Xiaflex (Collagenase) has finally been approved by the FDA for the treatment of Dupuytren’s contracture. When work began on the development of collagenase to treat Dupuytren’s contracture, the bar was pretty low: anything better than fasciectomy in terms of either safety or efficacy would be a great advance. No other treatment options were available in the United States. However, during the time that research was being performed on collagenase, needle aponeurotomy was introduced into the US and has gained some popularity. This changes the equation for collagenase – it’s no longer the only alternative to fasciectomy. How will this play out?