Collagenase may prove to be able to weaken Dups tissue that might be hard to get to with NA. Our NA guys have done some *amazing* things, but I believe Denkler indicated that Collagenase might extend his grasp, especially where the PIP is involved.

MCP joint is a "snap" for NA (so to speak) so Collagenase would simply be a far more expense way to do the same thing on that joint.

Some CHS have suggested that Collagenase may not be as prone to recurrence as NA, but we have no data on that speculation.

I also would speculate that eventually Collagenase could be used to disrupt nodules in the palm through direct injection. This has not been tried, but why wouldn't it work? We'd all like these sometimes painful little suckers zapped wouldn't we?

If a cord is too diffuse, NA can't cut enough of it to weaken it. In fact, Eaton told me that with enough repeated NA this can eventually happen. It may be that multiple injections of Collagenase would do the trick here where NA can't.

We don't know what Collagenase treatment might cost, but it will certainly be more than NA. So, in practical and economic terns, NA should be the workhorse, and Collagenase the backup for difficult cases. I doubt it will work that way, depending on how far the NA movent gets before Collagenase is available. Many CHS may just take the FDA approved method (and easy way out) with Collagenase and not learn NA. Let the insurance companies pay for it. I'm not wild about that eventuality, and that's why we should support the increased use of NA so it will have a strong foothold before the competition arrives. NA and Collagenase are competitive procedures, make no mistake.

Diane:

I think I read somewhere that there tends to me a maximum number of times that N.A. can be repeated.

Perhaps Randy, Wolfgang, or one of our other leaders, could enlighten us about that.

Mark

Mark, Wolfgang,

Eaton informed me that some people with numerous NA re-treatment eventually wind up with a wider more diffuse cord that NA can't touch. He has not seen this, but the French have as they've been doing NA for 30+ years. Eaton wasn't specific, but it sounded like it would take may years and a lot of NA before this eventuality.

Would Collagenase suffer from the same limitation? One would think. They are just two ways to do the *exact* same thing. One is less expensive and has a proven track record. Still, the more the merrier when it comes to the offering of noninvasive treatment for *any* orthopedic procedure: knees, hips, you name it. Now it's *our* turn.

Bottom Line:

My question to Eaton then became, "What % of new Dups patitnets could use NA to avold OS entirely?" ANSWER: "Something *well* over 50%".

combination of NA+ AA4500- this is the true