Clinical Outcomes of Collagenase Injections During a Surgeon’s Initial Learning Phase

Abstract

Purpose: Collagenase Clostridium histolyticum (CCH) has increasingly been used to treat Dupuytren contracture since its Food and Drug Administration approval in 2010. One concern among practitioners is the learning curve of this new technique. This study characterizes success and complication rates for surgeons with no prior experience with CCH treatment. Methods: We recruited 10 hand and upper-extremity surgeons for this study. Retrospective clinical records were reviewed for the first 10 CCH injections by each surgeon. Preinjection, postmanipulation, and 30- to 90-day follow-up measurements were recorded, along with any complications. Finally, provider opinions regarding CCH for Dupuytren contracture were collected. Results: There were 100 CCH injections in 100 fingers: 42 with isolated metacarpophalangeal contractures, 24 with isolated proximal interphalangeal contractures, and 34 with both metacarpophalangeal and proximal interphalangeal contractures. At 30- to 90-day follow-up, 61.4% of primary joints demonstrated improvement of contracture to within 0° to 5° degrees from full extension, 85.2% showed greater than 50% reduction in contracture, and 12 patients were lost to follow-up. Trend analysis suggested a flat initial learning curve. Complications occurred in 33 cases and included skin tears (31) and lymphadenopathy (4). No tendon ruptures were observed. All surgeons were either satisfied or extremely satisfied with CCH and continued using it in their practices. Conclusions: Clinical results achieved from practitioners’ early injections mirrored success and surgeon satisfaction rates previously reported in the literature. However, complication rates were higher than those in initial clinical trials but similar to later studies that used local anesthesia during manipulation. Trends in clinical outcomes among the first 10 injections suggest an initially flat learning curve for CCH. Practitioners’ opinions of CCH remained favorable after early use. Type of study/level of evidence: Therapeutic III. Key words: collagenase, Dupuytren, initial learning phase