Outcomes of limited fasciectomy, needle fasciotomy and collagenase injection for Dupuytren’s disease: a systematic review and meta-analysis of individual patient data
Bente A. van den Berge, Hosniya Habibi, Pieter U. Dijkstra, Isam Atroshi, Tim Davis, Per Jenmalm, Annet van Rijssen, Ruud W. Selles, Peter Scherman, Joakim Strömberg, Simon Toftgaard Skov, Esther Vögelin, Paul M. N. Werker, Dieuwke C Broekstra
Abstract
This systematic review and meta-analysis of individual patient data evaluates the outcomes of treatment for Dupuytren's disease using limited fasciectomy (LF), percutaneous needle fasciotomy (PNF) and collagenase clostridium histolyticum (CCH) injection. A total of 1423 studies were identified, of which 15 met the eligibility criteria for meta-analysis. The postoperative total extension deficit was smaller after LF than after PNF or CCH, but the difference was not clinically relevant. Minor complications were more frequent after CCH than after LF and PNF. The risk of major complications did not differ between the treatments. Recurrence occurred earlier after PNF and CCH than after LF during 36 months of follow-up. Patient-reported outcome measures showed substantial heterogeneity, which precluded meta-analysis. Overall, the clinically relevant contracture correction was comparable between LF, PNF and CCH, but CCH had a higher risk of minor complications and LF had the longest time to recurrence. Treatment decisions should consider the trade-off between complications and recurrence risk.