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Updated: Jun 11, 2025

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Collagenase Injection versus Limited Fasciectomy for Dupuytren's Contracture.

Joseph Dias1, Puvanendran Tharmanathan1, Catherine Arundel1

  • 1From the Academic Team of Musculoskeletal Surgery, Undercroft, Leicester General Hospital, University Hospitals of Leicester NHS Trust (J.D., M.A., J.J.), Leicester (J.C.), the York Trials Unit (P.T., C.A., C.W., S.J., S.B., L.G.F., C.N.K., M.W., A.K., C.E.H., D.T.) and the Department of Health Sciences (Q.W.), University of York, York, the University of Nottingham, Nottingham (P.L.), University Hospitals of Derby and the Burton NHS Trust, Derby (N.J., L.B.), the Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham (M.C.), and the University Hospital Southampton NHS Foundation Trust, Southampton (D.W.) - all in the United Kingdom.

The New England Journal of Medicine
|October 9, 2024
PubMed
Summary

Collagenase injection was not found to be noninferior to limited fasciectomy for treating Dupuytren's contracture. Limited fasciectomy showed better patient-reported hand health outcomes at one year.

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Area of Science:

  • Orthopedics
  • Hand Surgery
  • Clinical Trials

Background:

  • Dupuytren's contracture is a condition affecting hand function.
  • Limited fasciectomy and collagenase injection are common treatments.
  • Comparative effectiveness data between these treatments are scarce.

Purpose of the Study:

  • To compare the effectiveness of collagenase injection versus limited fasciectomy for moderate Dupuytren's contracture.
  • To determine if collagenase injection is noninferior to limited fasciectomy based on patient-reported outcomes.

Main Methods:

  • An unblinded, multicenter, pragmatic, randomized controlled noninferiority trial.
  • 672 participants were randomized to either collagenase injection or limited fasciectomy.
  • The primary outcome was the Patient Evaluation Measure-Hand Health Profile (PEM) score at 1 year.

Main Results:

  • The mean PEM score at 1 year was higher (worse outcomes) in the collagenase group (17.8) compared to the limited fasciectomy group (11.9).
  • Collagenase injection was not noninferior to limited fasciectomy (estimated difference 5.9 points; 95% CI, 3.1 to 8.8).
  • Complication rates were lower with collagenase (1.8%) versus fasciectomy (5.1%), but recurrence was higher (14.6% vs 3.4%).

Conclusions:

  • Collagenase injection did not meet noninferiority criteria compared to limited fasciectomy for Dupuytren's contracture at one year.
  • Limited fasciectomy resulted in better patient-reported hand health outcomes.
  • While complications were fewer with collagenase, higher recurrence rates necessitate further consideration.