Surgical Fasciectomy Versus Collagenase Injection for Recurrent Dupuytren Contracture: A Randomized Controlled Trial

BACKGROUND: Collagenase injection is effective in primary Dupuytren contracture but efficacy in treating recurrence has not been evaluated in randomized trials. The aim was to compare surgical fasciectomy and collagenase injection for recurrent Dupuytren contracture. METHOD: In a single-center trial, 59 patients with recurrent Dupuytren contracture were randomized to fasciectomy (28 patients) or collagenase injection (31 patients). The primary endpoints were change in total active extension deficit (TAED) in treated fingers from baseline to 12 weeks and re-recurrence rate (TAED worsening ≥ 20° from 12 weeks to 2 years). Secondary endpoints included total passive extension deficit (TPED), QuickDASH, pain and satisfaction scores, and adverse events. RESULTS: Mean improvement in TAED from baseline to 12 weeks was 52° in the fasciectomy group versus 49° in the collagenase group (adjusted mean difference -1; 95% CI -9 to 8), and from baseline to 2 years 47° versus 34° (adjusted mean difference -8; 95% CI -23 to 7). The re-recurrence rate was 14.8% in the fasciectomy and 27.6% in the collagenase group (RR 1.9; 95% CI 0.6 to 5.6). Mean QuickDASH score showed clinically important worsening, baseline to 3 weeks, in the fasciectomy group only (adjusted mean between-group difference -11.7; 95% CI -18.5 to -5.0), with no other significant score differences. In the fasciectomy group there were 1 digital nerve and 2 digital artery lacerations. CONCLUSION: In recurrent Dupuytren contracture, the 2-year outcomes of surgical fasciectomy and collagenase did not show any statistically significant differences, but surgery was associated with more severe adverse events.