Finger Joint Contractures 5 Years After Treatment for Dupuytren Disease: A Comparative Cohort Study of Collagenase Injection Versus Surgical Fasciectomy

Risk Factors for Long-Term Contracture Recurrence after Collagenase Injection for Dupuytren Disease: A Prospective Cohort Study

“…The mean QuickDASH of 10 in our study is higher than what is reported in other studies (mean 4.5, and median 4.5) [ 14 , 21 ] but these studies excluded patients with severe PIP contractures, a well-known risk factor for recurrence [ 13 ]. The mean score in our study is, however, comparable to those after surgical fasciectomy as presented in a recent study from our center [ 11 ].…”

“…Most of the current controversy concerns the relative merits of the different treatments and, therefore, studies of comparative effectiveness are important. We have however, as mentioned earlier, shown in a previous study similar rates of current contracture (defined as joint contracture ≥20°) in collagenase-treated joints and joints that were treated with surgical fasciectomy [ 11 ]. Still, as we also mention above, current contracture is not the same as recurrence.…”

“…In contrast to the present study in which recurrence was defined as worsening of ≥20° from the early follow-up, both studies that were mentioned above defined recurrence as a joint contracture ≥20° at follow-up, thus introducing possible bias by including those that may have initially failed intervention [ 14 , 15 ]. In a recent study using the same cohort, current contracture (defined as a joint contracture ≥20°) was present in 25% of MCP and 33% of PIP joints [ 11 ]. Current joint contracture at follow-up does not necessarily mean recurrence because it could be disease extension or incomplete initial correction.…”

“…In addition, little is known about the factors that predict long-term contracture recurrence after treatment with collagenase injection. In a previous study comparing 5-year outcomes after collagenase and surgical fasciectomy, we have shown a similar prevalence of joint contractures in the treated fingers after both treatments [ 11 ]. Using the same cohort, the purpose of this study is to evaluate the 5-year outcomes of collagenase injections and determine the risk factors for recurrence.…”

Comparison of Patient Demographics, Utilization Trends, and Costs of Treatment for Dupuytren’s Disease in the United States From 2012 to 2019

“…As nonoperative modalities of managing Duputryen disease, such as radiation and oral medications, have shown unreliable patient outcomes, plastic and orthopedic hand surgeons have come to favor multiple procedure-based modalities, including open fasciotomy and fasciectomy, as well as collagenase clostridium histolyticum (CCH) injection, which was approved by the Food and Drug Administration (FDA) as an alternative treatment option in the United States on February 2, 2010 9 . Each procedural modality has its own advantages and disadvantages; for example, CCH injections allow early return of hand function and avoidance of surgical complications, but the open surgical methods are more capable of addressing complicated presentations and multiple joint contractures at once 10–12 . Prior studies have evaluated the treatment trends in patients with Dupuytren’s disease; however, most do not cover an adequate period after CCH was introduced to the market, and thus, it is generally inconclusive of how provider preferences have been influenced over the past 8 years 9,13,14 .…”