Steroid Injection and Needle Aponeurotomy for Dupuytren Disease: Long-Term Follow-Up of a Randomized Controlled Trial

Purpose To compare long-term outcomes and retreatment rates for patients with Dupuytren disease who underwent needle aponeurotomy (NA) combined with a series of triamcinolone acetonide injections or underwent NA alone as part of a prior randomized controlled trial. Methods During this follow-up study, 44 of 47 participants in the original study were examined as needed between 6 and 53 months from their initial procedure. Those who had not been reassessed within 18 months of the original NA were asked to return for follow-up. The average total active extension deficit (TAED) of previously treated joints was compared between groups 7 to 12, 13 to 24, 25 to 36, and 37 to 48 months following treatment. Timing of retreatment (if performed) was recorded. Results Forty-four participants returned for assessment an average of 4.8 times over 53 months. Mean TAED was significantly less in needle aponeurotomy triamcinolone injection patients at 6 months and between 13 and 24 months. Sixty-two percent of NA group patients and 30% of needle aponeurotomy triamcinolone injection patients returned for a second treatment on the same digit(s) (retreatment). This difference was not significant. Mean time to retreatment and mean TAED immediately prior to retreatment did not differ significantly between groups. Kaplan-Meier survival estimates demonstrated a significantly higher percentage of NA group patients expected to return for retreatment by 24 but not by 36 months. Younger age, more than one joint treated at the initial NA, and TAED severity throughout the follow-up period were associated with earlier retreatment. Conclusions Serial triamcinolone injections combined with NA was associated with lower TAED for up to 24 months. A larger study would more accurately quantify the potential benefits of combining triamcinolone injections with NA for treatment of Dupuytren disease. Copyright (C) 2014 by the American Society for Surgery of the Hand. All rights reserved.