Sir:FigureThank you very much for your comments on our article. In reply to your letter, “Need for a Standard Procedure for Needle Aponeurotomy, Consensus Definition of Recurrence, and Functional Assessment in Dupuytren Disease,” we would like to make the following comments. We do not agree that our recurrence rates are much higher than previously reported: this only accounts for one retrospective study, which was performed by Badois et al., in which the authors, as you have correctly mentioned, do not state their definition of recurrence.1 The study by Badois et al. is also the only study that presents long-term results of needle aponeurotomy with the use of steroids. In a pilot for this study, we found a 65 percent rate of recurrence after a mean of 33 months,2,3 and in our randomized controlled series, the recurrence rate was 64 percent after 3 years. Foucher et al. reviewed 100 cases after a mean of 3.2 years4 and found a recurrence rate of 58 percent. These figures indicate that we executed percutaneous needle fasciotomy well and that our recurrence data are in fact comparable. This is even more so, because we are the first to publish a prospective randomized study on the results of percutaneous needle fasciotomy versus limited fasciectomy and therefore there has not been selection bias. We would also like to address the statement that local corticosteroids reduce the risk for recurrence, as this has not irrefutably been proven: it has been used since the mid 1940s and has largely been abandoned.5,6 It was never proven to be beneficial other than in painful nodules, where these would sometimes soften.7 Regarding the Disabilities of the Arm, Shoulder and Hand score: as time progressed during the study, many patients appeared to be unwilling to fill out the long questionnaire over and over again. This resulted in failure rates that were too high, which made the Disabilities of the Arm, Shoulder and Hand questionnaire useless. In 2006, the Quick Disabilities of the Arm, Shoulder and Hand was developed. This is a much shorter questionnaire with reliable outcome in Dupuytren disease.8 If this had been available at the start of our study, this would have been a much better alternative. We have no experience with the Unité Rhumatologique des Affections de la Main scale; it might be a good alternative, as it is designed specifically for the hand instead of the whole upper extremity, which is a shortcoming of the Disabilities of the Arm, Shoulder and Hand scoring system. Other alternatives worth considering are the Patient Evaluation Measure, the Michigan Hand Outcomes Questionnaire, Patient-Rated Wrist/Hand Evaluation, and the very recently presented Southhampton Dupuytren's Scoring Scheme.9–12 Annet van Rijssen, M.D. Paul M. N. Werker, M.D., Ph.D. Isala Clinics, Zwolle, The Netherlands DISCLOSURE The authors have no financial interest to declare in relation to the content of this communication.