title: Comparison of Treatment Outcome After Collagenase and Needle Fasciotomy for Dupuytren Contracture: A Randomized, Single-Blinded, Clinical Trial With a 1-Year Follow-Up.
abstract: OBJECTIVE
  This study compared the efficacy of collagenase treatment and needle fasciotomy for contracture of the metacarpophalangeal (MCP) joint in Dupuytren disease.
  
  
  METHODS
  This is a prospective, single-blinded, randomized study with follow-up 1 week and 1 year after treatment. One hundred and forty patients with an MCP contracture of 20° or more in a single finger were enrolled, of whom 69 patients were randomized to collagenase treatment and 71 patients to needle fasciotomy. The patients were followed at 1 week and were examined by a physiotherapist after 1 year. Measurements of joint movement and grip strength were recorded as well as patient-perceived outcomes measured by the Unité Rhumatologique des Affections de la Main (URAM) questionnaire and a visual analog scale (VAS) for the estimation of procedural pain and subjective treatment efficacy.
  
  
  RESULTS
  Eighty-eight percent of the patients in the collagenase group and 90% of the patients in the needle fasciotomy group had a reduction in their MCP contracture to less than 5° 1 week after treatment, and the median gains in passive MCP movement were 48° and 46°, respectively. The median VAS score for procedural pain was 4.9 of 10 in the collagenase group and 2.7 of 10 in the needle fasciotomy group. After 1 year, 90% of the patients in both groups had full extension of the treated MCP joint. One patient in each group had a recurrence of the contracture. The median improvement in URAM score was 8 units in both groups and the VAS estimation of treatment efficacy by the patients was 8.7 of 10 in both groups.
  
  
  CONCLUSIONS
  There was no significant difference between the treatment outcomes after collagenase and needle fasciotomy treatment after 1 year.
  
  
  METHODS
  Therapeutic I.
authors.affiliation: Department of Hand Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden; Centre for Advanced Reconstruction of Extremities, Sahlgrenska University Hospital, Gothenburg, Sweden. Electronic address: joakim.stromberg@vgregion.se.
authors.forename: Joakim
authors.initials: J
authors.lastname: Strömberg
authors.affiliation: Department of Hand Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Allan
authors.initials: A
authors.lastname: Ibsen-Sörensen
authors.affiliation: Department of Hand Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden; Centre for Advanced Reconstruction of Extremities, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Jan
authors.initials: J
authors.lastname: Fridén
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D017364:Collagenases / Q000008:administration & dosage*; D004387:Dupuytren Contracture / Q000628:therapy*; D000071938:Fasciotomy / Q000295:instrumentation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D008662:Metacarpophalangeal Joint / Q000187:drug effects / Q000601:surgery*; D008875:Middle Aged; D009339:Needles; D011446:Prospective Studies; D016037:Single-Blind Method; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D017364:Collagenases
keywords: Dupuytren; collagenase; needle aponeurotomy; needle fasciotomy; percutaneous needle fasciotomy