Skip to main content
SpringerLink
Log in

Factors predicting the 1-year outcome of collagenase treatment for Dupuytren’s disease

  • Handsurgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Several studies have investigated the clinical outcome after collagenase treatment for Dupuytren’s disease in terms of range of motion of the affected finger. However, good objective clinical outcome defined by a small remaining flexion contracture does not necessarily translate into satisfactory patient-subjective hand function. The aim of the present study was to identify predictors of patient-reported as well as objective clinical outcome in patients 1 year after collagenase treatment for Dupuytren’s disease.

Materials and methods

Socio-demographic and disease-related data of 92 Dupuytren patients were collected prior to the intervention. Flexion contracture of the most affected finger was measured at baseline and 1 year after treatment. Patients also completed the brief Michigan Hand Outcomes Questionnaire (brief MHQ) before the intervention and at 1-year follow-up. First, univariate correlations using Pearson’s correlation coefficient of the baseline variables with the two target variables were investigated. All variables with r > 0.35 were selected for a multivariate linear stepwise backwards regression model.

Results

The mean brief MHQ score increased between baseline (72 ± 14) and the 1-year follow-up (85 ± 15) (p ≤ 0.001) and baseline flexion contracture decreased from 76° (± 26) to 33° (± 31) (p ≤ 0.001). Higher hand function at baseline (R2 = 0.31) and less flexion contracture (R2 = 0.46) were identified as positive predictors for the outcome 1 year after collagenase treatment for Dupuytren’s disease. Other variables such as age, gender, manual work and if the MCP or PIP joint was affected did not determine outcome in our patient series.

Conclusions

Collagenase treatment resulted in considerable improvement in flexion contracture as well as patient-reported hand function at the 1-year follow-up. Clinicians can expect better outcome after collagenase infiltration in patients with less flexion contracture and in patients showing good initial self-reported hand function.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Wolfe S, Pederson W, Kozin S, Cohen M (2011) Green’s operative hand surgery, 6th edn. Elsevier, Amsterdam

    Google Scholar 

  2. Gilpin D, Coleman S, Hall S et al (2010) Injectable Collagenase Clostridium histolyticum: a new nonsurgical treatment for Dupuytren’s disease. J Hand Surg Am 35:2027–2038.e1

    Article  Google Scholar 

  3. Bear BJ, Peimer CA, Kaplan FTD et al (2017) Treatment of recurrent dupuytren contracture in joints previously effectively treated with collagenase Clostridium histolyticum. J Hand Surg Am 42:391:e1–391.e8

    Article  PubMed  Google Scholar 

  4. Peimer CA, Blazar P, Coleman S et al (2013) Dupuytren contracture recurrence following treatment with collagenase Clostridium histolyticum (CORDLESS Study): 3-year data. J Hand Surg Am 38:12–22

    Article  PubMed  Google Scholar 

  5. Raven RB, Kushner H, Nguyen D et al (2014) Analysis of efficacy and safety of treatment with collagenase Clostridium histolyticum among subgroups of patients with Dupuytren contracture. Ann Plast Surg 73:286–290

    Article  CAS  PubMed  Google Scholar 

  6. Warwick D, Arner M, Pajardi G et al (2015) Collagenase Clostridium histolyticum in patients with Dupuytren’s contracture: results from POINT X, an open-label study of clinical and patient-reported outcomes. J Hand Surg Eur 40:124–132

    Article  CAS  Google Scholar 

  7. Witthaut J, Jones G, Skrepnik N et al (2013) Efficacy and safety of collagenase Clostridium histolyticum injection for dupuytren contracture: short-term results from 2 open-label studies. J Hand Surg Am 38:2–11

    Article  PubMed  Google Scholar 

  8. Lipman MD, Carstensen SE, Deal DN (2017) Trends in the treatment of Dupuytren disease in the United States between 2007 and 2014. Hand 12:13–20. https://doi.org/10.1177/1558944716647101

    Article  PubMed  Google Scholar 

  9. Keller M, Arora R, Schmiedle G, Kastenberger T (2017) Treatment of Dupuytren’s disease with collagenase Clostridium histolyticum. Orthopade 46:321–327. https://doi.org/10.1007/s00132-017-3386-6

    Article  CAS  PubMed  Google Scholar 

  10. Van Beeck A, Van den Broek M, Michielsen M et al (2017) Efficacy and safety of collagenase treatment for Dupuytren’s disease: 2-year follow-up results. Hand Surg Rehabil 36:346–349

    Article  PubMed  Google Scholar 

  11. McMillan C, Yeung C, Binhammer P (2017) Variation in treatment recommendations for Dupuytren disease. J Hand Surg Am 42:963–970.e6. https://doi.org/10.1016/j.jhsa.2017.08.023

    Article  PubMed  Google Scholar 

  12. Degreef I, Vererfve PB, De Smet L (2009) Effect of severity of Dupuytren contracture on disability. Scand J Plast Reconstr Surg Hand Surg 43:41–42. https://doi.org/10.1080/02844310802410125

    Article  PubMed  Google Scholar 

  13. Zyluk A, Jagielski W (2007) The effect of the severity of the Dupuytren’s contracture on the function of the hand before and after surgery. J Hand Surg Eur 30:326–329

    Article  Google Scholar 

  14. Tsai T, Orav J, Jha A (2015) Patient satisfaction and quality of surgical care in US hospitals. Ann Surg 261:2–8

    Article  PubMed  PubMed Central  Google Scholar 

  15. Engstrand C, Krevers B, Kvist J (2015) Factors affecting functional recovery after surgery and hand therapy in patients with Dupuytren’s disease. J Hand Ther 28:255–260

    Article  PubMed  Google Scholar 

  16. Zhou C, Hovius SER, Slijper HP et al (2016) Predictors of patient satisfaction with hand function after fasciectomy for Dupuytren’s contracture. Plast Reconstr Surg 138:649–655

    Article  CAS  PubMed  Google Scholar 

  17. Bradley J, Warwick D (2016) Patient satisfaction with collagenase. J Hand Surg Am 41:689–697

    Article  PubMed  Google Scholar 

  18. Scherman P, Jenmalm P, Dahlin LB (2016) One-year results of needle fasciotomy and collagenase injection in treatment of Dupuytren’s contracture: a two-centre prospective randomized clinical trial. J Hand Surg Eur 41:577–582. https://doi.org/10.1177/1753193415617385

    Article  CAS  Google Scholar 

  19. Haase S, Chung K (2018) Bringing it all together. Hand Clin 34:427–436

    Article  PubMed  Google Scholar 

  20. Ball C, Pratt AL, Nanchahal J (2013) Optimal functional outcome measures for assessing treatment for Dupuytren’s disease: a systematic review and recommendations for future practice. BMC Musculoskelet Disord 14:131

    Article  PubMed  PubMed Central  Google Scholar 

  21. Knobloch K, Kraemer R, Papst S et al (2012) German version of the brief Michigan hand outcomes questionnaire: implications for early quality of life following collagenase injection in Dupuytren contracture. Plast Reconstr Surg 129:886–887

    Article  CAS  Google Scholar 

  22. Waljee J, Kim M, Burns P, Chung K (2011) Development of a brief, 12-item version of the Michigan Hand Questionnaire. Plast Reconstr Surg 128:208–220

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. McMillan CR, Binhammer PA (2009) Which outcome measure is the best? Evaluating responsiveness of the disabilities of the arm, shoulder, and hand questionnaire, the Michigan hand questionnaire and the patient-specific functional scale following hand and wrist surgery. Hand 4:311–318

    Article  PubMed  Google Scholar 

  24. Taylor J (1990) Interpretation of the correlation coefficient: a basic review. J Diagn Med Sonogr 6:35–39

    Article  Google Scholar 

  25. Descatha A, Jauffret P, Chastang JF et al (2011) Should we consider Dupuytren’s contracture as work-related? A review and meta-analysis of an old debate. BMC Musculoskelet Disord 12:96

    Article  PubMed  PubMed Central  Google Scholar 

  26. Logan AJ, Mason G, Dias J, Makwana N (2005) Can rock climbing lead to Dupuytren’s disease? Br J Sports Med 39:639–644

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Legge, JWHMcFarelane RM (1980) Prediction of results of treatment of Dupuytren’s disease. J Hand Surg Am 5:608–616

    Article  Google Scholar 

  28. Melamed E, Beutel BG, Goldstein S, Angel D (2017) Predictors of outcomes following fasciectomy for Dupuytren’s disease in diabetic and non-diabetic patients. J Hand Surg 22:309–314

    Google Scholar 

Download references

Acknowledgements

We would like to thank Martina Wehrli for her assistance during data collection and Dr Melissa Wilhelmi for manuscript editing.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Hand Surgery, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland

    Anne-Gita Scheibler & Daniel B. Herren

  2. Department of Teaching, Research and Development, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland

    Miriam Marks & Stefanie Hensler

  3. Department of Plastic and Hand Surgery, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland

    Maurizio Calcagni

Authors
  1. Anne-Gita Scheibler
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Miriam Marks
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stefanie Hensler
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Daniel B. Herren
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Maurizio Calcagni
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Daniel B. Herren.

Ethics declarations

Conflict of interest

M. Calcagni has received sponsoring from SOBI for an event on Dupuytren treatment. All other authors have no conflict of interest to declare.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Patient informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Scheibler, AG., Marks, M., Hensler, S. et al. Factors predicting the 1-year outcome of collagenase treatment for Dupuytren’s disease. Arch Orthop Trauma Surg 139, 583–588 (2019). https://doi.org/10.1007/s00402-019-03120-y

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-019-03120-y

Keywords

Search

Navigation