• Mikko Petteri Räisänen, Olli V Leppänen, Janne Soikkeli, Aleksi Reito, Antti Malmivaara, Rachelle Buchbinder, Hannu Kautiainen, Antti Kaivorinne, Susanna Stjernberg-Salmela, Minna Lappalainen, Toni Luokkala, Annele Pönkkö, Hanna-Stiina Taskinen, Markus Pääkkönen, Kati Jaatinen, Joona Juurakko, Venla-Linnea Karjalainen, and Teemu Karjalainen.
• Department of Orthopedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, and Tampere University, Tampere, Finland (M.P.R.).
• Ann. Intern. Med. 2024 Mar 1; 177 (3): 280290280-290.

BackgroundSurgery, needle fasciotomy, and collagenase injection are used to treat Dupuytren contracture. The treatment decision requires balancing initial morbidity and costs of surgery against its potential long-term benefits over needle fasciotomy and collagenase.ObjectiveTo compare the effectiveness of surgery, needle fasciotomy, and collagenase injection at 3 months and 2 years (secondary time points of the trial).DesignA multicenter, randomized, outcome assessor-blinded, superiority trial. (ClinicalTrials.gov: NCT03192020).Setting6 public hospitals in Finland.Participants302 persons with treatment-naive Dupuytren contracture (contracture angle <135°).InterventionSurgery (n = 101), needle fasciotomy (n = 101), or collagenase (n = 100).MeasurementsThe primary outcome was the success rate, defined as greater than 50% contracture release and patients reaching the patient acceptable symptom state. Secondary outcomes included hand function, pain, quality of life, patient satisfaction, residual contracture angle, finger flexion, risk for retreatment, and serious adverse events.ResultsA total of 292 (97%) and 284 (94%) participants completed the 3-month and 2-year follow-ups. Success rates were similar at 3 months: 71% (95% CI, 62% to 80%) for surgery, 73% (CI, 64% to 82%) for needle fasciotomy, and 73% (CI, 64% to 82%) for collagenase. At 2 years, surgery had superior success rates compared with both needle fasciotomy (78% vs. 50%; adjusted risk difference [aRD], 0.30 [CI, 0.17 to 0.43]) and collagenase (78% vs. 65%; aRD, 0.13 [CI, 0.01 to 0.26]). Secondary analyses paralleled with the primary analysis.LimitationParticipants were not blinded.ConclusionInitial outcomes are similar between the treatments, but at 2 years success rates were maintained in the surgery group but were lower with both needle fasciotomy and collagenase despite retreatments.Primary Funding SourceResearch Council of Finland.

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