PT  - JOURNAL ARTICLE
AU  - Lauritzson, Anna
AU  - Atroshi, Isam
TI  - Collagenase injections for Dupuytren's disease: prospective cohort study assessing 2-year treatment effect durability
AID  - 10.1136/bmjopen-2016-012943
DP  - 2017 Mar 01
TA  - BMJ Open
PG  - e012943
VI  - 7
IP  - 3
4099  - http://bmjopen.bmj.com/content/7/3/e012943.short
4100  - http://bmjopen.bmj.com/content/7/3/e012943.full
SO  - BMJ Open2017 Mar 01; 7
AB  - Objectives To assess 2-year durability of joint contracture correction following collagenase injections for Dupuytren's disease.Design Prospective cohort study.Setting Orthopaedic Department in Sweden.Participants Patients with palpable Dupuytren's cord and active extension deficit (AED) ≥30° in the metacarpophalangeal (MCP) and/or proximal interphalangeal (PIP) joint. A surgeon injected 0.80 mg collagenase into multiple cord parts and performed finger manipulation under local anaesthesia after 24–48 hours. A hand therapist measured joint contracture before and 5 weeks after injection in all treated patients. Of 57 consecutive patients (59 hands), 48 patients (50 hands) were examined by a hand therapist 24–35 months (mean 26) after injection. Five of the patients had received a second injection in the same finger within 6 months of the first injection.Outcome measures Primary outcome was proportion of treated joints with ≥20° worsening in AED from 5 weeks to 2 years.Results Between the 5-week and the 2-year measurements, AED had worsened by ≥20° in seven MCP and seven PIP joints (28% of the treated hands; all had received a single injection). Mean AED for the MCP joints was 54° before injection, 6° at 5 weeks and 9° at 2 years and for the PIP joints 30°, 13° and 16°, respectively. For joints with ≥10° contracture at baseline, mean (95 % CI) baseline to 2 years AED improvement was for MCP 49° (41–54) and for PIP 25° (17–32). No treatment-related adverse events were observed at the 2-year follow-up evaluation.Conclusions Two years after collagenase injections for Dupuytren's disease, improvement was maintained in 72% of the treated hands. Complete contracture correction was seen in more than 80% of the MCP but in less than half of the PIP joints.