Surgical Management of Dupuytren Disease: A Systematic Review and Network Meta-analyses

Silas Nann; Joshua Kovoor; James Fowler; James Kieu; Aashray Gupta; Joseph Hewitt; Christopher Ovenden; Suzanne Edwards; Stephen Bacchi; Jonathan Henry W Jacobsen; Richard Harries; Guy Maddern

doi:10.1177/15589447231174175

Surgical Management of Dupuytren Disease: A Systematic Review and Network Meta-analyses

Hand (N Y). 2023 May 28:15589447231174175. doi: 10.1177/15589447231174175. Online ahead of print.

Authors

Silas Nann^{1

2}, Joshua Kovoor^{1

3

4}, James Fowler³, James Kieu², Aashray Gupta^{1

3}, Joseph Hewitt^{1

2}, Christopher Ovenden^{1

2}, Suzanne Edwards³, Stephen Bacchi^{1

3}, Jonathan Henry W Jacobsen⁴, Richard Harries³, Guy Maddern^{1

3}

Affiliations

¹ The University of Adelaide, SA, Australia.
² Royal Adelaide Hospital, SA, Australia.
³ The Queen Elizabeth Hospital, Adelaide, SA, Australia.
⁴ Royal Australasian College of Surgeons, Adelaide, SA, Australia.

PMID: 37246411
DOI: 10.1177/15589447231174175

Abstract

Background: Dupuytren disease is a common fibroproliferative disease that affects the palmar fascia of the hands. Currently, there is limited consensus regarding the optimal therapy for this condition, with treatment decisions based largely on surgeon preference. Therefore, the aim of this study was to determine which treatments are the most effective for Dupuytren disease.

Method: A systematic review and network meta-analyses were conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. Medline, EMBASE, and Web of Science were searched for randomized trials comparing treatments for Dupuytren disease in adults. Eligible treatments included open limited fasciectomy, collagenase injection, and percutaneous needle fasciotomy. Study selection, data extraction, and quality appraisal were performed in duplicate. The methodological quality was evaluated with the Cochrane risk-of-bias critical appraisal tool.

Results: Eleven randomized clinical trials were included in this study. At short-term (1-12 weeks) and long-term (2-5 years) time points, fasciectomy improved contracture release more than collagenase and needle fasciotomy as inferred by a lower total passive extension deficit. However, there was no difference between the groups regarding the best possible outcome at any time point. Fasciectomy was also superior in terms of recurrence and patient satisfaction compared with collagenase and needle fasciotomy, but only at later time points. There was no difference in skin damage-related and nerve damage-related complications following fasciectomy compared with other modalities. Risk of bias was generally moderate.

Conclusions: Fasciectomy provides superior long-term advantages in terms of patient outcomes when compared with collagenase and needle fasciotomy. Larger trials with better blinding of outcome assessors are needed in the future.

Keywords: Dupuytren disease; collagenase clostridium histolyticum injection; network meta-analysis; open limited fasciectomy; percutaneous needle fasciotomy; systematic review.