title: Does collagenase injection disrupt or digest the Dupuytren's cord: a magnetic resonance imaging study.
abstract: Collagenase clostridium histolyticum has been extensively studied as a treatment modality for Dupuytren's contracture. Its mechanism of action has been documented. It is unknown whether injected collagenase weakens the Dupuytren's cord sufficiently to cause failure during manipulation or if there is digestion and reduction in cord volume. We examined five patients with isolated contractures of the ring or middle metacarpalphalangeal (MP) joint using magnetic resonance imaging (MRI) prior to injection with collagenase and again 1 month following injection. All patients had full correction after manipulation which was maintained at follow-up. The Dupuytren's cord was evaluated with respect to volume, signal intensity, inflammatory changes and continuity. Additionally, signal intensity changes of the flexor tendons and neurovascular structures were recorded. MRI demonstrated cord discontinuity, significant reduction of cord volume and a significant increase in cord signal intensity after treatment with collagenase. There was a slight increase in flexor tendon signal intensity that was not significant. These findings suggest that there may be local chemical dissolution of the cord. Future studies may establish whether or not this will have prognostic implications in terms of correction and recurrence following collagenase injection.
  
  
  METHODS
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authors.affiliation: Mercer Bucks Orthopaedics, Lawrenceville, NJ, USA.
authors.forename: K M
authors.initials: KM
authors.lastname: Crivello
authors.affiliation: The Hospital for Special Surgery, New York, NY, USA.
authors.forename: H G
authors.initials: HG
authors.lastname: Potter
authors.affiliation: Mt. Tam Orthopedics and Sports Medicine, Larkspur, CA, USA.
authors.forename: E S
authors.initials: ES
authors.lastname: Moon
authors.affiliation: The Hospital for Special Surgery, New York, USA.
authors.forename: S K
authors.initials: SK
authors.lastname: Rancy
authors.affiliation: The Hospital for Special Surgery, New York, USA wolfes@hss.edu.
authors.forename: Scott W
authors.initials: SW
authors.lastname: Wolfe
mesh_terms: D000368:Aged; D004387:Dupuytren Contracture / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D005500:Follow-Up Studies; D006801:Humans; D015552:Injections, Intralesional; D008279:Magnetic Resonance Imaging; D008297:Male; D008662:Metacarpophalangeal Joint; D003012:Microbial Collagenase / Q000627:therapeutic use*; D008875:Middle Aged; D010865:Pilot Projects; D016059:Range of Motion, Articular; D016896:Treatment Outcome
chemical_list: D003012:Microbial Collagenase
keywords: Clostridium histolyticum; Dupuytren’s contracture; Xiaflex; collagenase; enzymatic fasciotomy; magnetic resonance imaging (MRI)