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Percutaneous Needle Fasciotomy Versus Collagenase Treatment for Dupuytren Contracture: A Randomized Controlled Trial with a Two-Year Follow-up.
J Bone Joint Surg Am. 2018 Jul 05; 100(13):1079-1086.JB

Abstract

BACKGROUND

Local disruption of the cord that causes contracture of the finger in Dupuytren disease can be achieved either through mechanical division by percutaneous needle fasciotomy (PNF) or through enzymatic digestion by injectable collagenase Clostridium histolyticum (CCH). This study was designed to compare clinical and patient-reported outcomes between patients who had been treated with each method.

METHODS

A prospective, randomized, single-blinded, controlled trial was designed and included 156 patients with a contracture of the metacarpophalangeal (MCP) joint of ≥20°. The patients were allocated to treatment with either PNF or CCH. The primary outcome was a reduction of the MCP contracture to <5°. Secondary outcomes included the reduction of any concomitant contracture of the proximal interphalangeal (PIP) joint, the presence of Dupuytren cords, and changes in patient-reported outcomes as measured with the URAM (Unité Rhumatologique des Affections de Main) and QuickDASH (an abbreviated version of the Disabilities of the Arm, Shoulder and Hand [DASH]) questionnaires and visual analog scales for patient satisfaction. All treatments were performed by a single surgeon and all blinded follow-up measurements were made by a single physiotherapist. The participants were assessed at 1 week, 6 months, and 1 and 2 years after the interventions.

RESULTS

A total of 152 patients (97%) were examined at 2 years, at which time 58 patients (76%) treated with CCH and 60 (79%) treated with PNF retained a straight MCP joint. No cords were detectable in >50% of the patients at 2 years. There were no significant differences in the reduction of PIP contracture, range of motion, or patient-reported outcomes between the 2 treatments.

CONCLUSIONS

This trial demonstrated no advantage of CCH treatment compared with PNF in terms of clinical outcome at any time during the 2-year follow-up. The significant decrease in the number of pathological cords (p < 0.0001, Wilcoxon signed-rank test) after disruption regardless of the method used may indicate that resorption of pathological collagen occurs when the tension in the Dupuytren cord is diminished.

LEVEL OF EVIDENCE

Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Authors+Show Affiliations

Department of Hand Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden. Centre for Advanced Reconstruction of Extremities, Sahlgrenska University Hospital, Mölndal, Sweden.Department of Hand Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.Department of Hand Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden. Centre for Advanced Reconstruction of Extremities, Sahlgrenska University Hospital, Mölndal, Sweden.

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

29975270

Citation

Strömberg, Joakim, et al. "Percutaneous Needle Fasciotomy Versus Collagenase Treatment for Dupuytren Contracture: a Randomized Controlled Trial With a Two-Year Follow-up." The Journal of Bone and Joint Surgery. American Volume, vol. 100, no. 13, 2018, pp. 1079-1086.
Strömberg J, Ibsen Sörensen A, Fridén J. Percutaneous Needle Fasciotomy Versus Collagenase Treatment for Dupuytren Contracture: A Randomized Controlled Trial with a Two-Year Follow-up. J Bone Joint Surg Am. 2018;100(13):1079-1086.
Strömberg, J., Ibsen Sörensen, A., & Fridén, J. (2018). Percutaneous Needle Fasciotomy Versus Collagenase Treatment for Dupuytren Contracture: A Randomized Controlled Trial with a Two-Year Follow-up. The Journal of Bone and Joint Surgery. American Volume, 100(13), 1079-1086. https://doi.org/10.2106/JBJS.17.01128
Strömberg J, Ibsen Sörensen A, Fridén J. Percutaneous Needle Fasciotomy Versus Collagenase Treatment for Dupuytren Contracture: a Randomized Controlled Trial With a Two-Year Follow-up. J Bone Joint Surg Am. 2018 Jul 5;100(13):1079-1086. PubMed PMID: 29975270.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Percutaneous Needle Fasciotomy Versus Collagenase Treatment for Dupuytren Contracture: A Randomized Controlled Trial with a Two-Year Follow-up. AU - Strömberg,Joakim, AU - Ibsen Sörensen,Allan, AU - Fridén,Jan, PY - 2018/7/6/entrez PY - 2018/7/6/pubmed PY - 2019/10/1/medline SP - 1079 EP - 1086 JF - The Journal of bone and joint surgery. American volume JO - J Bone Joint Surg Am VL - 100 IS - 13 N2 - BACKGROUND: Local disruption of the cord that causes contracture of the finger in Dupuytren disease can be achieved either through mechanical division by percutaneous needle fasciotomy (PNF) or through enzymatic digestion by injectable collagenase Clostridium histolyticum (CCH). This study was designed to compare clinical and patient-reported outcomes between patients who had been treated with each method. METHODS: A prospective, randomized, single-blinded, controlled trial was designed and included 156 patients with a contracture of the metacarpophalangeal (MCP) joint of ≥20°. The patients were allocated to treatment with either PNF or CCH. The primary outcome was a reduction of the MCP contracture to <5°. Secondary outcomes included the reduction of any concomitant contracture of the proximal interphalangeal (PIP) joint, the presence of Dupuytren cords, and changes in patient-reported outcomes as measured with the URAM (Unité Rhumatologique des Affections de Main) and QuickDASH (an abbreviated version of the Disabilities of the Arm, Shoulder and Hand [DASH]) questionnaires and visual analog scales for patient satisfaction. All treatments were performed by a single surgeon and all blinded follow-up measurements were made by a single physiotherapist. The participants were assessed at 1 week, 6 months, and 1 and 2 years after the interventions. RESULTS: A total of 152 patients (97%) were examined at 2 years, at which time 58 patients (76%) treated with CCH and 60 (79%) treated with PNF retained a straight MCP joint. No cords were detectable in >50% of the patients at 2 years. There were no significant differences in the reduction of PIP contracture, range of motion, or patient-reported outcomes between the 2 treatments. CONCLUSIONS: This trial demonstrated no advantage of CCH treatment compared with PNF in terms of clinical outcome at any time during the 2-year follow-up. The significant decrease in the number of pathological cords (p < 0.0001, Wilcoxon signed-rank test) after disruption regardless of the method used may indicate that resorption of pathological collagen occurs when the tension in the Dupuytren cord is diminished. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence. SN - 1535-1386 UR - https://www.unboundmedicine.com/medline/citation/29975270/Percutaneous_Needle_Fasciotomy_Versus_Collagenase_Treatment_for_Dupuytren_Contracture:_A_Randomized_Controlled_Trial_with_a_Two_Year_Follow_up_ L2 - http://dx.doi.org/10.2106/JBJS.17.01128 DB - PRIME DP - Unbound Medicine ER -