Results of Needle Aponeurotomy for Dupuytren Contracture in Over 1,000 Fingers

Purpose To critically review the efficacy, recurrence rate, and complications of needle aponeurotomy (NA) for the treatment of Dupuytren contracture. Methods This was a retrospective study of the results of NA for the treatment of Dupuytren contracture. We included in the study all patients who had NA performed for metacarpophalangeal (MP) or proximal interphalangeal (PIP) joint contracture of 20 degrees or greater between March 2005 and May 2008. There were 474 patients with 1,013 fingers treated. The average age was 62 years (range, 33-92 y). Pre-procedure MP joint contracture averaged 35 degrees (range, 15 degrees to 95 degrees), and PIP joint 50 degrees (range, 15 degrees to 110 degrees). Immediately postprocedure and at least 3 years after treatment (range, 3.0-6.2 y), we measured MP and PIP joint contractures and reviewed records for complications. Results MP joint contractures were corrected an average of 99% and PIP contractures an average of 89% immediately postprocedure. At final follow-up, 72% of the correction was maintained for MP joints and 31% for PIP joints. The difference between the final corrections for MP versus PIP joints was statistically significant. When we compared the final results of patients age 55 years and older versus under 55 years, we found a statistically significant difference at both MP and PIP joints, with greater correction maintained in the older group. Gender differences were not statistically significant. Needle aponeurotomy provided successful correction to 5 degrees or less contracture immediately postprocedure in 98% (791) of MP joints and 67% (350) of PIP joints. There was recurrence of 20 degrees or less over the original postprocedure corrected level in 80% (646) of MP joints and 35% (183) of PIP joints. Complications were rare except for skin tears, which occurred in 3.4% (34) of digits. Conclusions This study shows that NA is a safe procedure that can be performed in an outpatient setting. The complication rate was low, but recurrences were frequent in younger patients and for PIP contractures. (J Hand Surg 2012;37A:651-656. Copyright (C) 2012 by the American Society for Surgery of the Hand. All rights reserved.)