A lower Instability Severity Index score threshold may better predict recurrent anterior shoulder instability after arthroscopic Bankart repair: a systematic review

Rosenberg, Samuel I.; Padanilam, Simon J.; Pagni, Brandon Alec; Tjong, Vehniah K.; Sheth, Ujash

doi:10.1136/jisakos-2020-000584

Cited by 11 publications

(7 citation statements)

References 37 publications

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“… 3 However, the clinical validity and predictive value of the Instability Severity Index Score have been called into question by more recent studies that have failed to find a correlation between outcomes and Instability Severity Index Score using the previously established cutoff threshold. 7 , 22 Shoulder hyperlaxity has been shown to be an independent risk factor for failure after revision arthroscopic anterior shoulder stabilization. 25 Similarly, studies have shown an increased risk of recurrence after arthroscopic Bankart with a stretched inferior glenohumeral ligament or anterior hyperlaxity (external rotation, >90°).…”

Section: Discussionmentioning

confidence: 99%

Recurrent Instability After Arthroscopic Bankart Repair in Patients With Hyperlaxity and Near-Track Lesions

Boden,

Charles,

Hughes

et al. 2023

Orthopaedic Journal of Sports Medicine

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Background: Recurrent anterior shoulder instability after arthroscopic Bankart repair presents a challenging clinical problem, with the primary stabilization procedure often portending the best chance for clinical success. Purpose: To determine if capsuloligamentous laxity affects failure (recurrent dislocation, subluxation, and/or perceived instability symptoms) after arthroscopic Bankart repair in patients with near-track lesions (ie, those with smaller distance to dislocation [DTD]). Study Design: Case-control study; Level of evidence, 3. Methods: The authors retrospectively reviewed consecutive patients who underwent primary arthroscopic Bankart repair for recurrent anterior glenohumeral instability at a single institution between 2007 and 2019 and who had at least 2 years of follow-up data. Patients with glenoid bone loss >20%, off-track lesions, concomitant remplissage, or rotator cuff tear were excluded. Capsuloligamentous laxity, or hyperlaxity, was defined as external rotation >85° with the arm at the side and/or grade ≥2 in at least 2 planes with the shoulder at 90° of abduction. Near-track lesions were defined as those with a DTD <10 mm. Results: Included were 173 patients (mean age, 20.5 years; mean DTD, 16.2 mm), of whom 16.8% sustained a recurrent dislocation and 6.4% had recurrent subluxations (defined as any subjective complaint of recurrent instability without frank dislocation), for an overall recurrent instability rate of 23.1%. The rate of revision stabilization was 15.6%. The mean time to follow-up was 7.4 years. Independent predictors of recurrent instability were younger age ( P = .001), smaller DTD ( P = .021), >1 preoperative instability episode ( P < .001), and the presence of hyperlaxity during examination under anesthesia ( P = .013). Among patients with near-track lesions, those with hyperlaxity had a recurrent instability rate almost double that of patients without hyperlaxity (odds ratio, 34.1; P = .04). The increased rate of failure and recurrent dislocation in the near-track hyperlaxity cohort remained elevated, even in patients with no bone loss. Conclusion: Capsuloligamentous shoulder laxity was a significant independent risk factor for failure after primary arthroscopic Bankart repair without remplissage and was more predictive of failure in patients with versus without near-track lesions.

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Section: Discussionmentioning

confidence: 99%

Recurrent Instability After Arthroscopic Bankart Repair in Patients With Hyperlaxity and Near-Track Lesions

Boden,

Charles,

Hughes

et al. 2023

Orthopaedic Journal of Sports Medicine

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“…Multiple factors are included when calculating the ISS, such as age, the risks associated with the sport played by the patient, the presence of glenoid loss or a Hill-Sachs lesion, and hyperlaxity. 42 43) Athletes involved in risky contact sports, especially younger athletes, have an increased chance of reinjury or redislocation. 44) The ISS uses a point scoring guideline where differing amounts of points are assigned to the patient for the varying factors that are evaluated before the operation.…”

Section: Indications For Open Stabilization Proceduresmentioning

confidence: 99%

“…Higher scores contraindicate an arthroscopic repair because an open procedure would provide more shoulder stability and better patient outcomes. 42 43 44) …”

Section: Indications For Open Stabilization Proceduresmentioning

confidence: 99%

Anterior Shoulder Instability and Open Procedures: History, Indications, and Clinical Outcomes

et al. 2023

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The shoulder, being the most mobile joint in the human body, is often susceptible to dislocations and subluxations more so than other joints. As such, shoulder instability constitutes a common complaint among patients worldwide, especially those who are young, participate in contact sports, and have increased innate flexibility in their joints. Management options in the setting of instability vary between conservative and surgical options that aim to mitigate symptoms and allow return of function. Surgical options can be arthroscopic and open, with a general shift among surgeons towards utilizing arthroscopic surgery in the past several decades. Nevertheless, open procedures still play a role in managing shoulder instability patients, especially those with significant bone loss, recurrent instability, coexisting shoulder pathologies, and high risk of failure with arthroscopic surgery. In these clinical settings, open procedures, like the Latarjet procedure, open Bankart repair, glenoid bone augmentation using iliac crest autograft or distal tibial allograft, and salvage options like glenohumeral arthrodesis and arthroplasty may show good clinical outcomes and low recurrence rates. Each of these open procedures possesses its own set of advantages and disadvantages and entails a specific set of indications based on published literature. It is important to cater treatment options to the individual patient in order to optimize outcomes and reduce the risk of complications. Future research on open shoulder stabilization procedures should focus on the long-term outcomes of recently utilized procedures, investigate different graft options for procedures involving bone augmentation, and conduct additional comparative analyses in order to establish concrete surgical management guidelines.

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“…The score was meant to be easily obtainable in the outpatient office setting, using information that is available at the first visit, including a preoperative questionnaire, physical examination, as well as simple, plain radiographs [6]. Surgeons have used the ISI measure to guide the surgical management of anterior shoulder instability [6,43]. This score has been used to try to improve communication among physicians and has been widely adopted in clinical research.…”

Section: Purposementioning

confidence: 99%

Classifications in Brief: The Instability Severity Index Score for Predicting Recurrent Shoulder Instability After Arthroscopic Bankart Repair

Sudah

Menendez

2022

Clin Orthop Relat Res

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A lower Instability Severity Index score threshold may better predict recurrent anterior shoulder instability after arthroscopic Bankart repair: a systematic review

Cited by 11 publications

References 37 publications

Recurrent Instability After Arthroscopic Bankart Repair in Patients With Hyperlaxity and Near-Track Lesions

Recurrent Instability After Arthroscopic Bankart Repair in Patients With Hyperlaxity and Near-Track Lesions

Anterior Shoulder Instability and Open Procedures: History, Indications, and Clinical Outcomes

Classifications in Brief: The Instability Severity Index Score for Predicting Recurrent Shoulder Instability After Arthroscopic Bankart Repair

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