What is the evidence for fasciectomy for Dupuytren’s contracture?
AMSTAR Rating
Summary
Patient Population:
- Adult patients (>18 years old) with primary or recurrent dupuytren’s contracture with measurable flexion contracture of hand.
- 9 studies, 903 participants
Intervention:
- Limited fasciectomy (LF) and percutaneous needle fasciectomy (NF)
Comparison:
- Collagenase injection (CI)
Outcome:
- Contracture Reduction
- Contracture reduction rates in treated joints (within 0–5° of full extension within 30 days) after NF treatment or the last dose of CI were comparable and significantly superior to placebo treatment based on the pooled data (CI vs. placebo: RD 0.62 [0.40 – 0.83]), (NF vs. placebo: RD 0.61 [0.39 – 0.84]). No significant differences between the groups.
- Post-Intervention Relative Reduction in Total Passive Extension Deficit (TPED)
- All treatment options yielded significantly better results compared to placebo (CI vs. placebo: WMD 56.9 [42.85 – 70.95]), (NF vs. placebo: WMD 56.45 [41.47 – 71.43]), (LF vs. placebo: WMD 70.45 [50.56 – 90.35])weighted mean difference 14.0% (95% CI 5.35% to 22.65%, I2 not available, 1 study).
- LF showed significantly superior reduction rates compared to CI and NF
- Number of treatment-related adverse events
- CI did result in significantly more adverse events, compared to NF and LF
Guideline Recommendations
| Source | Recommendation |
|---|---|
| NICE | Current evidence on the safety and efficacy support use |
Outcomes Assessed
- Benefit
- Harm
- Inconclusive
Contracture Reduction (within 0–5° of full extension within 30 days)
Percutaneous needle fasciectomy (NF) v. Placebo
Post-Intervention Relative Reduction in Total Passive Extension Deficit (TPED)
Limited fasciectomy (LF) v. NF and CI
Adverse Effects
LF and NF superior to Collagenase injection (CI)
Relevant Clinical Info
LF yields promising short-term functional results in terms of relative reduction of TPED when compared to CI and NF and may be able to provide patients with severe disease superior flexion contracture release postoperatively. Results have to be interpreted with caution given the limited evidence for LF in this analysis. Also see EBM reviews on Collagenase Injection and Radiotherapy for Dupuytren’s
Participant Information
of participants
Male
of participants
Female
the sample size was 903
Mean age of 64 years.
their were 9 studies used.
