“Collagenase injections versus limited fasciectomy in treating patients with Dupuytren's contracture: A systematic review and meta-analysis”

Background

Dupuytren's contracture is a progressive disorder characterized by palmar fascia thickening, leading to nodules and cords formation. Limited fasciectomy (LF) is the standard surgical treatment, while Collagenase Clostridium Histolyticum (CCH) injection offers a minimally invasive alternative. Despite multiple studies, the comparative efficacy and safety of these approaches remain debated.

Purpose

To compare the effectiveness and safety of CCH and LF by analyzing change in extension deficit (ED), recurrence rate, residual contracture, Michigan Hand Questionnaire (MHQ) score, and complications.

Study design

Systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies.

Methods

A systematic search was conducted in PubMed, EMBASE, Cochrane, and Scopus. The review followed PRISMA guidelines for transparent reporting. Fifteen studies (RCTs and observational) comparing CCH and LF were included. Data were extracted on MHQ score, change in ED, recurrence rate, residual contracture, and complications. Meta-analysis was performed using RevMan 5.4. Heterogeneity was assessed using Higgins' I². Risk of bias was evaluated with the Newcastle-Ottawa Scale and RoB-2 tool, while certainty of evidence was assessed using GRADEPro.

Results

LF resulted in a significantly lower change in ED and lower recurrence rate compared to CCH. However, CCH had higher residual contracture and a lower complication rate. MHQ score improvements were comparable between groups.

Conclusions

LF is superior in reducing recurrence and residual contracture but has a higher complication rate. CCH yields greater change in ED. Further research is needed to refine treatment strategies.