Dupuytren Disease from Past to Present: A Review of the Historical and Evolving Landscape of Its Management.

Abstract

Dupuytren disease (DD) has been described since the 17th century, but its true aetiology remains a mystery. The treatment of DD largely involves addressing the end stage of a complex fibroproliferative pathway, specifically, the cords. In recent years, there has been a shift to less radical approaches, with an increased adoption of percutaneous needle aponeurotomy (PNA) or collagenase. However, the difficulty in comparing outcomes across various treatments is likely to persist due to limitations in evaluating the effectiveness of those treatments. Patient-reported outcome measures may not accurately reflect disease severity or treatment success; objective measures might not correlate well with subjective improvements and treating all joints with equal weight is unrealistic. Additionally, the inherent difficulties of blinding in studies comparing surgical and percutaneous techniques, along with heterogeneity of the affected population, further complicate outcome assessment. There are interesting developments in the basic science arena resulting in a deeper understanding of the signalling pathways driving DD. Targeting molecular targets early in the signalling pathway may hold the key to preventing pathological contractures in Dupuytren patients. Level of Evidence: Level V (Therapeutic).