Date of Award
Selective Evidence-Based Medicine Review
Master of Science in Health Sciences - Physician Assistant
Physician Assistant Studies
Objective: The objective of this selective EBM review is to determine whether or not collagenase injection decreases recurrence rates greater than percutaneous needle fasciotomy in the treatment of Dupuytren’s contracture.
Study Design: A systematic review of three randomized control trials.
Data Sources: The reviewed articles were written in English and published in peer-reviewed journals between 2016 and 2017. These articles were chosen based on their ability to answer the proposed question of this review and obtained through Cochran and PubMed databases.
Outcomes Measured: Outcomes were measured by the recurrence of contractures, which is defined as passive extension deficits of 20-30 degrees post-treatment or requiring additional treatment after initial therapy.
Results: Scherman et al. (J Hand Surg Eur Vol. 2018;43(8):836-840. doi: 10.11771753193418786947.) concluded there was no statistically significant difference in 3-year recurrence rates between collagenase injection and needle fasciotomy (P-value >0.05). Stromberg et al. (J Hand Surg A. 2016;41(9):873-880. doi: 10.1016/j.jhsa.2016.06.014.) found similar 1-year recurrence rates in the treatment of MCP joint Dupuyten’s contractures with collagenase injection and needle fasciotomy (P-value >0.05). Skov et al. (J Hand Surg Am. 2017; 42(5):321-328.e3. doi: S0363-5023(16)30817-6.) concluded collagenase injection and needle fasciotomy had similar 1-year recurrence rates in the treatment of PIP joint Dupytren’s contractures (P-value >0.05).
Conclusions: Based on the analysis of three randomized controlled trials, there is no significant difference in the rate of contracture recurrence between CCH injection and PNF at the 1 and 3-year follow-up mark. Variability among the treated joint and digit among the reviewed studies and non-blinding of evaluators may have impacted these results. Given the similarities in recurrence rates, it may be beneficial if future studies are directed toward other patient-oriented outcomes: associated healthcare cost, adverse events, visits required, and patient satisfaction.
Cawley, Elisabeth, "Does Collagenase Injection Decrease Recurrence Rates Greater than Percutaneous Needle Fasciotomy in the Treatment of Dupuytren’s Contracture?" (2021). PCOM Physician Assistant Studies Student Scholarship. 583.