Collagenase clostridium histolyticum injection versus limited fasciectomy for the treatment of Dupuytren's disease: a systematic review and meta-analysis of comparative studies.

INTRODUCTION: The aim of the present study is to systematically review the literature on well-selected comparative studies for meta-analysis on outcome differences between collagenase clostridium histolyticum (CCH) injection and limited fasciectomy (LF) for Dupuytren's disease. MATERIALS AND METHODS: PubMed/Medline, Embase, and the Cochrane Library were searched for comparative studies assessing differences in outcomes of CCH and LF. Effect estimates were pooled across studies using random effects models and presented as weighted mean difference (MD) and odds ratio (OR) with corresponding 95% confidence interval (CI). RESULTS: A total of 11 studies encompassing 1'051 patients was included (619 patients in the CCH and 432 in the LF group). The residual contracture at a minimal average follow-up of three months was higher in the CCH group than in the LF group (27.8 vs. 16.2°, MD 11.6°, 95% CI [8.7, 14.5°], p < 0.001). The recurrence rate was significantly higher in the CCH group (25.8 vs. 9.3%, OR 5.2, 95% CI [1.5, 18.8], p = 0.01) while the rate of severe complications was significantly higher in the LF group (0.3 vs. 7.3%, OR 0.12, 95% CI [0.03, 0.42], p = 0.001). CONCLUSIONS: Evidence of the present study confirms that CCH injection has a higher rate of disease recurrence whereas LF carries a higher risk for severe complications. It's imperative that the trade-off between these aspects is considered, keeping in mind that CCH injections may be repeated in case of disease recurrence without increasing procedure related risks, especially in complex cases.

Validation of a Handprint for Clinical Evaluation of Dupuytren's Contracture.

Objective We have developed a handprint-based method for visualizing and quantifying the palmar contact of patients with Dupuytren's contracture. The purpose of this study was to examine whether the generated handprint was useful for assessing the severity of flexion contracture of the fingers and for evaluating the therapeutic effects of collagenase clostridium histolyticum (CCH) injection for Dupuytren's contracture. Methods The handprint was created by applying medical-grade ethanol-containing hand sanitizer over the entire palmar surface of the affected hand and then pressing it on thermal paper for word processors. The reliability of the handprint was evaluated through test-retest of 10 healthy volunteers at an interval of 10 days, and the validity of the handprint was assessed using a flexion contracture model in which the little finger was fixed in an Alfence splint. In addition, we obtained handprints of the affected hand in 33 patients with unilateral Dupuytren's contracture both before CCH injection and at the final observation after injection to investigate the contact area of the hand (CAH) and the length of the hand (LH). The relationships between CAH, LH, total extension deficit angle (TEDA), and patient-reported outcome measures (Japanese Society for Surgery of the Hand Version of the Quick Disability of Arm, Shoulder, and Hand Questionnaire [Quick DASH-JSSH] and Hand20) were examined. Results The test-retest correlation coefficient was 0.9187 ( p < 0.001) for CAH and 0.9052 ( p < 0.001) for LH, indicating high reliability of the handprint. The ratios of CAH and LH decreased gradually as the contracture angle of the splinted finger increased. The handprint revealed a marked improvement of palmar contact after CCH injection for Dupuytren's contracture. Furthermore, the ratios of CAH and LH were strongly correlated with TEDA, Quick DASH-JSSH, and Hand20 before treatment. Conclusion Our handprint-based assessment method was extremely useful for clinical evaluation of CCH treatment for Dupuytren's contracture. Type of Study/Level of Evidence Therapeutic.

Experimental animal models and evaluation techniques in intracerebral hemorrhage.

Intracerebral hemorrhage (ICH) is the most lethal type of cerebral stroke without effective therapy. Although clinical trials with various surgeries have been conducted, none have improved clinical outcomes compared to the current medical management for ICH. Several ICH animal models, including autologous blood injection, collagenase injection, thrombin injection, and microballoon inflation methods, have been developed to elucidate the underlying mechanisms of ICH-induced brain injury. These models could also be used for discovering new therapy for ICH preclinically. We summarize the existing ICH animal models and the evaluation parameters used to measure the disease outcomes. We conclude that these models, resembling the different aspects of ICH pathogenesis, have their advantages and disadvantages. None of the current models closely represent the severity of ICH seen in clinical settings. More appropriate models are needed to streamline ICH's clinical outcomes and be used for validating newly developed treatment protocols.

Patients' perspectives of collagenase injection or needle fasciotomy and rehabilitation for Dupuytren disease, including hand function and occupational performance.

PURPOSE: To describe patients' perspectives of collagenase injection or needle fasciotomy for Dupuytren disease (DD) including hand therapy, and their view of hand function and occupational performance. MATERIALS AND METHODS: Interviews were performed with twelve patients who had undergone non-surgical treatment and rehabilitation for DD. Data was analysed using a problem-driven content analysis using the model of Patient Evaluation Process as a theoretical framework. RESULTS: The participants' previous experiences influenced their expectations of the upcoming treatment and they needed information to be prepared for treatment. Treatment and rehabilitation had a positive impact on daily life and were regarded as effective and simple with quick recovery. However, there could be remaining issues with tenderness or stiffness. The participants expressed their belief in rehabilitation and how their own efforts could contribute to an improved result. Despite concerns about future recurrence participants described increased knowledge and sense of control regarding future needs. CONCLUSION: Undergoing a non-surgical treatment and rehabilitation process for DD was regarded as quick and easy and can meet the need for improved hand function and occupational performance. Taking responsibility for one's own rehabilitation was considered to influence the outcome positively. The theoretical framework optimally supported the exploration of participants' perspective.Implications for rehabilitationTreatment of Dupuytren Disease (DD) with needle/collagenase combined with hand therapy was experienced as giving fast improvement in hand function and occupational performance.An individualized care process which satisfies the need for knowledge about the disease, prognosis, treatment options and rehabilitation can give individuals suffering from DD a sense of security.The need for active participation in the DD care process can vary and it is crucial to listen to individuals' opinions and needs.Individuals can take considerable responsibility for rehabilitation after non-surgical treatment for DD and regard it as important for the outcome.

Short-term efficacy and adverse effects of collagenase clostridium histolyticum injections, percutaneous needle fasciotomy and limited fasciectomy in the treatment of Dupuytren's contracture: a network meta-analysis of randomized controlled trials.

AIMS: Dupuytren's contracture (DC) is a chronic debilitating fibroproliferative disorder. Common treatment options include collagenase clostridium histolyticum injections (CI), percutaneous needle fasciotomy (NF) and limited fasciectomy (LF). Superiority of one specific treatment remains controversial. This study aims to assess the short-term efficacy and safety of CI, NF, and LF for the treatment of DC. METHODS: We included randomized controlled trials of CI compared with placebo, NF and LF for patients with DC. PubMed, Embase and the Cochrane Library were searched from inception to August 2021. Contracture reduction rates in treated joints (within 0-5° of full extension within 30 days), relative reduction in total passive extension deficit (TPED), occurrence of one or more adverse events and number of treatment-related adverse events per patient were the outcomes of interest. The Cochrane risk-of-bias tool was employed for quality assessment of the studies. A network meta-analysis was performed using MetaXL. RESULTS: Nine studies met our inclusion criteria (n = 903). Overall, risk bias was mixed and mostly low. Short term TPED reduction achieved with LF was superior compared to CI and NF. Although CI achieved greater TPED reduction compared to NF, it was associated with the highest risk of overall adverse effects. The analyzed data was limited to a maximum three-year follow-up period and therefore insufficient for long-term outcome evaluation. CONCLUSIONS: In DC, LF may be able to provide patients with severe disease, superior flexion contracture release postoperatively. CI is a valid treatment alternative to NF, however the higher risk of overall adverse effects must be considered. The quality-of-evidence is limited due to short-term follow-up periods and a lack of standardized definitions of complications and adverse events.

Effect of Oral Prednisolone after Collagenase Injection for Dupuytren's Contracture: A Randomized, Controlled Trial with a 1-Year Follow-Up.

Introduction This study verified the effectiveness of oral prednisolone after collagenase clostridium histolyticum (CCH) (10 mg/day for 2 weeks) for Dupuytren's contracture with a 1-year follow-up. Materials and Methods This study included 31 patients with a contracture of the metacarpophalangeal joint of ≥ 30 degrees. A total of 16 patients were allocated randomly to treatment with prednisolone and 15 patients were treated without prednisolone (control group). Results At day 7, mean total active motion (TAM) was 235 degrees in the prednisolone group and 228 degrees in the control group. Mean Visual Analog Scale was 3.3 in the prednisolone group and 4.6 in the control group. There was significant difference between two groups. At day 30, mean TAM was 241 degrees in the prednisolone group and 233 degrees in the control group. There were significant difference between two groups The mean QuickDASH score was significantly higher in the control group (5.8 vs. 3.4). Recurrence was observed in 2/16 patients (13%) in the prednisolone group and 5/15 patients (33%) in the control group; there was no significant difference. Conclusion The administration of prednisolone decreased the likelihood of adverse effects, and also improved finger flexion range of motion and reduced pain after CCH.

Dupuytren's Disease: An Outcomes-Focused Update.

Dupuytren's disease (DD) remains a common fibroproliferative condition with significant sequelae and impact on patient's lives. The etiology of DD is poorly understood, and genetic predisposition is thought to be a strongly associated factor. Despite remarkable strides in improving our molecular understanding of DD, clinical treatment options have not yet overcome the frequently encountered challenge of recurrence. Recurrence rates continue to shape the prognosis of this fibrotic condition. In this outcomes-focused article, the various treatment modalities are reviewed. This further emphasizes the importance of patient education and providing them with the information to make informed decisions about their treatment.

Seven-year clinical outcomes after collagenase injection in patients with Dupuytren's disease: A prospective study.

INTRODUCTION: This investigation is a prospective cohort study examining the use of Clostridium histolyticum collagenase injection (CCH) for the treatment of Dupuytren's disease (DD) with a 7 years follow-up. METHODS: Forty-five monodigital DD patients were injected with CCH on a single joint. Assessment included measurement of residual passive extension deficit (PED), function (using QuickDASH) and patient satisfaction. RESULTS: 86.7% of PIPJ and 65.6% of MPJ had a worsening of PED. Nevertheless, thirty-nine patients (86.7%) concluded their treatment with only one injection, without any further treatment. CONCLUSION: CCH provides a long-term effective solution. Recurrence occurs, especially in PIPJ, with acceptable rates.

Three-year recurrence of Dupuytren's contracture after needle fasciotomy and collagenase injection: a two-centre randomized controlled trial.

Collagenase injection and needle fasciotomy have similar short-term outcomes in the treatment of Dupuytren's contracture. The purpose of this study was to compare the recurrence rate of these two procedures 3 years after index treatment of primary disease. We enrolled 93 patients (96 rays) from a previous two-centre randomized controlled trial. The rays that had been retreated or showed an increase in the total passive extension deficit of 30° or more compared with 3 months after treatment were regarded as recurrences. Seventeen of 40 needle fasciectomies and 12 of 36 of collagenase injections had recurred. This difference was not statistically significant. We conclude that collagenase injection and needle fasciotomy have similar 3-year recurrence rates in the treatment of Dupuytren's contracture. LEVEL OF EVIDENCE: I.

Needle Aponeurotomy for Dupuytren Disease.

Needle aponeurotomy is an effective, minimally invasive treatment for metacarpophalangeal and interphalangeal joint contractures caused by Dupuytren disease. Multiple joints and digits can be safely treated in 1 session. Needle aponeurotomy is more cost-effective and has a significantly lower complication rate compared with open fasciectomy and collagenase injections. Recurrence rates are higher compared with open fasciectomy and collagenase injections. Patient satisfaction rates are high following needle aponeurotomy; the single clinic visit required and the minimal downtime after treatment are advantages unique to this procedure compared with other treatment modalities, including open fasciectomy, dermatofasciectomy, collagenase injections, and lipofilling.

Animal Stroke Model: Ischemia-Reperfusion and Intracerebral Hemorrhage.

Stroke is a major health issue worldwide-one with serious financial and public health implications. As a result, ongoing clinical research on novel and improved stroke therapies is not only pertinent but also paramount. Due to the complexity of a stroke-like event and its many sequelae, devising usable methods and experimental models are necessary to study and better understand the pathophysiological processes that ensue. As it stands, animal models that simulate stroke-like events have proven to be the most logical and effective options in regards to experimental studies. A number of animal stroke models exist and have been demonstrated in previous studies on ischemic as well as hemorrhagic stroke. Considering the efficiency and reproducibility of animal models, here, we introduce an ischemic stroke model induced by middle cerebral artery occlusion (MCAO) and an intracerebral hemorrhagic stroke model induced by collagenase injection. The models outlined here have been proven to demonstrate the clinical relevance desired for use in continued research on stroke pathophysiology and the study of future therapeutic options.

One-year results of needle fasciotomy and collagenase injection in treatment of Dupuytren's contracture: A two-centre prospective randomized clinical trial.

UNLABELLED: The objective of this study was to compare early and 1 year outcome of needle fasciotomy and collagenase injection for Dupuytren's disease. Inclusion criteria were primary Dupuytren's contracture excluding the thumb with a palpable cord and a total extension deficit, i.e. a fixed flexion from 30° to 135° with less than 60° in the proximal interphalangeal joint. The most affected ray was randomized to either treatment at two centres. Passive extension deficits for each joint before and after treatment, and at 3 and 12 months, were recorded together with complications. A total of 96 rays in 93 patients were included. The average total extension deficits before treatment were 60° or more in both groups, and were largely made up of contractures at the metacarpophalangeal joints. The deficits were reduced by 75% in both groups at 3 months and by 70% in both groups at 12 months. Four patients in the needle fasciotomy group and eight patients in the collagenase group had skin ruptures. At 3 months and 1 year, the outcomes of needle fasciotomy and collagenase injection are the same in Dupuytren's disease with predominantly metacarpophalangeal joint involvement. LEVEL OF EVIDENCE: 2.

Management of complications of Dupuytren contracture.

This evidence-based article discusses the current management options of Dupuytren disease and strategies to avoid and manage any potential complications. Treatment options include fasciectomy, needle fasciotomy/aponeurotomy, and collagenase injection. Complications include digital nerve and artery injury, flexor tendon injury, skin fissures and wound healing complications, hematoma, infection, flare reaction/complex regional pain syndrome, and recurrence. Complication rates, prevention, and management differ with each treatment modality. A detailed understanding of each of these options allows hand surgeons to select the most appropriate treatment for each patient.

Dupuytren's disease: current state of the art.

BACKGROUND: This review article critically examines the current literature for Dupuytren's disease. METHODS: Five procedures are considered: dermofasciectomy, limited fasciectomy, segmental aponeurectomy, needle aponeurotomy, and collagenase injection. Studies regarding the efficacy of these treatments focus primarily on the initial degree of correction, rate of recurrence, and complications. RESULTS: No one treatment has been declared superior and substantial controversy exists. Comparison between studies has been hampered by the absence of uniform definitions for clinical success and measurable disease progression. Traditional post-operative care includes formal therapy and night splinting, but recent studies have questioned the value of these adjuncts. CONCLUSION: The extent of involvement at which the surgeon should intervene was previously well accepted by convention, but as the paradigm shifts towards less invasive procedures, treatment may be offered at an earlier stage. Future research should be structured to recognize the value-based decision making used by patients when selecting treatment.

Needle aponeurotomy for the treatment of Dupuytren's disease.

PNA is one of many treatments available for the treatment of hand contractures resulting from Dupuytren's disease. It is generally recommended for elderly patients with less severe contractures who desire a less invasive procedure, or as a first stage to delay surgery in those with more aggressive disease. The procedure is safe and easily tolerated by patients, but there is a high rate of recurrence.

The clinical value of double collagenase injection in treating patients with lumbar intervertebral disc herniation / 介入放射学杂志

Objective To explore the clinical value of double collagenase injection in treating patients with lumbar disc herniation. Methods Thirty one patients with lumbar disc herniation to whom DCI had been applied were analyzed with 15 to 31 months follow-up. Results The therapeutic effects were excellent in 27, good in 3, fail in 1. The total effective rate was 96.7%.Conclusions DCI is a good method in treating lumbar disc herniation with high effectiveness, extensive indications, low complications and profitable clinical application prospectively.