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. 2022 Sep;17(5):815-824.
doi: 10.1177/1558944720974119. Epub 2021 Jan 21.

Treatment of Dupuytren's Contracture With Collagenase: A Systematic Review

Alexis B Sandler  1 , John P Scanaliato  2 , Thomas Dennis  3 , Gilberto A Gonzalez Trevizo  4 , Sorana Raiciulescu  5 , Leon Nesti  5 , John C Dunn  2
Affiliations

Treatment of Dupuytren's Contracture With Collagenase: A Systematic Review

Alexis B Sandler et al. Hand (N Y). 2022 Sep.

Abstract

This systematic review investigates complications and recurrence of Dupuytren's contracture in metacarpophalangeal joints (MCPJs) and/or proximal interphalangeal joints (PIPJs) of fingers treated with collagenase clostridium histolyticum (CCH). A review of the literature on Dupuytren's disease was performed using PRISMA guidelines. Included publications described complications and/or recurrences for contractures ≥20° in MCPJs and/or PIPJs treated with CCH. Successful treatments reduced contractures to ≤5° immediately. Treatment-related adverse events (AEs) were classified as minor, major surgical, and major nonsurgical. Contracture recurrence involved return of fixed-flexion contracture ≥20° in a successfully treated finger in patients with ≥12 months of follow-up. Of 2675 patients (3753 joints), 94% experienced ≥1 treatment-related AE, most commonly peripheral edema (64%), pain in extremity (53%), and contusion (51%). Major surgical complications occurred in 9 patients (1.0%). Major nonsurgical complications occurred in 2 patients, specifically nonrupture tendon injury and anaphylaxis. Of 1488 patients (2069 joints), recurrences were reported in 23% of successfully treated joints (n = 466; 20% MCPJs, 28% PIPJs), on average 12 to 24 months after treatment. MCPJs achieved greater success than PIPJs in initial contracture reduction (77% versus 36%). CCH is a safe, effective treatment to improve hand function in Dupuytren's contracture. Most AEs are minor and self-resolving, although the risk of major AEs still exists. Following treatment, 23% of successfully treated joints experience recurrence, typically within 12 to 24 months but sometimes as early as 6 months. Surgeons are encouraged to discuss these risks with patients for shared decision-making regarding optimal treatment modalities.

Keywords: CCH; Dupuytren; anatomy; collagenase; contracture; hand.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
PRISMA flow diagram. Note. PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Figure 2.
Figure 2.
Contracture recurrence versus study follow-up. Note. MCPJ = metacarpophalangeal joint; PIPJ = proximal interphalangeal joint.
See this image and copyright information in PMC

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