title: Collagenase clostridium histolyticum in Dupuytren's contracture: a systematic review.
abstract: In the last few years, the use of collagenase clostridium histolyticum for management of Dupuytren's contracture has increased. The procedure of enzymatic fasciectomy has become popular because it is non-invasive, safe and fast to perform.
  
  
  
  A systematic search was performed on Medline (PubMed), Web of Science and Scopus databases using the combined keywords 'Dupuytren collagenase' and 'Dupuytren clostridium histolyticum'. Forty-three studies were identified. The quality of the studies was assessed using the Coleman Methodological Score.
  
  
  
  The use of collagenase clostridium histolyticum provides better outcomes in patients with mild-moderate joint contracture, with lower complications and side effects than open fasciectomy. Manipulation can be performed 2-7 days after the injection. The use of collagenase is cost-effective.
  
  
  
  Most of the studies did not report patient-related outcomes. The role of dynamic splint has to be investigated with randomized clinical trials.
  
  
  
  The shorter recovery time and the low incidence of serious or major adverse effects are the main advantages of this new technology.
  
  
  
  There is a need to perform studies with longer follow-up because the recurrence rate seems to increase with time. Further investigations are necessary to assess whether it is safe and effective to inject two or more cords at the same time.
authors.affiliation: Department of Orthopaedic Surgery, 'Federico II' University of Naples, Naples, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Smeraglia
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Ospedale Vaio Fidenza(PR), Fidenza, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Del Buono
authors.affiliation: Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84081 Baronissi, Salerno, Italy Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentirstry, Mile End Hospital, 275 Bancroft Road, London E1 4 DG, UK n.maffulli@qmul.ac.uk.
authors.forename: Nicola
authors.initials: N
authors.lastname: Maffulli
mesh_terms: D047009:Hathewaya histolytica / Q000201:enzymology*; D003362:Cost-Benefit Analysis; D004387:Dupuytren Contracture / Q000188:drug therapy* / Q000503:physiopathology / Q000628:therapy; D000071938:Fasciotomy / Q000379:methods*; D006801:Humans; D015552:Injections, Intralesional; D003012:Microbial Collagenase / Q000627:therapeutic use*; D016059:Range of Motion, Articular; D016896:Treatment Outcome
chemical_list: D003012:Microbial Collagenase
keywords: Dupuytren; clostridium histolyticum; collagenase; contracture; non-operative