Passiatore M, Cilli V, Cannella A, Caruso L, Sassara GM, Taccardo G, De Vitis R. Long-term assessment of collagenase treatment for Dupuytren’s contracture: A 10-year follow-up study. World J Orthop 2024; 15(4): 355-362 [PMID: 38680672 DOI: 10.5312/wjo.v15.i4.355]
Corresponding Author of This Article
Rocco De Vitis, MD, Additional Professor, Surgeon, Department of Orthopedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Unità Operativa Complessa di Chirurgia della mano, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 8, Roma 00168, Italy. roccodevitis@yahoo.com
Research Domain of This Article
Orthopedics
Article-Type of This Article
Prospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. Apr 18, 2024; 15(4): 355-362 Published online Apr 18, 2024. doi: 10.5312/wjo.v15.i4.355
Long-term assessment of collagenase treatment for Dupuytren’s contracture: A 10-year follow-up study
Marco Passiatore, Vitale Cilli, Adriano Cannella, Ludovico Caruso, Giulia Maria Sassara, Giuseppe Taccardo, Rocco De Vitis
Marco Passiatore, Department of Bone and Joint Surgery, ASST-Spedali Civili, Brescia 25123, Italy
Vitale Cilli, Department of Chirurgie de la Main, Centre Hospitalier Interregional Edith Cavell, Bruxelles 1160, Belgium
Adriano Cannella, Ludovico Caruso, Giulia Maria Sassara, Giuseppe Taccardo, Rocco De Vitis, Department of Orthopedics, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome 00168, Italy
Author contributions: Passiatore M wrote the manuscript; Cilli V, Cannella A, Caruso L, and Sassara GM participated in acquisition, analysis, and interpretation of the data; Taccardo G was the guarantor, designed the study, and performed the surgical treatments; De Vitis R designed the study and performed the surgical treatments; Taccardo G and De Vitis R critically revised the article for important intellectual content; All authors read and approved the final manuscript.
Institutional review board statement: This prospective study was approved by the local ethics committee (Ethics Committee Protocol P/488-857-872-1041-1113/CE/2012).
Clinical trial registration statement: This study is registered at ClinicalTrial.Gov. The registration identification number is NCT01229436.
Informed consent statement: The authors declare that all patients signed the informed consent.
Conflict-of-interest statement: The authors declare that are no conflicts of interest.
Data sharing statement: No additional data are available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Rocco De Vitis, MD, Additional Professor, Surgeon, Department of Orthopedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Unità Operativa Complessa di Chirurgia della mano, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 8, Roma 00168, Italy. roccodevitis@yahoo.com
Received: December 31, 2023 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 Processing time: 107 Days and 8 Hours
ARTICLE HIGHLIGHTS
Research background
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.
Research motivation
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.
Research objectives
This study compared the short-term (12 wk) and long-term (10 years) outcomes of CCH treatment of DC.
Research methods
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 interphalangeal (PIP) joint. Additionally, there was evidence of disease recurrence in patients injected at the metacarpophalangeal (MCP) joint.
Research results
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.
Research conclusions
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.
Research perspectives
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.
