Surgical and Injection Interventions for Dupuytren's Disease: A Systematic Review Protocol

Abstract

Objective

To compare the effectiveness and safety of surgical and injection-based interventions for Dupuytren's disease (DD) using systematic review and network meta-analysis methodology.

Methods

The current protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guidelines and is registered in The International Prospective Register of Systematic Reviews (PROSPERO). Randomized controlled trials involving adult patients with DD treated by surgical (e.g., fasciectomy, fasciotomy) or injection-based interventions (e.g., collagenase, corticosteroids) must be included. A comprehensive search must be conducted across MEDLINE, CENTRAL, EMBASE, LILACS, IBECS, and trial registries, without language or date restrictions. Two reviewers must perform independent screening, data extraction, and risk of bias assessment (RoB2). Primary outcomes must include functional improvement and adverse effects. Secondary outcomes must include recurrence, range of motion, and pain. Data synthesis should involve random-effects pairwise and network meta-analyses, with GRADE used to assess certainty of evidence. Subgroup analyses should explore heterogeneity based on clinical and methodological variables.

Results

This proposal of review aims to generate comparative estimates of effectiveness and safety across all eligible interventions, incorporating both direct and indirect evidence. Functional outcomes must be synthesized using a predefined hierarchy of patient-reported outcome measures (PROMs), and treatments must be ranked based on efficacy and safety profiles.

Conclusion

The present systematic review aims to fill current evidence gaps by comparing all relevant interventions for DD, supporting clinical decision-making through robust synthesis of functional and safety outcomes.

Resumo

Objetivo

Comparar a eficácia e a segurança de intervenções cirúrgicas e injetáveis para tratamento da contratura de Dupuytren (CD) por meio de revisão sistemática e metodologia de metanálise em rede.

Métodos

Este protocolo segue as diretrizes Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) e está registrado no The International Prospective Register of Systematic Reviews (PROSPERO). Devem ser incluídosestudos clínicos randomizados com pacientes adultos com CD e submetidos a intervenções cirúrgicas (ex.: fasciectomia e fasciotomia) ou injetáveis (ex.: colagenase e corticosteroides). Uma busca abrangente deve ser conduzida nas bases de dados MEDLINE, CENTRAL, EMBASE, LILACS, IBECS e registros de estudos clínicos, sem restrições de idioma ou data. Dois revisores devem realizer a triagem, extração de dados e avaliação de risco de viés (RoB2) de forma independente. Os desfechos primários devem incluir melhora funcional e efeitos adversos. Os desfechos secundários devem incluir recidiva, amplitude de movimento e dor. A síntese de dados deve envolver metanálises pareadas e de rede de efeitos aleatórios e a certeza da evidência deve ser avaliada de acordo com a abordagem Grading of Recommendation, Assessment, Development and Evaluation (GRADE). As análises de subgrupos devem explorar a heterogeneidade com base em variáveis clínicas e metodológicas.

Resultados

Esta proposta de revisão pretende gerar estimativas comparativas de eficácia e segurança em todas as intervenções elegíveis, incorporando evidências diretas e indiretas. Os desfechos funcionais devem ser sintetizados usando uma hierarquia predefinida de medidas de desfecho relatadas pelo paciente (PROMs, do inglês patient-reported outcome measures) e os tratamentos devem ser classificados com base nos perfis de eficácia e segurança.

Conclusão

Esta revisão sistemática visa preencher lacunas de evidências atuais comparando todas as intervenções relevantes para o tratamento da CD, apoiando a tomada de decisão clínica por meio de síntese robusta de resultados funcionais e de segurança.

Keywords

collagenases - Dupuytren contracture - fasciotomy - systematic review'

Palavras-chave

colagenases - contratura de Dupuytren - fasciotomia - revisão sistemática

Author Contributions

RGS led the study, overseeing conceptualization, methodology, and review, and is the guarantor of the work. VYM, JBGS, and FF contributed to the study's conceptualization and methodology, and provided critical revisions. VTC and NCJ were responsible for the search strategy and statistical data analysis. All authors contributed to the writing and reviewing of the manuscript and approved the final version.

Financial Support

The authors declare that they did not receive financial support from agencies in the public, private, or non-profit sectors to conduct the present study.

The present work was developed at the Disciplina de Cirurgia da Mão e Membro Superior, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brasil.

Publikationsverlauf

Eingereicht: 14. April 2025

Angenommen: 09. Juni 2025

Artikel online veröffentlicht:
08. September 2025

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