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Surgery, Needle Fasciotomy, or Collagenase Injection for Dupuytren Contracture : A Randomized Controlled Trial.
Mikko Petteri Räisänen1, Olli V Leppänen2, Janne Soikkeli3
1Department of Orthopedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, and Tampere University, Tampere, Finland (M.P.R.).
Annals of Internal Medicine
|February 12, 2024
Summary
Surgery maintained superior success rates for Dupuytren contracture at two years compared to needle fasciotomy and collagenase injections. While initial outcomes were similar, long-term effectiveness favored surgical intervention for this condition.
Area of Science:
- Orthopedics
- Hand Surgery
- Musculoskeletal Disorders
Background:
- Dupuytren contracture is treated with surgery, needle fasciotomy, or collagenase injection.
- Treatment choice involves balancing immediate risks and costs against long-term benefits.
Purpose of the Study:
- To compare the effectiveness of surgery, needle fasciotomy, and collagenase injection for Dupuytren contracture.
- Evaluate outcomes at 3 months and 2 years post-treatment.
Main Methods:
- A multicenter, randomized, superiority trial involving 302 treatment-naive participants.
- Participants were assigned to surgery (n=101), needle fasciotomy (n=101), or collagenase (n=100).
- Primary outcome was success rate (contracture release >50% and patient acceptable symptom state).
Main Results:
- At 3 months, success rates were similar across all groups (approx. 71-73%).
- At 2 years, surgery showed superior success rates (78%) compared to needle fasciotomy (50%) and collagenase (65%).
- Secondary outcomes and analyses supported the primary findings, with surgery demonstrating better long-term efficacy.
Conclusions:
- Initial treatment outcomes for Dupuytren contracture are comparable across surgery, needle fasciotomy, and collagenase.
- Surgery offers superior long-term success rates at 2 years compared to needle fasciotomy and collagenase, even with retreatment.
- The findings support surgery for maintaining effectiveness in Dupuytren contracture treatment.
