Arbeitsunfähigkeitsdauer und berufliche Rehabilitation nach arthroskopischer und offener Labrumrefixation

Zusammenfassung

Hintergrund: Bisher gibt es keine Studie zur Arbeitsunfähigkeitsdauer (AU) in Abhängigkeit von der beruflichen Belastung nach offener und arthroskopischer Labrumrekonstruktion (LR). Ziel dieser Studie war daher der verfahrensspezifische Vergleich in Bezug auf die berufliche Tätigkeit nach REFA-Kriterien und der damit verbundenen Erfolgsrate beruflicher Rehabilitation. Patienten und Methodik: Insgesamt wurden 93 Patienten (20 w/73 m) nach arthroskopischer und offener LR in diese retrospektive Studie eingeschlossen. 72 Patienten wurden arthroskopisch und 21 Patienten offen (Bankart/Neer) versorgt. Das klinische Follow-up beinhaltete den Constant-Murley, UCLA Shoulder sowie den Rowe Score. Das mittlere Follow-up betrug 48,3 Monate (Durchschnittsalter 37,1 Jahre). Die Arbeitsbelastung wurde nach REFA in 0–1 (gering) und 2–4 (hoch) klassifiziert. Ergebnisse: Arthroskopische LR (ALR): Die mittlere AU betrug 3,3 Monate (± 2,5). Die AU für Patienten mit REFA 0–1 betrug im Mittel 2,4 Monate (± 1,6) und war signifikant kürzer als für Fälle mit REFA 2–4 mit 4,2 Monaten (± 2,9; p = 0,0053). Zwei von 35 Patienten (5,7 %) mit REFA 0–1 und 10 von 37 Patienten (27,0 %) mit REFA 2–4 konnten ihre ursprüngliche Tätigkeit nicht wieder aufnehmen. Offene LR (OLR): Die mittlere AU betrug 2,7 Monate (± 2,3). Die AU betrug für Patienten mit REFA 0–1 durchschnittlich 1,8 Monate (± 1,0 Monate) und war kürzer als für Fälle mit REFA 2–4 mit 4,3 Monaten (± 3,3; p = 0,1196). Einer aus 14 Patienten mit REFA 0–1 (7,1 %) und 4 aus 7 Patienten (57,1 %) mit REFA 2–4 konnten ihre ursprüngliche Tätigkeit nicht wieder vollständig aufnehmen. Es fanden sich keine verfahrensbedingten Unterschiede hinsichtlich des Vergleichs zwischen den REFA-spezifischen Subgruppen nach offener und arthroskopischer LR. Insgesamt konnten 18,3 % aller Patienten ihre ursprüngliche Arbeit nicht mehr ausüben. Schlussfolgerung: Höhere Arbeitsbelastungen (REFA 2–4) führen zu signifikant längerer AU, sowohl nach offener wie arthroskopischer LR, wobei keine verfahrensbedingten Vorteile vorliegen. Das arthroskopische und offene Vorgehen zeigten klinisch äquivalente Ergebnisse. Die primäre arthroskopische LR kann auch für Betroffene mit belastender Tätigkeit empfohlen werden, wobei die berufliche Rehabilitationsprognose verbesserungswürdig ist.

Abstract

Background and Introduction: The duration of inability for work according to work load and the rate of successful return to work after open and arthroscopic Bankart repair (BR) due to anterior shoulder dislocation has not yet been examined with regard to validated work strain by the REFA classification. Thus, the objective of this study was to determine the duration of inability to work according to work load (REFA criteria) after open and arthroscopic BR as well as the rate of successful return to the original occupation. Patients and Methods: A total of 93 patients (20 f/73 m) with isolated anterior arthroscopic or open BR due to posttraumatic anterior shoulder instability with no items of hyperlaxity were included in this study. There were 72 patients with arthroscopic and 21 patients with open BR. The postoperative aftercare was standardised and identical. The clinical assessment included the Constant and Murley scores, UCLA shoulder and the Rowe score for shoulder instability. Average follow-up time was 48.3 months (SD ± 23.6 months) with a mean age of 37.1 years (SD ± 14.4 years). The work load was classified according to the German REFA Association. Operation time, duration of inability for work and clinical outcome were analysed and compared according to the operation technique. Results: Mean incapacity for work in the group of arthroscopic BR was 3.3 months (SD ± 2.5) and 2.7 months (SD + 2.3 months; p = 0.37) in the group of open BR demonstrating no statistical difference. Both mean time for surgery (p = 0.0003) and in-hospital stay (p = 0.0083) showed significant differences when comparing patients with low work load (REFA 0–1) and higher work load (REFA 2–4) irrespective of the surgical approach. Overall analysis showed an average time of 2.3 months (SD ± 1.5) to return to work for patients with low work load (REFA 0–1) and 4.2 months (SD ± 2.9) for individuals with high work load (REFA 2–4) revealing significant differences (p = 0.0006). The mean inability for work after arthroscopic BR for patients with REFA 0–1 was 2.4 months (SD ± 1.6) and 4.2 months (± 2,9; p = 0.0053) for patients with REFA 2–4 revealing a significant difference. The mean inability for work after open BR for individuals with REFA 0–1 was 1.8 months (± 1.0) and 4.3 months (± 3.3; p = 0.1196) for individuals with REFA 2–4. Two out of 35 patients (5.7 %) with low work load (REFA 0–1) and 10 out of 37 patients (27 %) with high work load (REFA 2–4) could not return to their original occupation after arthroscopic BR. One out of 14 patients (7.1 %) with low work load (REFA 0–1) and 4 out of 7 patients (57.1 %) with high work load (REFA 2–4) could not return to their original occupation after open BR. Comparing these results between arthroscopic and open BR, no significant differences were obtained (chi-square, Pearson). Recurrent shoulder dislocation occurred in the arthroscopic group in 14.3 % (REFA 0–1) and 8.1 % (REFA 2–4) compared to the open procedure group in 0 % (REFA 0–1) and 14 % (REFA 2–4) revealing no statistically significant differences. Conclusion: This study showed equivalent results after performing open and arthroscopic BR with significantly shorter operation times and in-hospital stays after arthroscopic BR. Higher work loads caused longer inability for work irrespective of the chosen surgical technique. On the basis of these results we recommend arthroscopic BR as the standard primary procedure, while the overall rate of return to work without restrictions of 81.7 % has to be improved in the future.

Schlüsselwörter

Schulterinstabilität - Bankart-Läsion - Labrumrefixation - Schulterstabilisierung - Instabilität

Key words

shoulder instability - Bankart lesion - Bankart repair - shoulder stabilisation - instability

^* Beide Autoren haben zu gleichen Teilen zur Entstehung dieser Arbeit beigetragen.

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