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Review
. 2025 Feb 8;15(2):259.
doi: 10.3390/life15020259.

Collagenase Clostridium Histolyticum Versus Percutaneous Needle Fasciotomy for Dupuytren's Disease: A Systematic Review and Meta-Analysis

Ishith Seth  1   2 , Vicki McClure  2 , Bryan Lim  2 , Roberto Cuomo  3 , Richard J Ross  1   2 , Warren M Rozen  1   2
Affiliations
Review

Collagenase Clostridium Histolyticum Versus Percutaneous Needle Fasciotomy for Dupuytren's Disease: A Systematic Review and Meta-Analysis

Ishith Seth et al. Life (Basel). .

Abstract

Minimally invasive treatments for Dupuytren's disease (DD), such as percutaneous needle fasciotomy (PNF) and collagenase clostridium histolyticum (CCH), have become alternatives to open surgeries. This meta-analysis compared these treatments in terms of complications, patient satisfaction, clinical outcomes, and recurrence. Relevant studies up to June 2024 were identified through major databases, following PRISMA guidelines, and the study was registered on PROSPERO. Statistical analysis using Review Manager 5.4 found PNF had lower post-operative rates of oedema (RR = 0.15, 95% CI [0.09, 0.27], p < 0.00001), lymphadenopathy (RR = 0.09, 95% CI [0.02, 0.38], p = 0.0010), and pruritus (RR = 0.1, 95% CI [0.01, 0.73], p = 0.02) compared to CCH. However, there were no significant differences in skin tears, recurrence, reintervention, extension deficit, or residual flexion at metacarpal and proximal interphalangeal joints (p > 0.05). Patient-reported outcomes, including QuickDASH and URAM scores, also showed no significant differences. Eleven studies involving 1443 patients were analysed, and most were at a low-to-moderate risk of bias, as assessed using the Cochrane or Newcastle-Ottawa tools. While PNF showed fewer minor complications, overall clinical and patient-reported outcomes were comparable between the treatments. These findings highlight the need to tailor treatment choices to patient preferences and clinical context.

Keywords: CCH; Dupuytren’s contracture; PNF; collagenase; percutaneous fasciotomy.

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Conflict of interest statement

The authors do not have any potential conflicts of interest with respect to this manuscript.

Figures

Figure 1
Figure 1
PRISMA flow diagram of selected studies.
Figure 2
Figure 2
Summary of the quality assessment of the included randomised controlled trials. Green represents low risk of bias, yellow represents moderate risk of bias and red represents high risk of bias.
Figure 3
Figure 3
Forest plot comparing edema rate between collagenase clostridium histolyticum and percutaneous needle fasciotomy.
Figure 4
Figure 4
Forest plot comparing lymphadenopathy rate between collagenase clostridium histolyticum and percutaneous needle fasciotomy.
See this image and copyright information in PMC

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