DETECT (needle fasciotomy vs. surgery)
Trial question
Is needle fasciotomy superior to surgery in patients with Dupuytren's contracture?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
19.0% female
81.0% male
N = 202
202 patients (39 female, 163 male).
Inclusion criteria: patients with untreated Dupuytren's contracture.
Key exclusion criteria: recurrent contracture; neurologic condition affecting finger function; contraindication for collagenase; pregnancy or lactation; contracture > 135 degree; rheumatoid arthritis.
Interventions
N=101 percutaneous needle fasciotomy (dividing the cord at 1-3 levels under local anesthesia using the tip of the needle, leaving only needle puncture holes in the skin).
N=101 limited fasciectomy (exposing and excising the cord limiting the extension through a longitudinal zigzag incision).
Primary outcome
Success rate at 3 months
73%
71%
73.0 %
54.8 %
36.5 %
18.3 %
0.0 %
Percutaneous needle
fasciotomy
Limited
fasciectomy
No significant
difference ↔
No significant difference in success rate at 3 months (73% vs. 71%; AD 2%, 95% CI -0.38 to 4.38).
Secondary outcomes
Significant decrease in success rate at 2 years (50% vs. 78%; ARD -0.3, 95% CI -0.43 to -0.17).
Significant decrease in reaching Patient Acceptable Symptom State at 2 years (72% vs. 90%; ARD -0.19, 95% CI -0.3 to -0.08).
Significant decrease in > 50% release at 2 years (62% vs. 80%; ARD -0.2, 95% CI -0.32 to -0.08).
Safety outcomes
No significant difference in serious adverse events.
Conclusion
In patients with untreated Dupuytren's contracture, percutaneous needle fasciotomy was not superior to limited fasciectomy with respect to success rate at 3 months.
Reference
Mikko Petteri Räisänen, Olli V Leppänen, Janne Soikkeli et al. Surgery, Needle Fasciotomy, or Collagenase Injection for Dupuytren Contracture : A Randomized Controlled Trial. Ann Intern Med. 2024 Mar;177(3):280-290.
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