Percutaneous Needle Fasciotomy versus Collagenase Injection for Dupuytren’s Contracture: A Systematic Review of Comparative Studies

Abstract

Introduction The purpose of this study was to review and compare clinical outcomes between percutaneous needle fasciotomy (PNF) and collagenase Clostridium histolyticum (CCH) injection for the treatment of Dupuytren’s contracture. Materials and Methods A systematic review was performed including all level I-III evidence studies investigating the clinical outcomes of PNF and CCH injection in the treatment of Dupuytren’s contracture. Results Five studies (278 CCH patients, 225 PNF patients; 285 CCH fingers, 246 PNF fingers, 405 males, and 98 females) were analyzed. Two randomized studies were level I evidence, one randomized study was level II, and two nonrandomized studies were level III. Two studies analyzed a total of 205 patients, each demonstrating statistically superior outcomes in one outcome measure (contracture improvement and Michigan Hand Questionnaire (MHQ) satisfaction subscore) with PNF, while the remaining three studies demonstrated no significant differences in outcomes between the two techniques. Three studies reported a statistically higher rate of minor complications (local pain, edema, ecchymosis, lymphadenopathy, pruritis) with CCH, while the remaining two studies demonstrated no significant difference in complication rates. Conclusion For the treatment of Dupuytren’s contracture, there is some evidence that suggests superior clinical outcomes of PNF compared with CCH and a higher minor complication rate with CCH.

Short-term efficacy and adverse effects of collagenase clostridium histolyticum injections, percutaneous needle fasciotomy and limited fasciectomy in the treatment of Dupuytren’s contracture: a network meta-analysis of randomized controlled trials

“…In this network meta-analysis, we show that CI presents an effective treatment option, however it does not yield superior short-term results compared to NF despite a higher complication profile. Although CI, rather than NF, is thought to be associated with greater functional improvement in some reports [28], in the available RCTs the differences between the treatment modalities appeared trivial when looking at TPED and contracture reduction to 0°-5° of full extension in treated joints within 30 days. Our results are in line with recent trials that have shown similar short-to medium-term functional results [14].…”

Bias in published randomized trials that compare collagenase injection with percutaneous needle fasciotomy in the treatment of Dupuytren disease: a systematic review

“…A previous systematic review of collagenase injection and PNF included three RCTs (also included in our review) and two retrospective cohort studies but with different assessment results ( 21 ). Judging the risk of bias is a complex procedure and requires meticulous reasoning and adequate knowledge of the subject of the study.…”

“…Previous reviews have approached the matter ( 21 , 24 ), but to our knowledge, this is the first study that primarily investigates the methodological quality of RCTs comparing collagenase injection with PFN in the treatment of DD. Our results regarding the quality of the published studies would be helpful when proposing future practice guidelines, particularly since the results of these published RCTs may apply to the treatment of isolated MCP joint contractures but cannot be generalized to more severe DD with PIP involvement.…”

Selection in Scopus

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