Outcomes Following Repeat Collagenase Treatment of Dupuytren Contracture
Joseph Legato, MD1, Meera Gill, DO1, Michaelia Sunderland, MD2 and Jason Nydick, DO1, (1)Florida Orthopaedic Institute, Temple Terrace, FL, (2)University of South Florida, Tampa, FL
Hypothesis: Dupuytren contracture will respond less effectively to collagenase treatment when a digit has been previously treated with collagenase therapy.
Methods: A retrospective chart review was performed on 332 patients treated with collagenase injection for Dupuytren contracture by three fellowship-trained hand surgeons at a single institution from 2009-2019. 45 patients with repeat collagenase therapy for recurrent contracture in the same digit for were identified, with a total of 59 digits identified. Pre-treatment and post-treatment total flexion contracture were recorded, and complete correction was defined as <5 degree residual flexion contracture in digit. Post-manipulation skin tears and adverse events were recorded. Paired t-test was utilized to compare average contracture improvement.
Results: 45 patients were identified with an average follow-up of 30 months (range, 6-73 months) between initial and repeat collagenase therapy. Mean total flexion contracture for digits prior to their first collagenase injection was 63.02 +/- 34.41 degrees and post-manipulation mean contracture was 4.58 +/- 15.43 degrees. Complete correction was achieved in 49/59 (83.1%) of digits in this group. Mean total flexion contracture for patients prior to their second collagenase injection was 64.92 +/- 34.90 degrees and post-manipulation mean contracture was 5.47 +/- 20.17 degrees. Complete correction was achieved in 46/59 (79.2%) of digits in this group. Mean improvement after first collagenase injection was 58.46 +/- 32.61 degrees compared to mean improvement of 59.44 +/- 34.70 degrees after their second injection (P=0.87).
Skin tears were seen in 19/59 (32.2%) of digits during their first collagenase post-injection manipulation and 18/59 (30.5%) of digits experienced skin tears during their second collagenase post-injection manipulation. Adverse events were seen in 2/59 (3.4%) digits after their first injection and 5/59 (8.5%) experienced adverse events following their second collagenase injection.
- Collagenase treatment for Dupuytren contracture yields effective total flexion contracture correction.
- Repeat collagenase treatment for a previously treated digit yields similar deformity correction and complete correction rates.
- Skin tears and adverse events were similar between the two groups.
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