Modified percutaneous needle aponeurotomy for Dupuytren's disease: case series with functional outcome

Over the past three decades, percutaneous needle aponeurotomy (PNA) for Dupuytren's disease has become increasingly prevalent and offers numerous potential benefits. However, significant rates of recurrences are observed in literature. We aimed to evaluate the effectiveness of our technical modifications of percutaneous needle aponeurotomy that significantly separates the cord in the palm and digits, thereby minimizing recurrences.

We treated 23 consecutive patients with our modified technique. We use a larger-bore needle in the dorsovolar direction which involves a more controlled extensive disruption of the cord under local anesthesia. The mean total passive extension deficit (TPED) and the Dupuytren's contracture-specific Unité rhumatologique desaffections de la main (URAM) scores were calculated at final follow-up.

Twenty-three patients underwent the procedure, involving 28 affected hands and 38 fingers, including 22 ring fingers, 6 little fingers, and 10 middle fingers. The average follow-up period was 22 months, ranging from 12 to 28 months. At presentation, the mean total passive extension deficit TPED was 50°. At the time of the final follow-up, the mean (TPED) was 10°, with a mean percent correction of 83% which was found to be statistically significant. This included 82% correction at the metacarpophalangeal joint and 81% at the proximal interphalangeal joint. Only four experienced recurrences, accounting for 14.2% of the total with a mean TPED of 30°. Lower URAM score indicated a significant short-term functional improvement.

Our modified PNA technique enhances cord division in the palm and fingers, leading to improved contracture correction and lower recurrence rates. However, further studies with larger cohorts and control groups are needed to validate these findings.