Collagenase Injection More Effective Than Needle Fasciotomy for Primary Dupuytren Contracture: study

Collagenase Clostridium histolyticum (CCH) and percutaneous needle fasciotomy (PNF) are two treatment options for Dupuytren disease. Ingi Thor Hauksson et al conducted a study was to compare these 2 methods in terms of clinical and patient reported outcomes. It was performed at Akershus University Hospital, Lørenskog, Norway

Eighty patients (median age, 72 years; 83% male) with a single-digit primary metacarpophalangeal (MCP) joint contracture of more than 30degree were randomized to either CCH or PNF and followed for 5 years.

Collagenase (0.58 mg) was injected into the palpable cord in the proximal zone 2 of the involved digit, followed by an extension manipulation 24 hours later under use of a local finger anesthetic block. PNF was performed according to the Lermusiaux multiple perforation technique.

The primary outcome was the difference in flexion-contracture reduction at the MCP joint from baseline to 2 years, with additional analysis examining the effect of the primary endpoint variable up to 5 years. Secondary outcomes included complications, grip strength, scores on the visual analogue scale (VAS) for pain, the shortened version of the Disabilities of the Arm, Shoulder and Hand, the brief Michigan Hand Questionnaire, Unit´e Rhumatologique des Affections de la Main, and a VAS for treatment satisfaction as well as recurrence and retreatments.

The main findings of the study were:

• The mean MCP joint contracture was 48deg at baseline and 2deg at 5 years in the CCH group, and 50deg at baseline and 7deg at 5 years in the PNF group.

• The reduction in MCP contracture at 2 years was larger in the CCH group than in the PNF group, with a mean difference between the groups of 12deg (95% confidence interval [CI], 1.5deg to 22.3deg; p = 0.026).

• At 5 years, this mean difference was reduced to 6deg (-1.5deg to 12.8deg; p = 0.1).

• There was no difference between the groups in any patient reported outcome scores or grip strength beyond 4 weeks, with the exception of the brief Michigan Hand Questionnaire at 5 years.

• Ten (25%) of the patients in the PNF group compared with no patient in the CCH group had recurrence (contracture of more than 30) at the MCP joint at 2 years.

• At 5 years, 17 (42.5%) of 40 patients in the PNF group had been retreated compared with 4 (10%) of 40 in the CCH group (p < 0.001).

• The CCH group experienced more transient complications (stiffness and

• hematoma) during the first week and were more satisfied (VAS satisfaction) from 1 year to the 5-year follow-up.

The authors concluded that – “Our study supports the use of CCH as a more durable treatment for primary Dupuytren disease MCP joint contracture. It reduced the need for further treatment for a large proportion of patients for at least 5 years. However, PNF treatment is a safe and effective initial option, which delays more costly treatments (CCH) or invasive surgical procedures.”

Level of Evidence: Therapeutic Level I.

Further reading:

Collagenase Clostridium histolyticum Versus Needle Fasciotomy for Primary Metacarpophalangeal Dupuytren Contracture Five-Year Results from a Randomized Controlled Trial Ingi Thor Hauksson et alJBJS Open Access 2024:e24.00038. http://dx.doi.org/10.2106/JBJS.OA.24.00038