Finger Joint Contractures 5 Years After Treatment for Dupuytren Disease : A Comparative Cohort Study of Collagenase Injection Versus Surgical Fasciectomy
(2022) In Journal of Hand Surgery 47(9). p.834-842- Abstract
Purpose: To compare collagenase injection with surgical fasciectomy in Dupuytren disease (DD) for the prevalence of contracture in treated fingers 5 years after treatment. Methods: This was a single-center, comparative cohort study comprising 2 cohorts of patients treated for DD in 1 or more of 3 ulnar fingers with collagenase injection (159 patients) or surgical fasciectomy (59 patients). At 5 years after treatment, 13 collagenase-treated and 8 fasciectomy-treated patients had undergone subsequent treatment on the treated fingers and were considered to have current contracture. Of the remaining patients, 112 collagenase-treated patients (128 hands, 180 fingers) and 46 fasciectomy-treated patients (49 hands, 63 fingers) attended... (More)
Purpose: To compare collagenase injection with surgical fasciectomy in Dupuytren disease (DD) for the prevalence of contracture in treated fingers 5 years after treatment. Methods: This was a single-center, comparative cohort study comprising 2 cohorts of patients treated for DD in 1 or more of 3 ulnar fingers with collagenase injection (159 patients) or surgical fasciectomy (59 patients). At 5 years after treatment, 13 collagenase-treated and 8 fasciectomy-treated patients had undergone subsequent treatment on the treated fingers and were considered to have current contracture. Of the remaining patients, 112 collagenase-treated patients (128 hands, 180 fingers) and 46 fasciectomy-treated patients (49 hands, 63 fingers) attended follow-up evaluation performed by 2 independent examiners (participation rate 84% and 93%, respectively). We defined current contracture in a treated finger as an active extension deficit of ≥20° in the metacarpophalangeal (MCP) or proximal interphalangeal (PIP) joint or a total (MCP + PIP) active extension deficit (TAED) of ≥30°. We used linear mixed models to analyze differences between the cohorts over time. Results: In the collagenase cohort, current contracture was present in 45 (25%) MCP and 60 (33%) PIP joints, and in the fasciectomy cohort, current contracture was present in 12 MCP (19%) and 30 PIP (48%) joints; a TAED of ≥30° was present in 79 (44%) of the collagenase-treated and 30 (48%) of the fasciectomy-treated fingers. In MCP and PIP joints with ≥20° pretreatment contracture, complete correction was observed in 82 (56%) MCP and 30 (30%) PIP joints in the collagenase cohort and 23 (70%) MCP and 5 (16%) PIP joints in the fasciectomy cohort. There was no statistically significant difference between the 2 cohorts in the TAED change over time. Conclusions: In patients with DD, collagenase injection and surgical fasciectomy improved finger joint contracture over the pretreatment status but had a high prevalence of joint contracture in the treated fingers 5 years after treatment. Type of study/level of evidence: Therapeutic IV.
(Less)
- author
- Eckerdal, David LU ; Lauritzson, Anna ; Nordenskjöld, Jesper LU ; Åkesson, Anna LU and Atroshi, Isam LU
- organization
- publishing date
- 2022-09
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Collagenase, Dupuytren contracture, fasciectomy
- in
- Journal of Hand Surgery
- volume
- 47
- issue
- 9
- pages
- 9 pages
- publisher
- Elsevier
- external identifiers
-
- scopus:85134798103
- pmid:35868901
- ISSN
- 0363-5023
- DOI
- 10.1016/j.jhsa.2022.04.019
- language
- English
- LU publication?
- yes
- id
- 9a59b603-79b9-461e-9bc0-91baa0f36575
- date added to LUP
- 2022-09-13 12:32:36
- date last changed
- 2024-06-13 19:19:44
@article{9a59b603-79b9-461e-9bc0-91baa0f36575,
abstract = {{<p>Purpose: To compare collagenase injection with surgical fasciectomy in Dupuytren disease (DD) for the prevalence of contracture in treated fingers 5 years after treatment. Methods: This was a single-center, comparative cohort study comprising 2 cohorts of patients treated for DD in 1 or more of 3 ulnar fingers with collagenase injection (159 patients) or surgical fasciectomy (59 patients). At 5 years after treatment, 13 collagenase-treated and 8 fasciectomy-treated patients had undergone subsequent treatment on the treated fingers and were considered to have current contracture. Of the remaining patients, 112 collagenase-treated patients (128 hands, 180 fingers) and 46 fasciectomy-treated patients (49 hands, 63 fingers) attended follow-up evaluation performed by 2 independent examiners (participation rate 84% and 93%, respectively). We defined current contracture in a treated finger as an active extension deficit of ≥20° in the metacarpophalangeal (MCP) or proximal interphalangeal (PIP) joint or a total (MCP + PIP) active extension deficit (TAED) of ≥30°. We used linear mixed models to analyze differences between the cohorts over time. Results: In the collagenase cohort, current contracture was present in 45 (25%) MCP and 60 (33%) PIP joints, and in the fasciectomy cohort, current contracture was present in 12 MCP (19%) and 30 PIP (48%) joints; a TAED of ≥30° was present in 79 (44%) of the collagenase-treated and 30 (48%) of the fasciectomy-treated fingers. In MCP and PIP joints with ≥20° pretreatment contracture, complete correction was observed in 82 (56%) MCP and 30 (30%) PIP joints in the collagenase cohort and 23 (70%) MCP and 5 (16%) PIP joints in the fasciectomy cohort. There was no statistically significant difference between the 2 cohorts in the TAED change over time. Conclusions: In patients with DD, collagenase injection and surgical fasciectomy improved finger joint contracture over the pretreatment status but had a high prevalence of joint contracture in the treated fingers 5 years after treatment. Type of study/level of evidence: Therapeutic IV.</p>}},
author = {{Eckerdal, David and Lauritzson, Anna and Nordenskjöld, Jesper and Åkesson, Anna and Atroshi, Isam}},
issn = {{0363-5023}},
keywords = {{Collagenase; Dupuytren contracture; fasciectomy}},
language = {{eng}},
number = {{9}},
pages = {{834--842}},
publisher = {{Elsevier}},
series = {{Journal of Hand Surgery}},
title = {{Finger Joint Contractures 5 Years After Treatment for Dupuytren Disease : A Comparative Cohort Study of Collagenase Injection Versus Surgical Fasciectomy}},
url = {{http://dx.doi.org/10.1016/j.jhsa.2022.04.019}},
doi = {{10.1016/j.jhsa.2022.04.019}},
volume = {{47}},
year = {{2022}},
}