title: Multi-needle aponeurotomy for advanced Dupuytren's disease: preliminary results of safety and efficacy (MNA 1 study).
abstract: OBJECTIVE
  To assess the safety and efficacy of multi-needle aponeurotomy (MNA) for advanced Duputren's disease.
  
  
  METHODS
  This prospective study included patients with age more than 17 years, Dupuytren's contracture with palmo-digital or poly-digital involvement, presumed NA number needed to treat>4, and availability for at least 1-month follow-up after MNA. Outcome measures were Tubiana score and passive extension deficit, after MNA and at 1 and 6 months; self-assessed disability and satisfaction at 1 and 6 months; and adverse events (AEs).
  
  
  RESULTS
  Thirty patients were included. MNA was performed on 37 hands and 99 rays. Among 25 assessed MNA sessions for treatment-related discomfort, patients considered 22 (88%) not at all to moderately painful. Six minor AEs, representing 2 for every 100 NAs, were reported. Tubiana scores at baseline (5.3±2.3, n=35) were improved after treatment (1.7±1.8, n=32, P<0.0001), at 1 month (2.2±1.4, n=26, P<0.0001) and at 6 months (2.8±2.7, n=19, P<0.01). Passive extension deficit was greatly reduced after treatment and persisted at follow-up. Disability scores at baseline (27.6±26.9, n=37) were reduced at 1 month (13.2±19.5, n=26, P=0.02) and at 6 months (5.2±11.6, n=20, P<0.001). Patients were highly satisfied at 1 month (100%, n=25) and 6 months (95%, n=19).
  
  
  CONCLUSIONS
  MNA appears safe and effective for advanced Dupuytren's disease. It could become a treatment of reference and contribute to reducing the need for surgery in this indication.
authors.affiliation: Unité rhumatologique des affections de la main, service de rhumatologie, Université Paris-7, Paris, France. johann.beaudreuil@lrb.aphp.fr
authors.forename: Johann
authors.initials: J
authors.lastname: Beaudreuil
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Lermusiaux
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Teyssedou
authors.forename: Sophie
authors.initials: S
authors.lastname: Lahalle
authors.forename: Sandra
authors.initials: S
authors.lastname: Lasbleiz
authors.forename: Brigitte
authors.initials: B
authors.lastname: Bernabé
authors.forename: Henri
authors.initials: H
authors.lastname: Lellouche
authors.forename: Philippe
authors.initials: P
authors.lastname: Orcel
authors.forename: Thomas
authors.initials: T
authors.lastname: Bardin
mesh_terms: D000368:Aged; D004185:Disability Evaluation; D004387:Dupuytren Contracture / Q000503:physiopathology / Q000628:therapy*; D005205:Fascia / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009339:Needles; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D011446:Prospective Studies; D012189:Retrospective Studies; D057566:Self Report; D012720:Severity of Illness Index; D016896:Treatment Outcome