Artikel
Can we predict the result 3 years after treatment with collagenase injections for Dupuytren disease?
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Autoren
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Anna Lauritzson
- Department of Rehabilitation, Hässleholm, Sweden
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Isam Atroshi
- Department of Orthopedics, Department of Clinical Sciences, Hässleholm, Sweden
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Jesper Nordenskjöld
- Department of Orthopedics, Hässleholm, Sweden
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Anna Åkesson
- Clinical Studies Sweden - Forum South, Lund, Sweden
| Veröffentlicht: | 6. Februar 2020 |
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Gliederung
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Objective: Dupuytren disease recurrence is common irrespective of treatment method. If baseline factors may predict long-term outcome is unknown. This study aimed to analyze predictors of outcome 3 years after treatment with collagenase injections.
Materials and Methods: A prospective cohort study was conducted at one orthopedic department in southern Sweden. Indication for treatment with collagenase injection was presence of a palpable cord and active extension deficit (AED) of at least 20 degrees in the metacarpophalangeal (MCP) and/or proximal interphalangeal (PIP) joint. The study included 86 consecutive patients (92 hands, 126 fingers). A surgeon injected 0.80 mg collagenase into multiple spots in the cord and performed finger manipulation after 24-48 hours. A hand therapist provided a custom-made extension splint to be worn a night for 2 months. Splint adjustment was done 1 week later, after which no routine therapy was used. A hand therapist measured AED before, 5 weeks and 3 years after treatment. Data were analyzed with a mixed-effects logistic regression model to identify predictors of recurrence, adjusting for sex and age.
Results: 3-year outcomes were available for 83 patients (97%, 120 treated fingers). Mean AED for MCP joints was 44 degrees before injection, 9 degrees 5 weeks and 12 degrees at 3 years, and for PIP joints 31 degrees, 12 degrees, 20 degrees respectively. Between the 5-week and 3-year measurements, AED worsened by 20 degrees or more in 17 MCP (14%) and 28 PIP (23%) joints. Treatment of small finger PIP joint contracture, severe pretreatment contracture and treatment of recurrence after surgical fasciectomy were significant predictors of recurrence between 5 weeks and 3 years.
Conclusions: In Dupuytren disease, contracture correction obtained with collagenase injections was maintained in the majority of the patients. Treatment of small finger PIP joint contracture, pretreatment contracture severity and treatment of recurrence after surgery are predictive of recurrence at 3 years.
