Comparative Effectiveness of Percutaneous Needle Aponeurotomy and Limited Fasciectomy for Dupuytren's Contracture: A Multicenter Observational Study.
BACKGROUND
Percutaneous needle aponeurotomy is a less invasive surgical alternative to limited fasciectomy for Dupuytren's contracture, but appeared less efficacious in a previous randomized clinical trial. This study compared the effectiveness of both techniques in contemporary clinical practice.


METHODS
The authors evaluated prospectively gathered data from all patients who were treated with percutaneous needle aponeurotomy or limited fasciectomy between 2011 and 2014 at six hand surgery practice sites in The Netherlands. The degree of total active extension deficit, Michigan Hand Outcomes Questionnaire subscores, and complications evaluated at 6 to 12 weeks after treatment were compared after propensity score-based inverse-probability weighting to account for the differences in baseline characteristics between the treatment groups.


RESULTS
After inverse-probability weighting, 78 percutaneous needle aponeurotomy patients and 103 limited fasciectomy patients remained with similar characteristics (88 percent Tubiana grade I or II). The degree of total residual extension deficit at follow-up was similar between the weighted groups (percutaneous needle aponeurotomy, 21 degrees; limited fasciectomy, 18 degrees; p = 0.330). Furthermore, percutaneous needle aponeurotomy was associated with a lower mild complication rate (percutaneous needle aponeurotomy, 5.2 percent; limited fasciectomy, 24.3 percent; p < 0.001) and larger increases in the subdomain scores of satisfaction (p < 0.001), work performance (p < 0.001), activities of daily living (p = 0.009), and overall hand function (p = 0.001).


CONCLUSIONS
This multicenter observational study found that, among patients with mildly to moderately affected digits, percutaneous needle aponeurotomy reduced contractures as effectively as limited fasciectomy does in clinical practice. Furthermore, percutaneous needle aponeurotomy provided a more rapid functional recovery and had a lower rate of mild complications.


METHODS
Therapeutic, III.
Rotterdam and Hilversum, The Netherlands.|From the Departments of Plastic, Reconstructive, and Hand Surgery and Rehabilitation Medicine, Erasmus MC University Medical Center; and Hand and Wrist Surgery, Xpert Clinic.
Chao
C
Zhou
Rotterdam and Hilversum, The Netherlands.|From the Departments of Plastic, Reconstructive, and Hand Surgery and Rehabilitation Medicine, Erasmus MC University Medical Center; and Hand and Wrist Surgery, Xpert Clinic.
Ruud W
RW
Selles
Rotterdam and Hilversum, The Netherlands.|From the Departments of Plastic, Reconstructive, and Hand Surgery and Rehabilitation Medicine, Erasmus MC University Medical Center; and Hand and Wrist Surgery, Xpert Clinic.
Harm P
HP
Slijper
Rotterdam and Hilversum, The Netherlands.|From the Departments of Plastic, Reconstructive, and Hand Surgery and Rehabilitation Medicine, Erasmus MC University Medical Center; and Hand and Wrist Surgery, Xpert Clinic.
Reinier
R
Feitz
Rotterdam and Hilversum, The Netherlands.|From the Departments of Plastic, Reconstructive, and Hand Surgery and Rehabilitation Medicine, Erasmus MC University Medical Center; and Hand and Wrist Surgery, Xpert Clinic.
Yara
Y
van Kooij
Rotterdam and Hilversum, The Netherlands.|From the Departments of Plastic, Reconstructive, and Hand Surgery and Rehabilitation Medicine, Erasmus MC University Medical Center; and Hand and Wrist Surgery, Xpert Clinic.
Thybout M
TM
Moojen
Rotterdam and Hilversum, The Netherlands.|From the Departments of Plastic, Reconstructive, and Hand Surgery and Rehabilitation Medicine, Erasmus MC University Medical Center; and Hand and Wrist Surgery, Xpert Clinic.
Steven E R
SER
Hovius
D000328:Adult; D000368:Aged; D000070606:Aponeurosis / Q000601:surgery*; D057186:Comparative Effectiveness Research; D004387:Dupuytren Contracture / Q000601:surgery*; D000071938:Fasciotomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D009339:Needles; D019637:Orthopedic Procedures / Q000295:instrumentation / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome