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Collagenase clostridium histolyticum injection versus limited fasciectomy for the treatment of Dupuytren’s disease: a systematic review and meta-analysis of comparative studies

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Abstract

Introduction

The aim of the present study is to systematically review the literature on well-selected comparative studies for meta-analysis on outcome differences between collagenase clostridium histolyticum (CCH) injection and limited fasciectomy (LF) for Dupuytren’s disease.

Materials and methods

PubMed/Medline, Embase, and the Cochrane Library were searched for comparative studies assessing differences in outcomes of CCH and LF. Effect estimates were pooled across studies using random effects models and presented as weighted mean difference (MD) and odds ratio (OR) with corresponding 95% confidence interval (CI).

Results

A total of 11 studies encompassing 1′051 patients was included (619 patients in the CCH and 432 in the LF group). The residual contracture at a minimal average follow-up of three months was higher in the CCH group than in the LF group (27.8 vs. 16.2°, MD 11.6°, 95% CI [8.7, 14.5°], p < 0.001). The recurrence rate was significantly higher in the CCH group (25.8 vs. 9.3%, OR 5.2, 95% CI [1.5, 18.8], p = 0.01) while the rate of severe complications was significantly higher in the LF group (0.3 vs. 7.3%, OR 0.12, 95% CI [0.03, 0.42], p = 0.001).

Conclusions

Evidence of the present study confirms that CCH injection has a higher rate of disease recurrence whereas LF carries a higher risk for severe complications. It’s imperative that the trade-off between these aspects is considered, keeping in mind that CCH injections may be repeated in case of disease recurrence without increasing procedure related risks, especially in complex cases.

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Data availability

The data used for this study were generated, processed, analyzed and stored on a specific form designed for this study. No registration within a recognized repository was performed. The data are available from the corresponding author on reasonable request.

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This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Plastic and Hand Surgery, Inselspital, University Hospital of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland

    Rémy Liechti, Dominique Nellie Merky, Damian Sutter, Ramin Ipaktchi & Esther Vögelin

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  1. Rémy Liechti
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  2. Dominique Nellie Merky
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Contributions

All listed authors have made substantial contributions to this article. The design and conception of the work, analysis, and interpretation of data was carried out by RL and DNM. RL wrote the first draft of the manuscript. Critical revision for important intellectual content as well as final approval of the version to be published was done by DS, RI and EV. All authors agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Rémy Liechti.

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Liechti, R., Merky, D.N., Sutter, D. et al. Collagenase clostridium histolyticum injection versus limited fasciectomy for the treatment of Dupuytren’s disease: a systematic review and meta-analysis of comparative studies. Arch Orthop Trauma Surg 144, 527–536 (2024). https://doi.org/10.1007/s00402-023-05004-8

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