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Dupuytren contracture can be treated with limited surgery, needle fasciotomy or collagenase injection. This multicentre randomized trial compared the three options at both short-term and two-year follow-up. At three months, success rates were similar, reinforcing the appeal of minimally invasive treatment for selected patients. By two years, however, the surgery group maintained a higher rate of durable success than either needle fasciotomy or collagenase injection. The clinical lesson is not that surgery should replace less invasive approaches. Rather, treatment choice should reflect the patient's need for durability, tolerance for recurrence or retreatment, functional impairment and willingness to accept operative morbidity. Needle procedures and collagenase can provide faster early recovery and less invasive treatment, but recurrence and retreatment may be more common. For surgeons, the paper provides useful evidence for shared decision-making because it separates short-term correction from longer-term durability. Patients with more advanced disease or a strong preference for durable correction may reasonably prioritise surgery, while others may accept a higher chance of recurrence in exchange for a less invasive initial treatment. The trial therefore supports a personalised approach to Dupuytren disease rather than a single preferred technique.
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Dupuytren contracture can be treated with limited surgery, needle fasciotomy or collagenase injection. This multicentre randomized trial compared the three options at both short-term and two-year follow-up. At three months, success rates were similar, reinforcing the appeal of minimally invasive treatment for selected patients. By two years, however, the surgery group maintained a higher rate of durable success than either needle fasciotomy or collagenase injection. The clinical lesson is not that surgery should replace less invasive approaches. Rather, treatment choice should reflect the patient's need for durability, tolerance for recurrence or retreatment, functional impairment and willingness to accept operative morbidity. Needle procedures and collagenase can provide faster early recovery and less invasive treatment, but recurrence and retreatment may be more common. For surgeons, the paper provides useful evidence for shared decision-making because it separates short-term correction from longer-term durability. Patients with more advanced disease or a strong preference for durable correction may reasonably prioritise surgery, while others may accept a higher chance of recurrence in exchange for a less invasive initial treatment. The trial therefore supports a personalised approach to Dupuytren disease rather than a single preferred technique.
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