RANDOMIZED CONTROLLED TRIAL OF LIMITED FASCIECTOMY WITH INJECTION OF ADIPOSE GRAFT FOR DUPUYTREN’S DISEASE

ABSTRACT Objective: Dupuytren’s disease is a genetic disorder related to the proliferation of myofibroblasts. The pluripotent property of stem cells present in adipose tissue inhibits myofibroblast proliferation. Our study sought to evaluate the effect of stem cell-rich fat grafts in patients that underwent limited fasciectomy. Methods: We studied 45 patients, in a single-blind, prospective, randomized clinical trial. All patients underwent limited fasciectomy. In one group, fat graft was injected. Results: The total passive extension deficit results did not exhibit a significant difference. Fat group exhibited worse functional score at 6 months and 1 year postoperatively, such as higher complication rates (43%), when compared with control group (8%), and more pain at 6 weeks follow-up. Conclusion: Fat grafting associated with limited fasciectomy promotes worse functional results compared to conventional limited fasciectomy in the short term. However, long-term results and recurrence rates should be further assessed. Level of Evidence II, Prospective comparative study.

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Dupuytren’s disease: limited fasciectomy, night splinting, and hand exercises—long-term results

European Journal of Orthopaedic Surgery & Traumatology ◽

10.1007/s00590-018-2340-6 ◽

2018 ◽

Vol 29 (2) ◽

pp. 349-355

Author(s):

Dimitrios Kitridis ◽

Paraskevi Karamitsou ◽

Iraklis Giannaros ◽

Nikolaos Papadakis ◽

Chris Sinopidis ◽

...

Keyword(s):

Dupuytren’S Disease ◽

Long Term Results ◽

Dupuytren's Disease ◽

Limited Fasciectomy ◽

Night Splinting ◽

Hand Exercises

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Predictors of Outcomes Following Fasciectomy for Dupuytren’s Disease in Diabetic and Non-Diabetic Patients

The Journal of Hand Surgery (Asian-Pacific Volume) ◽

10.1142/s0218810417500356 ◽

2017 ◽

Vol 22 (03) ◽

pp. 309-314 ◽

Cited By ~ 1

Author(s):

Eitan Melamed ◽

Bryan G. Beutel ◽

Shaul Goldstein ◽

David Angel

Keyword(s):

Grip Strength ◽

Smoking Status ◽

Female Gender ◽

Dupuytren’S Disease ◽

Diabetic Patients ◽

Complication Rates ◽

Limited Joint Mobility ◽

Dupuytren's Disease ◽

Flexion Contractures ◽

Significant Difference

Background: The aim of this study was to compare clinical outcomes, and identify predictors thereof, after fasciectomy for Dupuytren’s disease in a series of diabetic patients compared with non-diabetic patients. Methods: Thirty-eight patients were examined following partial palmar and/or digital fasciectomy for Dupuytren’s disease (11 diabetics, 27 non-diabetics). Each patient was assessed for degree of pre- and post-operative flexion contractures at the MCP and PIP joints, post-operative Patient Evaluation Measure (PEM) total score, post-operative grip strength, limited joint mobility (LJM), recurrence, extension, and a composite outcomes score based upon grip strength and the degree of joint contractures. All measurements in the diabetic cohort were compared to those in the non-diabetic group, and a logistic regression analysis was performed to identify the predictive value of several variables on outcomes. Results: Complication rates between the two groups were statistically similar (p = 0.67). There were no significant differences in pre-operative MCP (p = 0.69), post-operative MCP (p = 0.39), pre-operative PIP (p = 0.40), or post-operative PIP (p = 0.13) joint flexion contractures between the two groups. Additionally, there was no significant difference in extension (p = 0.35) or recurrence (p~1) rates, post-operative grip strengths (p = 0.64), or PEM total scores (p = 0.32). However, the rate of LJM was significantly higher in the diabetic population (p = 0.02). Both female gender (p = 0.01) and a non-smoking status (p = 0.04) were found to be predictive of better outcomes following fasciectomy. Diabetes was not found to be an independent predictor of outcome (p = 0.73). Conclusions: Clinical results after fasciectomy for Dupuytren’s disease in diabetic patients are not different from results obtained in non-diabetic patients. Diabetes is not independently predictive of surgical outcomes. Female gender and non-smoking status are independent predictors of a better outcome following fasciectomy.

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A Comparison of the Direct Outcomes of Percutaneous Needle Fasciotomy and Limited Fasciectomy for Dupuytren’s Disease: A 6-Week Follow-Up Study

The Journal Of Hand Surgery ◽

10.1016/j.jhsa.2006.02.021 ◽

2006 ◽

Vol 31 (5) ◽

pp. 717-725 ◽

Cited By ~ 182

Author(s):

Annet L. van Rijssen ◽

Feike S.J. Gerbrandy ◽

Hein Ter Linden ◽

Helen Klip ◽

Paul M.N. Werker

Keyword(s):

Dupuytren’S Disease ◽

Dupuytren's Disease ◽

Follow Up Study ◽

Limited Fasciectomy

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Functional outcome and complications following surgery for Dupuytren’s disease: a multi-centre cross-sectional study

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193416660045 ◽

2016 ◽

Vol 42 (1) ◽

pp. 7-17 ◽

Cited By ~ 9

Author(s):

J. N. Rodrigues ◽

W. Zhang ◽

B. E. Scammell ◽

I. Chakrabarti ◽

P. G. Russell ◽

...

Keyword(s):

Monte Carlo Simulation ◽

Monte Carlo ◽

Functional Outcome ◽

Dupuytren’S Disease ◽

Complication Rates ◽

Loss Of Function ◽

Chi Square ◽

Level Of Evidence ◽

Dupuytren's Disease ◽

Chi Square Test

Variables associated with recurrent Dupuytren’s disease, or a ‘diathesis’, have been investigated, but those associated with functional outcome and complications are less well studied. Outcomes 1 or 5 years after an aponeurotomy, fasciectomy or dermofasciectomy were assessed by patient interview and examination at five UK centres. A total of 432 procedures were studied. The reoperation rate did not differ at 1 year ( p = 0.396, Chi-square test with Monte Carlo simulation), but was higher after aponeurotomy in the 5-year group (30%, versus 6% after fasciectomy and 0% after dermofasciectomy, p = 0.003, Chi square test with Monte Carlo simulation). Loss of function (DASH>15) did not differ between procedures at 5 years, even when reoperation and other variables were controlled. Diabetes, female gender and previous ipsilateral surgery were associated with poorer function in logistic regression analysis. The variables associated with poor function after treatments differ from diathesis variables. Aponeurotomy had lower complication rates than fasciectomy and dermofasciectomy. This may counterbalance the former’s higher recurrence rate and explain why aponeurotomy demonstrated similar long-term functional outcome compared with excisional surgery in this study. Level of evidence: III

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Primary Repair for Injury of Medial Collateral Ligament During Total Knee Arthroplasty

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00051 ◽

2020 ◽

Vol 8 (5_suppl5) ◽

pp. 2325967120S0005

Author(s):

Cheng Jin ◽

Jia-yi Zhao ◽

Jong-Keun Seon ◽

Asep Santoso

Keyword(s):

Clinical Outcomes ◽

Suture Anchor ◽

Primary Repair ◽

Hospital Length Of Stay ◽

Functional Score ◽

Control Group ◽

Subjective Feeling ◽

Valgus Stress ◽

Ambulatory Ability ◽

Significant Difference

This study, we aim to determine whether intraoperative over-release of MCL that is treated with primary repair can achieve satisfactory clinical results when compared to those who did not have over-release of MCL. At the same time, we seek to look into the difference between two methods of primary repair (anchor suture and staple) in terms of clinical outcomes. Purposes: We determined whether, after TKA, patients with CIA versus patients with CACB demonstrated (1) decreased pain scores (2) greater ambulatory ability postoperatively (3) decreased daily opioid consumption and hospital length of stay Methods: 3897 TKAs were performed from year 2003-2014. Sixty-five patients with MCL injury due to over-release during TKA who were repaired with suture anchor or staple (suture anchor: 36 vs. staple: 29) were studied whereas matched group of 65 patients without MCL injury were selected and served as the control group. Subjective feeling of instability and functional score were assessed using Knee Society Score (KSS) and Western Ontario & McMaster Universities Osteoarthritis Index (WOMAC). Objective stability was evaluated through measurement of opening angles in extension and 30° of knee flexion on valgus stress radiographs. The clinical and stability results of repair between the suture anchor and staple were compared. Results: The KSS and WOMAC scores in patients with primary repair of MCL during TKA from 50.6±14.8 to 87.3±8.3 and 65.9±16.3 to 17.7±8.3, respectively. However, there were neither statistical nor clinical significant difference when comparing between the group with primary repair and the control group. Radiographic stability also showed no differences between repair and control groups in extension and 30° of flexion (p= .63 and p= .37). Regarding the subgroups, There were no significant differences between the suture anchor and staple in terms of the stability and clinical outcomes Conclusion: Primary repair either with suture anchor or with staple for injury of the MCL in varus gonarthrosis during TKA provides a good stability and clinical outcomes as those of result with no MCL injury.

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Subvastus Exposure Compared to Parapatellar Approach in Navigated Sequential Bilateral Total Knee Arthroplasty (SBTKA): A Prospective Randomized Study

The Journal of Knee Surgery ◽

10.1055/s-0039-1700496 ◽

2019 ◽

Author(s):

Anoop Jhurani ◽

Piyush Agarwal ◽

Mukesh Aswal ◽

Chetan Rasquinha ◽

Mudit Srivastava

Keyword(s):

Blood Loss ◽

Range Of Motion ◽

Knee Arthroplasty ◽

Randomized Study ◽

Prospective Randomized Study ◽

Functional Score ◽

Control Group ◽

Subvastus Approach ◽

Bilateral Knee ◽

Significant Difference

AbstractSubvastus approach preserves the quadriceps mechanism and may lead to improved early functional outcomes as compared with a parapatellar approach in primary knee arthroplasty. We performed a prospective randomized study to test the hypothesis if subvastus approach improves patient- and physician-reported outcomes in navigated sequential bilateral knee arthroplasty when compared with the standard parapatellar approach. A total of 93 patients were allotted in each group after power analysis and randomization done by computer-generated sequence: group S by subvastus approach and control group P by parapatellar approach. The patient's ability to walk without an aid, range of motion, blood loss, tourniquet time, complications, Knee Society Score (KSS), Knee Society Functional Score (KSFS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS), High Flexion Knee Score (HFKS), and visual analog scale (VAS) for pain were recorded preoperatively and postoperatively at 2 and 6 weeks and 3, 6, and 12 months. Final follow-up was done at 2 years. There was no statistical difference in the patient's ability to achieve a straight leg raise (p = 0.88), walk without an aid (p = 0.25), leaving pain medication (p = 0.48), and mean duration of hospital stay (p = 0.58) between both groups. There was no difference in KSS, FS, KOOS, WOMAC, HFKS, and VAS at 2 weeks and later follow-ups. There was no significant difference in range of motion or lateral retinacular release in both groups. Blood loss was significantly less in group S (p < 0.05), but there was a higher rate of proximal wound dehiscence and delayed healing in subvastus group (p = 0.03). Subvastus approach does not improve patient- and physician-reported outcome measures except blood loss in computer-navigated sequential bilateral knee arthroplasty and has an increased incidence of wound healing problems. The Level of evidence for the study is I.

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Transpancreatic biliary sphincterotomy for biliary access is safe also on a long-term scale

Surgical Endoscopy ◽

10.1007/s00464-019-07364-y ◽

2020 ◽

Vol 35 (1) ◽

pp. 104-112

Author(s):

Vilja Koskensalo ◽

Marianne Udd ◽

Mia Rainio ◽

Jorma Halttunen ◽

Matias Sipilä ◽

...

Keyword(s):

Abdominal Pain ◽

University Hospital ◽

Long Term Results ◽

Biliary Duct ◽

Complication Rates ◽

Biliary Sphincterotomy ◽

Significant Difference ◽

Upper Abdominal

Abstract Background Transpancreatic biliary sphincterotomy (TPBS) is an advanced cannulation method for accessing common bile duct (CBD) in endoscopic retrograde cholangiopancreatography (ERCP). If CBD cannulation is difficult, an endoscopist can open the septum between the pancreatic and biliary duct with a sphincterotome to gain access. Long-term results of this procedure are unclear. We wanted to evaluate the short- and long-term complications of TPBS on patients with native papilla and benign indication for ERCP. Patients and Methods ERCPs performed in Helsinki University Hospital between 2007 and 2013 were reviewed. The study group comprised 143 consecutive patients with TPBS and 140 controls (CG). Data were collected from patient records and a phone survey was performed as a follow-up ≥ 4 years after the index ERCP. Results Post-ERCP pancreatitis (PEP) developed in seven patients (4.9%) in TPBS and one patient (0.7%) in CG (p = 0.067). The rates of other acute complications were similar between the groups. ERCP ended with no access to CBD in four cases (2.8%) in TPBS. The median length of follow-up was 6 years in TPBS and 7 years in CG. During this period, three patients (2.1%) in TPBS and six patients (4.3%) in CG suffered from acute pancreatitis (AP) (p = 0.238). One (0.7%) patient in CG and none in TPBS developed chronic pancreatitis (CP). Abdominal pain was suffered by ten patients (6.9%) in TPBS and twelve patients (8.6%) in CG daily, whereas by six patients (4.2%) in TPBS and twelve patients (8.6%) in CG weekly. Conclusion TPBS is a useful procedure, with acceptable complication rates. No significant difference occurred between the groups when evaluating the short-term or long-term complications with a follow-up period of four to 10 years. Additionally, no significant differences occurred in upper abdominal pain, episodes of AP, or development of CP.

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Serious complications and risk of re-operation after Dupuytren’s disease surgery: a population-based cohort study of 121,488 patients in England

Scientific Reports ◽

10.1038/s41598-020-73595-y ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Osaid Alser ◽

Richard S. Craig ◽

Jennifer C. E. Lane ◽

Albert Prats-Uribe ◽

Danielle E. Robinson ◽

...

Keyword(s):

Cohort Study ◽

High Risk ◽

Case Series ◽

Population Based ◽

Dupuytren’S Disease ◽

Dupuytren's Disease ◽

Systemic Complications ◽

Increased Risk ◽

Risk Patients ◽

Limited Fasciectomy

Abstract Dupuytren’s disease (DD) is a common fibro-proliferative disorder of the palm. We estimated the risk of serious local and systemic complications and re-operation after DD surgery. We queried England’s Hospital Episode Statistics database and included all adult DD patients who were surgically treated. A longitudinal cohort study and self-controlled case series were conducted. Between 1 April 2007 and 31 March 2017, 121,488 adults underwent 158,119 operations for DD. The cumulative incidence of 90-day serious local complications was low at 1.2% (95% CI 1.1–1.2). However, the amputation rate for re-operation by limited fasciectomy following dermofasciectomy was 8%. 90-day systemic complications were also uncommon at 0.78% (95% CI 0.74–0.83), however operations routinely performed under general or regional anaesthesia carried an increased risk of serious systemic complications such as myocardial infarction. Re-operation was lower than previous reports (33.7% for percutaneous needle fasciotomy, 19.5% for limited fasciectomy, and 18.2% for dermofasciectomy). Overall, DD surgery performed in England was safe; however, re-operation by after dermofasciectomy carries a high risk of amputation. Furthermore, whilst serious systemic complications were unusual, the data suggest that high-risk patients should undergo treatment under local anaesthesia. These data will inform better shared decision-making regarding this common condition.

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T- and B-Lymphocyte Subsets in Patients with Dupuytren’s Disease

Journal of Hand Surgery (European Volume) ◽

10.1016/s0266-7681(98)80083-1 ◽

1998 ◽

Vol 23 (6) ◽

pp. 724-727 ◽

Cited By ~ 22

Author(s):

K. G. GUDMUNDSSON ◽

R. ARNGRÍMSSON ◽

S. ARINBJARNARSON ◽

A. OLAFSSON ◽

T. JONSSON

Keyword(s):

T Cells ◽

B Cells ◽

B Lymphocyte ◽

Lymphocyte Subsets ◽

Autoimmune Disorder ◽

Dupuytren’S Disease ◽

Control Group ◽

Activated T Cells ◽

Dupuytren's Disease ◽

Immunological Mechanisms

Previous reports have indicated that inflammatory mechanisms may be involved in the pathogenesis of Dupuytren’s disease and it has even been suggested that this condition is a T-cell mediated autoimmune disorder. We investigated peripheral blood lymphocyte subsets from 21 patients with Dupuytren’s disease and compared them with ten healthy blood donors. The Dupuytren’s patients had an increase in DR+ T-cells compared with healthy controls. Furthermore, patients with both palmar and plantar involvement had a higher percentage of DR+ T-cells than those with only the palm affected. The percentage of circulating CD5+ B-cells was lower in the Dupuytren’s patients compared with the control group; this feature was marginally significant for the whole group of Dupuytren’s patients but was strongest in the group of patients with both palmar and plantar involvement. These findings support previous suggestions that immunological mechanisms, involving activated T-cells and probably also B-cells, are involved in the pathogenesis of Dupuytren’s disease.

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