A clinical study by British scientists showed that collagenase injections were just as effective as fascia incision in restoring movement in patients with Dupuytren's contracture. As reported in The New England Journal of Medicine, the difference in hand function preservation between the two treatment groups was statistically insignificant.
Dupuytren's contracture is a symptom of Dupuytren's disease, in which fibrous bands form in the hand. These bands shorten over time, leading to permanent flexion of one or more fingers, limiting extension. These changes impair quality of life, and surgical treatment of the contracture often leads to recurrence. Another increasingly popular treatment for contracture is the injection of collagenase, an enzyme that breaks down collagen, into the fibrous bands. However, there is virtually no literature comparing the effectiveness of these two methods.
A team of physicians led by Joseph Dias from the University Hospitals of Leicester evaluated the efficacy and safety of collagenase injections compared with limited fascial dissection (band dissection) in the treatment of moderate Dupuytren's contracture. Six hundred and seventy-two patients were randomly divided into two groups: one group received three collagenase injections followed by contracture dissection, while the other received surgical removal of the affected ligaments to correct the contracture.
One year after treatment, the average score on the hand health and quality of life questionnaire (the higher the score, the worse the hand health) was 17.8 in the collagenase treatment group, compared to 11.9 in the surgery group. Analysis showed that collagenase was no less effective than fascia incision (p = 0.49). These results were maintained after two years. Similar findings were reached when measuring hand function using other questionnaires and scales. The difference in the risk of recurrence was also statistically insignificant.
Doctors conclude that collagenase injections may be just as effective and safer than surgery for Dupuytren's contracture. Moderate or severe complications were rare, but they were more common in the surgical group than in the collagenase group.
However, there are quite affordable ways to reduce the risk of surgery. We recently reported that taking 7,500 steps a day for a month before surgery reduced the risk of complications afterward.
