Examining the Efficacy and Maintenance of Contracture Correction after Collagenase Clostridium Histolyticum Treatment for Dupuytren's Disease

Abstract

This study examined the efficacy, complications, and contracture recurrence in patients who received injectable collagenase clostridium histolyticum (CCH) for Dupuytren's-induced metacarpophalangeal (MP) and proximal interphalangeal (PIP) joint contractures. A retrospective chart review at one center compared the degree of MP and PIP joint contracture pre-injection, post-cord rupture, and at final follow-up after a minimum duration of 6months. Recurrence was defined as a 20° or greater increase in contracture above the minimum value achieved. Of 102 eligible patients, 48 patients (47%) (31 males, 17 females) were available for review. 53 digits and 64 joints (46 MP joints and 18 PIP joints) were studied. The mean patient age was 66years (range, 48-87years) and mean follow-up duration was 15months (range, 6 to 25months). The mean MP joint contracture was 51 ± 20° at baseline, 4 ± 8° post-cord rupture, and 9 ± 15° at latest follow-up. The mean PIP joint contracture was 39 ± 23° at baseline, 14 ± 14° at cord rupture, and 29 ± 20° at latest follow-up. Of the 46 MP joints and 18 PIP joints, 11 MP (24%) and 7 (39%) PIP joints met the recurrence criteria. Of 102 patients, 1 patient had a small finger flexor tendon rupture. Despite the dramatic initial reduction in contracture, recurrence developed in a high proportion of patients over the study period. While initially effective, CCH may not provide durable contracture reduction. However, CCH remains a viable nonsurgical treatment for Dupuytren's disease.