Treatment of Single Cords in Dupuytren Disease with Collagenase Clostridium Histolyticum: Study of a Cohort with Follow-up at 1 Year

Abstract

Objective The purpose of the present work was to assess the effectiveness of collagenase Clostridium histolyticum in patients with Dupuytren disease with single cords and assess the recurrence rate in the first year after the treatment.

Material and Methods In this classic cohort study, a total of 53 patients (50 of them male) with a mean age of 68 years were studied who had been diagnosed with Dupuytren disease located in the metacarpophalangeal joint, in single cords, with more than 40° of extension loss. They were given an injection of collagenase C. histolyticum and later manipulation under locoregional anesthesia. The loss of extension was evaluated after a week and at the 1st, 3rd, 6th and 12th months. The effectiveness was analyzed with basis on the results of the Student t-test for paired data, as well as those of the effect size (ES) test.

Results An important and statistically significant correlation was found for the loss of cord extension in the metacarpophalangeal joint (t = 32.113; p < 0.01; ES = 4.11; standardized response mean [SRM] = 4.15).

Conclusion Collagenase is an injectable treatment, which is not very aggressive compared with surgery and is effective for the loss of extension in the metacarpophalangeal region secondary to single cord in Dupuytren disease during the first year.

Keywords

collagenase clostridium histolyticum - injection - extension - dupuytren disease

• References

• 1 Rayan GM. Nonoperative treatment of Dupuytren's disease. J Hand Surg Am 2008; 33 (07) 1208-1210
• 2 Ketchum LD, Donahue TK. The injection of nodules of Dupuytren's disease with triamcinolone acetonide. J Hand Surg Am 2000; 25 (06) 1157-1162
• 3 Betz N, Ott OJ, Adamietz B, Sauer R, Fietkau R, Keilholz L. Radiotherapy in early-stage Dupuytren's contracture. Long-term results after 13 years. Strahlenther Onkol 2010; 186 (02) 82-90
• 4 Rayan GM, Parizi M, Tomasek JJ. Pharmacologic regulation of Dupuytren's fibroblast contraction in vitro. J Hand Surg Am 1996; 21 (06) 1065-1070
• 5 Hurst LC, Badalamente MA, Hentz VR. , et al; CORD I Study Group. Injectable collagenase clostridium histolyticum for Dupuytren's contracture. N Engl J Med 2009; 361 (10) 968-979
• 6 Gilpin D, Coleman S, Hall S, Houston A, Karrasch J, Jones N. Injectable collagenase Clostridium histolyticum: a new nonsurgical treatment for Dupuytren's disease. J Hand Surg Am 2010; 35 (12) 2027-38.e1
• 7 Starkweather KD, Lattuga S, Hurst LC. , et al. Collagenase in the treatment of Dupuytren's disease: an in vitro study. J Hand Surg Am 1996; 21 (03) 490-495
• 8 Arandes JM. Aponeurotomía enzimática (Enzymatic Aponeurotomy). RICMA 2014; 42 (01) 3-8
• 9 Muppavarapu RC, Waters MJ, Leibman MI, Belsky MR, Ruchelsman DE. Clinical outcomes following collagenase injections compared to fasciectomy in the treatment of Dupuytren's contracture. Hand (NY) 2015; 10 (02) 260-265
• 10 Pérez-Giner R, Aguilella L. Resultado precoz del tratamiento de la enfermedad de Dupuytren mediante inyección de colagenasa. (Early outcome of the treatment of Dupuytren's disease by collagenase injection). RICMA 2015; 43 (01) 13-19
• 11 Crivello KM, Potter HG, Moon ES, Rancy SK, Wolfe SW. Does collagenase injection disrupt or digest the Dupuytren's cord: a magnetic resonance imaging study. J Hand Surg Eur Vol 2016; 41 (06) 614-620
• 12 Hurst LC, Badalamente M, Smith T. Author's reply: Injectable collagenase clostridium histolyticum for Dupuytren's contracture. N Engl J Med 2009; 361: 2578-2580
• 13 Peimer CA, Blazar P, Coleman S, Kaplan FTD, Smith T, Lindau T. Dupuytren's contracture recurrence following treatment with collagenase clostridium histolyticum (CORDLESS [Collagenase Option for Reduction of Dupuytren Long-Term Evaluation of Safety Study]): 5-year data. J Hand Surg Am 2015; 40 (08) 1597-1605
• 14 Bear BJ, Peimer CA, Kaplan FTD, Kaufman GJ, Tursi JP, Smith T. Treatment of recurrent Dupuytren contracture in joints previously effectively treated with Collagenase Clostridium histolyticum. J Hand Surg Am 2017; 42 (05) 391.e1-391.e8
• 15 Bainbridge C, Gerber RA, Szczypa PP. , et al. Efficacy of collagenase in patients who did and did not have previous hand surgery for Dupuytren's contracture. J Plast Surg Hand Surg 2012; 46 (3-4): 177-183
• 16 Gaston RG, Larsen SE, Pess GM. , et al. The efficacy and safety of concurrent collagenase clostridium histolyticum injections for 2 dupuytren contractures in the same hand: a prospective, multicenter study. J Hand Surg Am 2015; 40 (10) 1963-1971
• 17 Pallant J. SPSS Survival Manual: A Step by Step Guide to Data Analysis using SPSS for Windows. 3rd ed. England: McGraw Hill; 2007
• 18 Syed AM, Mcfarlane J, Chester T. , et al. Clinical efficacy and cost-effectiveness of Clostridium histolyticum collagenase injections in a subpopulation of Dupuytren's contracture patients. Eur Orthop Traumatol 2014; 5 (03) 311-316
• 19 Watt AJ, Curtin CM, Hentz VR. Collagenase injection as nonsurgical treatment of Dupuytren's disease: 8-year follow-up. J Hand Surg Am 2010; 35 (04) 534-539 , 539.e1
• 20 Scherman P, Jenmalm P, Dahlin LB. One-year results of needle fasciotomy and collagenase injection in treatment of Dupuytren's contracture: A two-centre prospective randomized clinical trial. J Hand Surg Eur Vol 2016; 41 (06) 577-582
• 21 Kim SG, Kim EK. Test-retest reliability of an active range of motion test for the shoulder and hip joints by unskilled examiners using a manual goniometer. J Phys Ther Sci 2016; 28 (03) 722-724