed to wear an extension splint at night and perform stretching exercises at home and were re-evaluated at 6 weeks, 4 months, 1 year, and 2 years. Resolution was defined as improvement of contracture to ≤ 5° of neutral. Recurrence was defined as an increase in FCC of ≥ 20° after treatment.
RESULTS
Immediate contracture resolution occurred in 42 of 44 MCP joints (p < 0.001), improving from 50° to 1.5°, and in 14 of 33 PIP joints (p = 0.182), improving from 44° to 16°. Four joints had recurrence within 6 weeks. Of the 48 joints with minimum 4-month follow-up (mean, 26 months), 12 had recurrence at 2-year follow-up (MCP, 6; PIP, 6). At 2-year follow-up, MCP and PIP contractures measured 17° and 35.5°, respectively. Older age and multiple digit involvement were associated with higher recurrence rates.
CONCLUSIONS
CCH offers a safe, nonoperative option to correct FCC in Dupuytren disease with greater success for MCP joints compared to PIP joints. There is a tendency of reoccurrence within 2 years of treatment. Further investigation is needed to determine optimal timing of repeat CCH injection to improve upon or extend the period of contracture resolution.

Keyword

Dupuytren contracture; Collagenase clostridium histolyticum; Fixed flexion contractures; Metacarpophalangeal joint; Proximal interphalangeal joint

MeSH Terms

Collagenases*
Contracture
Dupuytren Contracture*
Exercise
Fingers
Follow-Up Studies*
Hand
Humans
Joints
Metacarpophalangeal Joint
Microbial Collagenase*
Prospective Studies
Recurrence
Splints
Collagenases
Microbial Collagenase

Figure

• 

  Fig. 1 Fixed flexion contracture (FFC) measurement for 77 joints after collagenase clostridium histolyticum injection. Only 48 joints were available for follow-up after the 4-month evaluation period. MCP: metacarpophalangeal, PIP: proximal interphalangeal.

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