Comparing 1-year efficacy of collagenase versus fasciotomy for Dupuytren's contracture

Study Type: Therapy
OE Level of Evidence: 2
Journal Level of Evidence: 2
93 patients with Dupuytren's contracture were randomized to either needle fasciotomy or collagenase injection. The purpose of the study was to compare the range of motion and clinical outcome measures over a 1-year follow-up. Despite immediate differences Please login to view the rest of this report. Please login to view the rest of this report.
Funding: Non-funded
Conflicts: Consultant
Why was this study needed now?
Dupuytren's disease is a disorder involving a fixed flexion contracture of an affected finger and can be quite debilitating, leading to difficulties with daily activities. Fasciectomy has been a standard operative treatment option, though it's invasiveness has led to the development of more conservative methods. Needle fasciotomy is a minimally invasive surgical option, while collagenase injections are a nonsurgical option. No high-quality comparisons have been performed comparing outcomes between needle fasciotomy and collagenase injections.
What was the principal research question?
In Dupuytren's contracture, are there any significant difference in the 1-year range of motion or clinical results between needle fasciotomy and collagenase injection?
Population: 93 patients with a total of 96 rays affected by Dupuytren's contracture of the metacarpophalangeal joint, demonstrating between 30-135deg extension deficit. Cases of thumb contracture were excluded. Nightly splinting was used in patients of one center, while no splinting was used in patients of the other center.
Intervention: Collagenase injection: Patients were treated with a single injection of collagenase to the affected joint. Manipulation under regional anesthesia was performed at 24h and 72h after injection.
Comparison: Needle fasciotomy: Under local anesthesia, affected cords were released using 19 gauge needles.
Outcomes: Total passive extension deficit was measured, as was the percentage reduction in total passive extensor deficit compared to baseline. In one center, the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), the Unite Rhumatologique des Affections de la Main (URAM), and visual analog scale for pain were used to assess clinical outcome.
Methods: RCT; two-center
Time: Patients were assessed immediately after treatment, and at 3- and 12-month follow-up.
What were the important findings?
What should I remember most?
How will this affect the care of my patients?
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.