Editorial Commentary: Which Patients Are Likely to Undergo Redislocation After an Arthroscopic Bankart Repair? Preoperative Instability Severity Index Scoring Over 3 Points—The Game Is Over!

Abstract

Risk factors for recurrent instability are present and identifiable preoperatively and can be incorporated into a severity scoring system to help with patient selection. The Instability Severity Index (ISI) Score is a tool used to preoperatively identify patients at risk of failure after an arthroscopic Bankart procedure for recurrent anterior shoulder instability. This 10-point score is also designed to help guide the treating surgeon's decision on whether a soft-tissue stabilization or bone block augmentation procedure is indicated. The ISI scoring system has been criticized for its lack of generalizability outside of the French health care system. However, evidence has emerged establishing the ISI Score as a valuable tool with excellent external validity. The ISI scoring system, based on factors derived from a preoperative questionnaire, physical examination, and imaging studies, is helpful to distinguish between patients who will benefit from an arthroscopic Bankart procedure and those who will not. The higher the score, the higher the risk of recurrence of instability. Patients with an ISI Score of 3 points or less may attain very good results with an arthroscopic Bankart procedure compared with patients with an ISI Score of more than 3 points. Performing this procedure in patients with an ISI Score of more than 6 points leads to an increased risk of recurrence (50%) within 5 years and is totally inacceptable. We believe that the information gained from this scoring system will help surgeons in their daily practice to not only decide the right procedure for the right patient but also inform their patients preoperatively of the risks and benefits of an arthroscopic Bankart procedure. As such, the ISI Score is an important strategic tool for shoulder surgeons.

Dynamic Anterior Stabilization with Hill‐Sachs Remplissage Can be Employed in Skeletally Immature Patients—Operative Technique

“…Our patient had several risk factors for recurrent shoulder instability: male, recurrent dislocations, young age, contact athlete. 32 The particularity of this case is represented by the subcritical glenoid bone loss in the presence of a Hill‐Sachs defect and a partially reparable anterior‐inferior labral capsular ligamentous complex. 23 , 33 It is also the authors experience that a partial Bankart repair with or without remplissage would not suffice especially in engaging bipolar lesions.…”

“…The long head of the biceps tendon is a useful tool in shoulder surgery because it is a locally accessible and viable autograft that may be used to augment rotator cuff repairs and be incorporated into capsulo‐labral reconstructions in anterior shoulder instability procedures. 9 , 31 , 32 , 33 …”

Current Evidence on Open and Arthroscopic Bristow-Latarjet Procedure

“…On an editorial commentary, Boileau et al presented a more recent perspective on the evidence about the relation between the ISI score and other factors on the recurrence rate after surgery (Fig. 3), even defining a simple strategy about the selection of the right procedure to the right patient 19 .…”

“…Surgical treatment à la carte in patients with recurrent anterior shoulder instability, proposed by Boileau and Lemmex 19 .…”

Editorial Commentary: Open or Arthroscopic Surgery? Practice Makes Perfect…We Do Best What We Do Most Often

“…Many factors impact the incidence of recurrent instability 7 ; they include symptom duration, number of dislocations (especially 5 or more), revision cases, Hill-Sachs lesion sizes, glenoid bone loss, and "on-track" or "off-track" lesions. [7][8][9] The instability severity index score 10,11 and glenoid track instability management score 12 scoring systems include meaningful prognostic factors impacting surgical outcomes that were not appreciated in earlier case series: younger than 20 years of age, competitive sports participation, overhead or contact sports, and shoulder hyperlaxity. Significant glenoid bone loss is perhaps the most widely appreciated variable.…”