Needle Aponeurotomy for the Treatment of Dupuytren’s Disease

Díaz, Roberto; Curtin, Catherine

doi:10.1016/j.hcl.2013.09.005

Cited by 17 publications

(17 citation statements)

References 17 publications

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“…The efficacy of percutaneous techniques in the release of the A1 pulley in trigger finger surgery has been shown in both cadaver and clinical applications, and successful clinical results of percutaneous needle tenotomies have also been reported. 6–9 In a cadaver study by Rowe et al, 4 successful percutaneous release of the carpal tunnel involving 9 tendons and 1 nerve was reported. Because of the advantages of minimally invasive techniques, the hypothesis of this study was that percutaneous release could be an alternative method in the surgical treatment of frequently seen clinical conditions such as De Quervain’s disease.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Release of the First Dorsal Extensor Compartment: A Cadaver Study

Güleç

Türkmen²,

Toker³

et al. 2016

Plastic and Reconstructive Surgery - Global Open

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Background:To evaluate the efficiency of the percutaneous 18-G needle technique in releasing the fibro-osseous sheath over the first dorsal extensor compartment of the hand.Methods:Using anatomic landmarks, percutaneous release was performed with an 18-G needle on 48 wrists of 24 cadavers. The specimens were then dissected and examined for the completeness of the first dorsal extensor compartment release and any tendon or neurovascular injuries. The tunnel length, number of abductor pollicis longus and extensor pollicis brevis tendons, presence of an intertendinous septum, and the effects of these parameters on percutaneous release were evaluated.Results:Percutaneous release was performed on all of the wrists, and the evaluation of the adequacy of release revealed 25 complete releases, 21 partial releases, and 2 missed releases. There were 19 cases of tendon complications. No neurovascular injuries were noted. The mean tunnel length was 2.66 ± 30 cm, and the mean number of tendons was 2.75 ± 0.86. A septum was present in 33.3% of cases. Tunnel length and tendon number had no statistically significant effect on release, whereas the presence of a septum was significantly associated with inadequate tunnel release and the development of tendon complications.Conclusions:Percutaneous release of the first dorsal extensor compartment using an 18-G needle was associated with high rates of incomplete release and tendon damage in the presence of an intertendinous septum. Further study is required under ultrasound guidance to determine the usefulness of percutaneous release in the first dorsal extensor compartment.Clinical Relevance:Release with a percutaneous needle tip in De Quervain’s syndrome may provide the advantages of better cosmetic results with less scar formation and an early return to work.

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Section: Discussionmentioning

confidence: 99%

Percutaneous Release of the First Dorsal Extensor Compartment: A Cadaver Study

Güleç

Türkmen²,

Toker³

et al. 2016

Plastic and Reconstructive Surgery - Global Open

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“…Needle tenotomies have been carried out in children with congenital talipes equinovarus with no reports of complications [ 14 – 17 ]. Similarly, the technique has been used to free Dupuytren’s contractures with few unwanted effects (cutaneous fissures in 8–16%, infection in 0.7–2% and rupture of a deeper tendon in 0.05–0.2%) [ 28 , 29 ]. Needle tenotomies have also been carried out under ultrasound guidance for chronic tennis elbow and trigger finger with no reports of complications [ 18 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

Effectiveness and Complications of Percutaneous Needle Tenotomy with a Large Needle for Muscle Contractures: A Cadaver Study

et al. 2015

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BackgroundTwenty-two percent of institutionalised elderly persons have muscle contractures. Contractures have important functional consequences, rendering hygiene and positioning in bed or in a chair difficult. Medical treatment (such as botulinum toxin injections, physiotherapy or positioning) is not very effective and surgery may be required. Surgery is carried out in the operating theatre, under local or general anaesthesia but is often not possible in fragile patients. Mini-invasive tenotomy could be a useful alternative as it can be carried out in ambulatory care, under local anaesthesia.ObjectiveTo evaluate the effectiveness of percutaneous needle tenotomy and the risks of damage to adjacent structures in cadavers.MethodThirty two doctors who had never practiced the technique (physical medicine and rehabilitation specialists, geriatricians and orthopaedic surgeons) carried out 401 tenotomies on the upper and lower limbs of 8 fresh cadavers. A 16G needle was used percutaneous following location of the tendons. After each tenotomy, a neuro-orthopaedic surgeon and an anatomist dissected the area in order to evaluate the success of the tenotomy and any adjacent lesions which had occurred.ResultsOf the 401 tenotomies, 72% were complete, 24.9% partial and 2.7% failed. Eight adjacent lesions occurred (2%): 4 (1%) in tendons or muscles, 3 (0.7%) in nerves and 1 (0.2%) in a vessel.ConclusionThis percutaneous needle technique effectively ruptured the desired tendons, with few injuries to adjacent structures. Although this study was carried out on cadavers, the results suggest it is safe to carry out on patients.

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“…6,38 Surgery has been the treatment of choice for severe contractures and for some people with moderate contractures. 1,2,9,32 There are no definitive indications for treatment but contraction of the MCP joint of > 30°is a commonly accepted indication.…”

Section: Management Of the Diseasementioning

confidence: 99%

Collagenase clostridium histolyticum for the treatment of Dupuytren’s contracture: systematic review and economic evaluation

Brazzelli

Cruickshank

Tassie

et al. 2015

Health Technol Assess

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BackgroundDupuytren’s disease is a slowly progressive condition of the hand, characterised by the formation of nodules in the palm that gradually develop into fibrotic cords. Contracture of the cords produces deformities of the fingers. Surgery is recommended for moderate and severe contractures, but complications and/or recurrences are frequent. Collagenase clostridium histolyticum (CCH) has been developed as a minimally invasive alternative to surgery for some patients.ObjectivesTo assess the clinical effectiveness and cost-effectiveness of collagenase as an alternative to surgery for adults with Dupuytren’s contracture with a palpable cord.Data sourcesWe searched all major electronic databases from 1990 to February 2014.Review methodsRandomised controlled trials (RCTs), non-randomised comparative studies and observational studies involving collagenase and/or surgical interventions were considered. Two reviewers independently extracted data and assessed risk of bias of included studies. A de novo Markov model was developed to assess cost-effectiveness of collagenase, percutaneous needle fasciotomy (PNF) and limited fasciectomy (LF). Results were reported as incremental cost per quality-adjusted life-year (QALY) gained. Deterministic and probabilistic sensitivity analyses were undertaken to investigate model and parameter uncertainty.ResultsFive RCTs comparing collagenase with placebo (493 participants), three RCTs comparing surgical techniques (334 participants), two non-randomised studies comparing collagenase and surgery (105 participants), five non-randomised comparative studies assessing various surgical procedures (3571 participants) and 15 collagenase case series (3154 participants) were included. Meta-analyses of RCTs assessing CCH versus placebo were performed. Joints randomised to collagenase were more likely to achieve clinical success. Collagenase-treated participants experienced significant reduction in contracture and an increased range of motion compared with placebo-treated participants. Participants treated with collagenase also experienced significantly more adverse events, most of which were mild or moderate. Four serious adverse events were observed in the collagenase group: two tendon ruptures, one pulley rupture and one complex regional pain syndrome. Two tendon ruptures were also reported in two collagenase case series. Non-randomised studies comparing collagenase with surgery produced variable results and were at high risk of bias. Serious adverse events across surgery studies were low. Recurrence rates ranged from 0% (at 90 days) to 100% (at 8 years) for collagenase and from 0% (at 2.7 years for fasciectomy) to 85% (at 5 years for PNF) for surgery. The results of the de novo economic analysis show that PNF was the cheapest treatment option, whereas LF generated the greatest QALY gains. Collagenase was more costly and generated fewer QALYs compared with LF. LF was £1199 more costly and generated an additional 0.11 QALYs in comparison with PNF. The incremental cost-effectiveness ratio was £10,871 per QALY gained. Two subgroup analyses were conducted for a population of patients with moderate and severe disease and up to two joints affected. In both subgroup analyses, collagenase remained dominated.LimitationsThe main limitation of the review was the lack of head-to-head RCTs comparing collagenase with surgery and the limited evidence base for estimating the effects of specific surgical procedures (fasciectomy and PNF). Substantial differences across studies further limited the comparability of available evidence. The economic model was derived from a naive indirect comparison and was hindered by a lack of suitable data. In addition, there was considerable uncertainty about the appropriateness of many assumptions and parameters used in the model.ConclusionsCollagenase was significantly better than placebo. There was no evidence that collagenase was clinically better or worse than surgical treatments. LF was the most cost-effective choice to treat moderate to severe contractures, whereas collagenase was not. However, the results of the cost–utility analysis are based on a naive indirect comparison of clinical effectiveness, and a RCT is required to confirm or refute these findings.Study registrationThis study is registered as PROSPERO CRD42013006248.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Needle Aponeurotomy for the Treatment of Dupuytren’s Disease

Cited by 17 publications

References 17 publications

Percutaneous Release of the First Dorsal Extensor Compartment: A Cadaver Study

Percutaneous Release of the First Dorsal Extensor Compartment: A Cadaver Study

Effectiveness and Complications of Percutaneous Needle Tenotomy with a Large Needle for Muscle Contractures: A Cadaver Study

Collagenase clostridium histolyticum for the treatment of Dupuytren’s contracture: systematic review and economic evaluation

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