Published online Apr 18, 2024. doi: 10.5312/wjo.v15.i4.355
Peer-review started: December 31, 2023
First decision: January 16, 2024
Revised: January 30, 2024
Accepted: March 18, 2024
Article in press: March 18, 2024
Published online: April 18, 2024
Dupuytren’s contracture (DC), also known as palmar fibromatosis, has been shown to be successfully treated with enzymatic fasciotomy. This novel approach involves the injection of collagenase derived from collagenase clostridium histolyticum (CCH) into a fibrous cord causing DC.
In contrast to traditional surgical procedures, enzymatic fasciotomy is a less invasive alternative. However, the long-term outcomes of this innovative technique remain largely unexplored. Recently, there has been a growing trend of re-assessing patients who underwent enzymatic fasciotomy. Notably, it has been observed that not all individuals treated with this technique have experience long-term efficacy.
This study compared the short-term (12 wk) and long-term (10 years) outcomes of CCH treatment of DC.
This was a prospective study that was part of a multicenter trial conducted in a university hospital beginning in 2012. Our institution conducted 45 injections of CCH for the treatment of DC with palpable cord manifestations. A comprehensive 7-year follow-up revealed a recurrence of the disease, particularly among patients injected at the proximal inter
When CCH was injected at the PIP joint, 100% of patients experienced recurrence at 10 years. When CCH was injected at the MCP joint, over 50% of patients experienced recurrence after 10 years. There was a statistically significant difference in passive extension deficit (PED) and total PED when comparing the outcomes at the 7-year follow-up and the 10-year follow-up.
The use of CCH for the treatment of DC is recommended when applied to palpable cords at the MCP joint. However, patients should be informed of the risk of recurrence. We do not recommend CCH for the treatment of DC at the PIP joint due to low patient satisfaction, the high rate of recurrence, and the need for re-intervention within 10 years.
The deterioration observed in our case series underscores the importance of re-evaluating cases beyond the typical 5-year follow-up. Further long-term studies are required to completely evaluate the long-term efficacy of CCH for the treatment of DC.