Injection therapy with collagenase clostridium histolyticum may offer a safe and effective nonsurgical treatment option for patients experiencing recurrence of Dupuytren contracture after prior surgery, according to a multicenter retrospective study conducted at ten US clinical centers.
Dupuytren contracture is a fibroproliferative disorder characterized by thickening and shortening of the palmar fascia that can lead to progressive finger flexion contractures and impaired hand function. Although surgical procedures such as fasciectomy or fasciotomy remain common treatments, recurrence is frequent, and repeat surgery can be technically challenging due to scar tissue and altered anatomy that can increase complications and amputation risks.
To explore alternative options for these patients, investigators reviewed medical records from individuals treated with collagenase clostridium histolyticum CCH injections for recurrent disease at least 6 months after a previously successful surgical correction. The researchers defined recurrence as a functionally considerable increase in flexion contracture of at least 20° that prompted a patient to seek care. The study included 101 patients (mean age, 64 years) approximately three-quarters of whom were men. The median time from initial surgery to recurrence requiring treatment was 36 months.
Across the cohort, 144 joints were treated with CCH, including 64 metacarpophalangeal joints and 75 proximal interphalangeal joints. Baseline contracture averaged 52°, with more severe deformity typically observed in proximal interphalangeal (PIP) joints compared with metacarpophalangeal (MP) joints.
Following treatment, the investigators observed substantial improvements in joint extension. At the first post-manipulation evaluation, mean contracture improved by 43°. By the final evaluation within 12 months of treatment, the average improvement remained 38° across all joints, with PIP joints improving by 41° and MP joints improving by 36°.
Clinical success – defined as reducing contracture to between 0° and 5°– was achieved in 65% of treated joints at the first evaluation and in 58% at the last evaluation. Outcomes were more favorable in MP joints than in PIP joints: 75% of MP joints met the clinical success threshold at final evaluation compared with 43% of PIP joints.
Safety findings were consistent with previous reports of collagenase therapy. Treatment-related adverse events occurred in 36% of patients, with skin tears being the most common complication. Twenty skin tears were reported in 19% of patients; all healed spontaneously, and half resolved within 21 days. Investigators also reported a single flexor tendon rupture, which did not require surgical reconstruction.
The study authors noted that surgical retreatment for recurrent Dupuytren disease carries higher complication risks – including neurovascular injury and, in rare cases, amputation – compared with primary procedures. Because of these risks, some patients may hesitate to undergo another operation.
Despite limitations inherent to retrospective chart reviews, the findings suggest that collagenase injection may represent a practical alternative for selected patients with recurrent Dupuytren contracture who wish to avoid repeat surgery. The investigators conclude that CCH treatment for postsurgical recurrence appears effective and well tolerated, with outcomes comparable to those observed in patients treated without prior surgery.
