Five-year results after collagenase treatment of Dupuytren disease

2018 ◽  
Vol 43 (8) ◽  
pp. 841-847 ◽  
Author(s):  
Jens C. Werlinrud ◽  
Karina L. Hansen ◽  
Søren Larsen ◽  
Jens Lauritsen
Keyword(s):  
Rank Test ◽  
Collagenase Clostridium Histolyticum ◽  
Recurrence Rates ◽  
Extension Deficit ◽  
Level Of Evidence ◽  
Metacarpophalangeal Joints ◽  
Clostridium Histolyticum ◽  
Significant Difference ◽  
Dupuytren Disease

This study assesses the joint-specific sustained effect of collagenase clostridium histolyticum treatment of Dupuytren disease over a 5-year follow-up period. The study includes 107 consecutive treatments in patients with extension deficits greater than 20° affecting the metacarpophalangeal or proximal interphalangeal joints. Success was defined as no follow-up treatment due to relapse or maintained extension deficit less than 20°. The 5-year estimate of no follow-up treatment was 79% (95% CI: 64–88) for metacarpophalangeal and 49% (95% CI: 26–69) for proximal interphalangeal joints, which was a significant difference (log-rank test, p = 0.0044). For those who did not undergo re-treatment, a non-significant relapse was found for metacarpophalangeal joints and a 65% (34°, 95% CI: 24–46) relapse for proximal interphalangeal joints. We conclude that treating metacarpophalangeal joints with collagenase clostridium histolyticum is effective with acceptable recurrence rates. However, when treating proximal interphalangeal joints with collagenase clostridium histolyticum, patients should be informed of the high risk of recurrence and the greater chance of need for further treatment. Level of evidence: II

Treatment of Single Cords in Dupuytren Disease with Collagenase Clostridium Histolyticum: Study of a Cohort with Follow-up at 1 Year

2018 ◽  
Vol 46 (01) ◽  
pp. 034-039
Author(s):  
Ignasi Manent Bistué ◽  
Sonia Suau Mateu ◽  
Ana Maria López Louzao ◽  
Pier Claudio Caputo ◽  
Víctor Rodriguez Roiz ◽  
...  
Keyword(s):  
Cohort Study ◽  
Metacarpophalangeal Joint ◽  
First Year ◽  
Collagenase Clostridium Histolyticum ◽  
Paired Data ◽  
Clostridium Histolyticum ◽  
Injectable Treatment ◽  
Locoregional Anesthesia ◽  
Dupuytren Disease

Objective The purpose of the present work was to assess the effectiveness of collagenase Clostridium histolyticum in patients with Dupuytren disease with single cords and assess the recurrence rate in the first year after the treatment. Material and Methods In this classic cohort study, a total of 53 patients (50 of them male) with a mean age of 68 years were studied who had been diagnosed with Dupuytren disease located in the metacarpophalangeal joint, in single cords, with more than 40° of extension loss. They were given an injection of collagenase C. histolyticum and later manipulation under locoregional anesthesia. The loss of extension was evaluated after a week and at the 1st, 3rd, 6th and 12th months. The effectiveness was analyzed with basis on the results of the Student t-test for paired data, as well as those of the effect size (ES) test. Results An important and statistically significant correlation was found for the loss of cord extension in the metacarpophalangeal joint (t = 32.113; p < 0.01; ES = 4.11; standardized response mean [SRM] = 4.15). Conclusion Collagenase is an injectable treatment, which is not very aggressive compared with surgery and is effective for the loss of extension in the metacarpophalangeal region secondary to single cord in Dupuytren disease during the first year.

scholarly journals Hand function 5 years after treatment with collagenase Clostridium histolyticum injection for Dupuytren’s disease

2021 ◽  
pp. 175319342110023
Author(s):  
Ingrid Göransson ◽  
Lars Brudin ◽  
Andra Irbe ◽  
Christina Turesson
Keyword(s):  
Range Of Motion ◽  
Hand Function ◽  
Treatment Method ◽  
Dupuytren’S Disease ◽  
Collagenase Clostridium Histolyticum ◽  
Extension Deficit ◽  
Level Of Evidence ◽  
Dupuytren's Disease ◽  
Clostridium Histolyticum ◽  
New Treatment

The aim of this study was to report hand function, disability and satisfaction and patients’ perception of functionally troublesome contractures 5 years after injection with collagenase Clostridium histolyticum and hand therapy for Dupuytren's disease. Data from 79 patients were collected before and at 3, 12 and 60 months after treatment. Hand function was significantly improved, and 70% achieved a functional range of motion in the treated hand. QuickDASH scores and range of motion were best at 3 months follow-up. At 60 months, mean total extension deficit was 48°, which was 57% of the deficit before treatment. Thirty-seven patients (47%) had developed recurrent contractures in treated finger(s) meeting the criteria for new treatment. The threshold for functionally troublesome contractures was found to be 30°–60° in the finger joints. Treatment was experienced as painful, but few hand function problems occurred. Most patients would choose this treatment method again. Level of evidence: IV

scholarly journals Arthroscopic Bankart Repair Versus Open Latarjet for First-Time Dislocators in Athletes

2021 ◽  
Vol 9 (8) ◽  
pp. 232596712110238
Author(s):  
Eoghan T. Hurley ◽  
Martin S. Davey ◽  
Connor Montgomery ◽  
Ross O’Doherty ◽  
Mohamed Gaafar ◽  
...  
Keyword(s):  
Shoulder Dislocation ◽  
Return To Play ◽  
Bankart Repair ◽  
Recurrence Rates ◽  
Level Of Evidence ◽  
Arthroscopic Bankart Repair ◽  
Significant Difference ◽  
Patient Reported ◽  
First Time

Background: In athletes with a first-time shoulder dislocation, arthroscopic Bankart repair (ABR) and the open Latarjet procedure (OL) are the most commonly utilized surgical procedures to restore stability and allow them to return to play (RTP). Purpose: To compare the outcomes of ABR and OL in athletes with a first-time shoulder dislocation. Study Design: Cohort study; Level of evidence, 3. Methods: We performed a retrospective review of patients with first-time shoulder dislocation who underwent primary ABR and OL and had a minimum 24-month follow-up. Indications for OL over ABR in this population were those considered at high risk for recurrence, including patients with glenohumeral bone loss. Patients who underwent ABR were pair-matched in a 2:1 ratio with patients who underwent OL by age, sex, sport, and level of preoperative play. The rate, level, and timing of RTP, as well as the Shoulder Instability–Return to Sport after Injury (SIRSI) score were evaluated. Additionally, we compared recurrence, visual analog scale pain score, Subjective Shoulder Value, Rowe score, satisfaction, and whether patients would undergo the surgery again. Results: Overall, 80 athletes who underwent ABR and 40 who underwent OL were included, with a mean follow-up of 50.3 months. There was no significant difference between ABR and OL in rate of RTP, return to preinjury level, time to return, or recurrent dislocation rate. There were also no differences between ABR and OL in patient-reported outcome scores or patient satisfaction. When collision athletes were compared between ABR and OL, there were no differences in RTP, SIRSI score, or redislocation rate. Conclusion: ABR and OL resulted in excellent clinical outcomes, with high rates of RTP and low recurrence rates. Additionally, there were no differences between the procedures in athletes participating in collision sports.

The Relationship between Serum Ferritin Levels and 5-Year All-Cause Mortality in Hemodialysis Patients

2021 ◽  
pp. 1-7
Author(s):  
Emre Erdem ◽  
Ahmet Karatas ◽  
Tevfik Ecder
Keyword(s):  
Serum Ferritin ◽  
Hemodialysis Patients ◽  
Rank Test ◽  
Significant Difference ◽  
All Cause Mortality ◽  
Group 3 ◽  
Group 2 ◽  
The Relationship ◽  
Group 1

<b><i>Introduction:</i></b> The effect of high serum ferritin levels on long-term mortality in hemodialysis patients is unknown. The relationship between serum ferritin levels and 5-year all-cause mortality in hemodialysis patients was investigated in this study. <b><i>Methods:</i></b> A total of 173 prevalent hemodialysis patients were included in this study. The patients were followed for up to 5 years and divided into 3 groups according to time-averaged serum ferritin levels (group 1: serum ferritin &#x3c;800 ng/mL, group 2: serum ferritin 800–1,500 ng/mL, and group 3: serum ferritin &#x3e;1,500 ng/mL). Along with the serum ferritin levels, other clinical and laboratory variables that may affect mortality were also included in the Cox proportional-hazards regression analysis. <b><i>Results:</i></b> Eighty-one (47%) patients died during the 5-year follow-up period. The median follow-up time was 38 (17.5–60) months. The 5-year survival rates of groups 1, 2, and 3 were 44, 64, and 27%, respectively. In group 3, the survival was lower than in groups 1 and 2 (log-rank test, <i>p</i> = 0.002). In group 1, the mortality was significantly lower than in group 3 (HR [95% CI]: 0.16 [0.05–0.49]; <i>p</i> = 0.001). In group 2, the mortality was also lower than in group 3 (HR [95% CI]: 0.32 [0.12–0.88]; <i>p</i> = 0.026). No significant difference in mortality between groups 1 and 2 was found (HR [95% CI]: 0.49 [0.23–1.04]; <i>p</i> = 0.063). <b><i>Conclusion:</i></b> Time-averaged serum ferritin levels &#x3e;1,500 ng/mL in hemodialysis patients are associated with an increased 5-year all-cause mortality risk.

The Efficacy of Etoposide-Based Therapy in Adult Secondary Hemophagocytic Lymphohistiocytosis

2021 ◽  
pp. 1-9
Author(s):  
Leonard Naymagon ◽  
Douglas Tremblay ◽  
John Mascarenhas
Keyword(s):  
Hemophagocytic Lymphohistiocytosis ◽  
Proportional Hazards ◽  
Multivariable Analysis ◽  
Cox Proportional Hazards ◽  
Rank Test ◽  
Kaplan Meier ◽  
Hazard Ratios ◽  
Significant Difference ◽  
The Impact

Data supporting the use of etoposide-based therapy in hemophagocytic lymphohistiocytosis (HLH) arise largely from pediatric studies. There is a lack of comparable data among adult patients with secondary HLH. We conducted a retrospective study to assess the impact of etoposide-based therapy on outcomes in adult secondary HLH. The primary outcome was overall survival. The log-rank test was used to compare Kaplan-Meier distributions of time-to-event outcomes. Multivariable Cox proportional hazards modeling was used to estimate adjusted hazard ratios (HRs) with 95% confidence intervals (CIs). Ninety adults with secondary HLH seen between January 1, 2009, and January 6, 2020, were included. Forty-two patients (47%) received etoposide-based therapy, while 48 (53%) received treatment only for their inciting proinflammatory condition. Thirty-three patients in the etoposide group (72%) and 32 in the no-etoposide group (67%) died during follow-up. Median survival in the etoposide and no-etoposide groups was 1.04 and 1.39 months, respectively. There was no significant difference in survival between the etoposide and no-etoposide groups (log-rank <i>p</i> = 0.4146). On multivariable analysis, there was no association between treatment with etoposide and survival (HR for death with etoposide = 1.067, 95% CI: 0.633–1.799, <i>p</i> = 0.8084). Use of etoposide-based therapy was not associated with improvement in outcomes in this large cohort of adult secondary HLH patients.

scholarly journals Slowly resorbable biosynthetic mesh: 2-year results in VHWG grade 3 hernia repair

Hernia ◽  
2021 ◽  
Author(s):  
M. M. J. Van Rooijen ◽  
T. Tollens ◽  
L. N. Jørgensen ◽  
T. S. de Vries Reilingh ◽  
G. Piessen ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Hernia Repair ◽  
Hernia Recurrence ◽  
Recurrence Rates ◽  
Elective Repair ◽  
Significant Difference ◽  
Grade 3

Abstract Introduction Information on the long-term performance of biosynthetic meshes is scarce. This study analyses the performance of biosynthetic mesh (Phasix™) over 24 months. Methods A prospective, international European multi-center trial is described. Adult patients with a Ventral Hernia Working Group (VHWG) grade 3 incisional hernia larger than 10 cm2, scheduled for elective repair, were included. Biosynthetic mesh was placed in sublay position. Short-term outcomes included 3-month surgical site occurrences (SSO), and long-term outcomes comprised hernia recurrence, reoperation, and quality of life assessments until 24 months. Results Eighty-four patients were treated with biosynthetic mesh. Twenty-two patients (26.2%) developed 34 SSOs, of which 32 occurred within 3 months (primary endpoint). Eight patients (11.0%) developed a hernia recurrence. In 13 patients (15.5%), 14 reoperations took place, of which 6 were performed for hernia recurrence (42.9%), 3 for mesh infection (21.4%), and in 7 of which the mesh was explanted (50%). Compared to baseline, quality of life outcomes showed no significant difference after 24 months. Despite theoretical resorption, 10.7% of patients reported presence of mesh sensation in daily life 24 months after surgery. Conclusion After 2 years of follow-up, hernia repair with biosynthetic mesh shows manageable SSO rates and favorable recurrence rates in VHWG grade 3 patients. No statistically significant improvement in quality of life or reduction of pain was observed. Few patients report lasting presence of mesh sensation. Results of biosynthetic mesh after longer periods of follow-up on recurrences and remodeling will provide further valuable information to make clear recommendations. Trial registration Registered on clinicaltrials.gov (NCT02720042), March 25, 2016.

Efficacy and safety of collagenase Clostridium histolyticum injection for Dupuytren’s contracture in non-Caucasian Japanese patients (CORD-J Study): the first clinical trial in a non-Caucasian population

2016 ◽  
Vol 42 (1) ◽  
pp. 30-38 ◽  
Author(s):  
H. Hirata ◽  
K. Tanaka ◽  
A. Sakai ◽  
R. Kakinoki ◽  
H. Ikegami ◽  
...  
Keyword(s):  
Clinical Success ◽  
Japanese Patients ◽  
Phase Iii ◽  
Dupuytren’S Contracture ◽  
Collagenase Clostridium Histolyticum ◽  
Open Label ◽  
Level Of Evidence ◽  
Dupuytren's Contracture ◽  
Clostridium Histolyticum ◽  
Corrective Effect

To assess the efficacy, safety and pharmacokinetics of 0.58 mg collagenase Clostridium histolyticum injections for the treatment of Dupuytren’s contracture in Japanese patients, we conducted a phase III, multicentre, uncontrolled, open-label clinical study in patients with Dupuytren’s contracture. Of the 77 patients, 66 achieved clinical success in the primary treated joint (86%; 95% confidence interval: 76% to 93%), confirming the efficacy of collagenase Clostridium histolyticum injections. More improvement was seen in the metacarpophalangeal joints than in the proximal interphalangeal joints (94% versus 73%). The main adverse reaction was a local reaction in the injected hand. No tendon rupture or anaphylactic reactions were seen. The concentrations of collagenase Clostridium histolyticum were below the lower limit of quantification in plasma samples at all time points. As seen in global studies in Caucasian patients, a corrective effect on Dupuytren’s contracture and good tolerance were observed in most non-Caucasian (Asian) Japanese patients. Level of Evidence: Level 3

A Prospective Comparison of 3 Hamstring ACL Fixation Devices - Rigidfix, BioScrew and Intrafix - Randomized Into 4 Groups with a Minimum Follow-Up of 5 Years.

2021 ◽  
Author(s):  
Leena Metso ◽  
Ville Bister ◽  
Arsi Harilainen ◽  
Jerker Sandelin
Keyword(s):  
Cruciate Ligament ◽  
Interference Screw ◽  
Controlled Clinical Trial ◽  
Level Of Evidence ◽  
Tibial Fixation ◽  
Fixation Group ◽  
Prospective Comparison ◽  
Group I ◽  
Significant Difference

Abstract Background: This is a five years follow-up report of some of the new devices for graft fixation. A two years follow-up data was published previously. As there were no statistically or clinically relevant differences in the results two years postoperatively, we hypothesize that after five years of follow-up there is no difference in the outcome after either cross-pin or absorbable interference screw fixation in ACL (anterior cruciate ligament) reconstruction with hamstring tendon autografts.Methods: 120 patients were randomized into four different groups (30 each) for ACL reconstruction with hamstring tendons: group I femoral Rigidfix cross-pin and Intrafix tibial extension sheath with a tapered expansion screw; group II Rigidfix femoral and BioScrew interference screw tibial fixation; group III BioScrew femoral and Intrafix tibial fixation; group IV BioScrew fixation into both tunnels. The evaluation methods were clinical examination, knee scores, and instrumented laxity measurements. Results: In this 5 years follow-up there were 102/120 (85%) patients available, but only 77 (64,2%) attended the clinical examinations. No significant difference between the groups in the clinical results was detected. There was a significant difference in additional procedures between the 2 and 5 years follow-up, group I had six additional procedures between the 2 and 5 years follow-up (P=.041). Conclusion: There was a statistically significant difference in the additional procedures, most in group I (six). None of these procedures found problems with the ACL graft. Other statistically or clinically significant differences in the 5 years follow-up results were not found. Study design: Randomized controlled clinical trial; Level of evidence, 1.Trial registration: ISRCTN registry with study ID ISRCTN34011837. Retrospectively registered 17.4.2020.

scholarly journals Direct Comparison of Modified Jobe and Docking Ulnar Collateral Ligament Reconstruction at Midterm Follow-up

2018 ◽  
Vol 47 (1) ◽  
pp. 144-150 ◽  
Author(s):  
Justin W. Arner ◽  
Edward S. Chang ◽  
Stephen Bayer ◽  
James P. Bradley
Keyword(s):  
Reconstructive Surgical Procedures ◽  
Ulnar Collateral Ligament ◽  
Return To Play ◽  
Shoulder Injuries ◽  
Collateral Ligament ◽  
Level Of Evidence ◽  
Overhead Athletes ◽  
Additional Surgery ◽  
Significant Difference

Background: The modified Jobe and docking techniques are the 2 most commonly employed techniques for ulnar collateral ligament (UCL) reconstruction among overhead athletes. However, no study has directly compared these techniques performed by a single surgeon. Current comparisons of these techniques have relied solely on systematic reviews and biomechanical studies. Hypothesis: There will be no difference in outcomes or return to play between the modified Jobe and docking techniques in elbow UCL reconstruction surgery. Study Design: Cohort study; Level of evidence, 3. Methods: Twenty-five modified Jobe and 26 docking UCL-reconstructive surgical procedures were performed by a single surgeon, each with a minimum 2-year follow-up. Kerlan-Jobe Orthopaedic Clinic (KJOC) score, Conway Scale, years played, sex, handedness, sport, position, palmaris versus gracilis graft type, concomitant or future arm/shoulder injuries, and need for additional surgery were compared between the groups. Patients who underwent future shoulder or elbow surgery, no matter the cause, were included. Results: No difference was seen between the modified Jobe and docking reconstruction cases in regard to KJOC scores (mean ± SD: 78.4 ± 19.5 vs 72.0 ± 26.0, P = .44), Conway Scale (return to play, any level: 84% vs 82%, P = .61), years played (14.7 ± 6.2 vs 15.2 ± 5.8, P = .52), sex ( P = .67), handedness ( P ≥ .999), sport ( P = .44), position ( P = .60), level of competition ( P = .59), and future surgery (12% vs 4%, P = .35). Palmaris graft type had significantly higher KJOC scores than hamstring grafts (82.3 ± 20.0 vs 57.9 ± 21.2, P = .001). The mean follow-up was 6.1 years in the modified Jobe group and 7.3 years in the docking group (mean = 6.7, P = .47). Conclusion: The modified Jobe and docking techniques are both suitable surgical options for elbow UCL reconstruction. There was no statistically significant difference between the techniques in regard to return to play, KJOC score, or need for subsequent surgery at 6.7-year follow-up. This is the first direct clinical comparison of these 2 techniques by a single surgeon at midterm follow-up.

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