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Recurrence of Dupuytren's Contracture Following Collagenase Clostridium Histolyticum Injection
Heather McMahon, BS; Sidney M. Jacoby, MD; Lauren DeTullio, OTR/L, CHT; Terri M. Skirven, OTR/L, CHT; Randall W. Culp, MD; A. Lee Osterman, MD;
Thomas Jefferson University

Introduction: The purpose of this study was to examine the rate of contracture recurrence in patients who received the treatment regimen for Dupytren's-induced metacarpophalangeal contractures (MP) and proximal interphalangeal (PIP) joint contractures consisting of injectable collagenase clostridium histolyticum (Xiaflex), splinting, and home therapy.

Methods: A retrospective chart review of patients treated with Xiaflex at one center over two years was conducted to compare pre-injection, post-injection, and a minimum 6 months of follow-up for MP and PIP contractures. All patients received one Xiaflex injection, cord manipulation, dorsal or volar-based customized thermoplastic splints, and home exercise education. Splinting and home therapy were not stringently enforced to achieve realistic compliance rates. A one-way repeated measures ANOVA, with Bonferroni post hoc analysis was conducted to determine the differences in means at the three time points. Statistical significance was set at a p<0.05. Recurrence was defined as a 10 or greater increase in contracture above the minimum value achieved at the time of cord rupture.

Results: There were a total of 21 patients with 25 digits: 10 males and 11 females with at least 6 months of clinical follow up. Average length of follow up was 11.6 months (range 6 to 23 months). The mean baseline contracture was 42.8 24.5; immediately following injection and cord rupture, the mean contracture became 8.4 12.1, and at the latest follow up, the average degree of contracture became 17.4 16.2. Of the 25 patients, 15 met the criteria for recurrence. The differences in means were found to be statistically significant at all time points. Complications included: ecchymosis (16 patients), edema (9 patients), skin tear (3 patients), and lymphadenopathy (1 patient).

Conclusions: The reduction in contracture following Xiaflex injection, as well as the complications experienced by our patients are in agreement with previously published data. However, despite the dramatic initial reduction in contracture following the therapeutic regimen of Xiaflex, splinting, and home therapy, we observed a statistically significant recurrence in contracture within an average of twelve months following treatment. Our results suggest that while effective at initially reducing joint contractures, Xiaflex may not be effective in maintaining this decreased contracture as time progresses. Given these preliminary results, the subject of contracture recurrence following Xiaflex injection warrants further investigation.

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