Evaluation of the Instability Severity Index score in predicting failure following arthroscopic Bankart surgery in an active military population

Chan, Andrew G.; Kilcoyne, Kelly G.; Chan, Stephen A.; Dickens, Jonathan; Waterman, Brian R.

doi:10.1016/j.jse.2018.11.048

Cited by 35 publications

(43 citation statements)

References 38 publications

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“…Previously, Kim et al 11 reported an 8.8% recurrence rate. The recurrence rates describe by Kin compared favorably with prior literature on arthroscopic labral repair using single-loaded anchors, with reported recurrence rates of 17%, 16 23%, 27 26%, 2 29%, 3 44%, 18 and 51%. 28 Recurrence rates are multifactorial and influenced by glenoid bone loss.…”

Section: Discussionsupporting

confidence: 53%

Double-loaded suture anchors in the treatment of anteroinferior glenohumeral instability

Chalmers¹,

Hillyard²,

Kawakami³

et al. 2020

JSES International

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Hypothesis The purpose of this study was to determine the clinical outcomes of arthroscopic labral repair for anteroinferior glenohumeral instability with the use of double-loaded suture anchors. Methods This study evaluated a series of consecutive patients treated after the senior author changed from single- to double-loaded suture anchors for the treatment of anteroinferior glenohumeral instability with a minimum follow-up period of 2 years. We collected the following outcomes at final follow-up: visual analog scale pain score, Simple Shoulder Test score, American Shoulder and Elbow Surgeons score, and instability recurrence data. Results A total of 41 consecutive patients underwent arthroscopic labral repair with double-loaded anchors, of whom 30 (71%) were able to be contacted at a minimum of 2 years postoperatively. These patients included 4 contact or collision athletes (13%). The patients had an average of 12 ± 13 prior dislocations over an average period of 56 ± 57 months preoperatively. Mean glenoid bone loss measured 16% ± 10%, and 67% (18 of 27 patients) had glenoid bone loss ≥ 13.5%. Intraoperatively, 3.2 ± 0.4 anchors were used. No posterior repairs or remplissage procedures were performed. At an average of 6.7 ± 2.7 years' follow-up, the visual analog scale pain score was 0.8 ± 1.4; Simple Shoulder Test score, 11 ± 2; and American Shoulder and Elbow Surgeons score, 90 ± 14. Patients with bone loss < 13.5% had a 0% redislocation rate and 11% subluxation rate, whereas those with bone loss ≥ 13.5% had a 6% reoperation rate, 22% redislocation rate, and 22% subluxation rate. Conclusion Arthroscopic labral repair with double-loaded anchors provides satisfactory clinical results at early to mid-term outcome assessment when glenoid bone loss is <13.5%.

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Section: Discussionsupporting

confidence: 53%

Double-loaded suture anchors in the treatment of anteroinferior glenohumeral instability

Chalmers¹,

Hillyard²,

Kawakami³

et al. 2020

JSES International

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“…Definition of dislocation Dislocation needing reduction (by medical professional or third party) 12,16,19,26,31,33,34,37,57,58,68,70,[72][73][74]87,91,102 Objective documentation of a dislocation either radiologically or clinically 24,32,59,62,71,75,92 Increased translation of the humerus relative to the glenoid to the point of complete separation of articular surfaces 96 More than 1 episode of instability which needed manual reduction by other people 97…”

Section: Table 3 Definitions Of Dislocation and Subluxationmentioning

confidence: 99%

“…Instability without the need of reduction 12,13,16,26,31,33,34,45,57,58,68,70,72,87,91,97,102 Subjective sense of subluxation/instability 24,37,44,60,69,71,99 Sense of dislocation with a positive anterior apprehension test 59 Transient instability event that did not require reduction but demonstrated a positive apprehension and relocation sign with radiographic or magnetic resonance imaging evidence of a Bankart or Hill-Sachs 19 Symptomatic self-reported subluxation 62 "Dead-arm" phenomenon or instability which spontaneously reduced 73,75 Symptomatic translation of the humeral head relative to the glenoid articular surface without a dislocation 96 Subluxation at the time of the clinical assessment or through a history of at least 1 episode of dead arm syndrome 84 with signs of a sustained dislocation in further radiographs, such as Hill-Sachs or bony Bankart lesion in comparison with the preoperative situation, could be categorized as a confirmed dislocation. For subluxations, we advise using the definition of the feeling of a dislocation that can be (spontaneously) reduced without the need for a radiographically confirmed dislocation.…”

Section: Definition Of Subluxationmentioning

confidence: 99%

High Variability of the Definition of Recurrent Glenohumeral Instability: An Analysis of the Current Literature by a Systematic Review

Alkaduhimi¹,

Connelly

Deurzen³

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose: To determine the definitions for recurrence used in the literature, assess the consensus in using these definitions, and determine the impact of these definitions on recurrence rates. Methods: A literature search was performed in PubMed and EMBASE including studies from 2000 to 2020 reporting on recurrence rates after anterior arthroscopic shoulder instability surgery. Dislocation, apprehension, subluxation and recurrence rates were compared. Results: Ninety-one studies were included. In 68% of the eligible studies, recurrence rates are not well defined. Thirty (33%) studies did not report on dislocations, 45 (49%) did not report on subluxations, and 58 (64%) did not report on apprehension. Seventeen different definitions for recurrence of instability, 4 definitions of dislocations, and 8 definitions of subluxation were used. Conclusion: Recurrence rates are poorly specified and likely underreported in the literature, hampering comparison with results of other studies. This highlights the need for a consensus on definition of recurrence across shoulder instability studies. We recommend not using the definition recurrence of instability anymore. We endorse defining dislocations as a radiographically confirmed dislocation or a dislocation that is manually reduced, subluxations as the feeling of a dislocation that can be (spontaneously) reduced without the need for a radiographically confirmed dislocation, and a positive apprehension sign as fear of imminent dislocation when placing the arm in abduction and external rotation during physical examination. Reporting on the events resulting in a dislocation or subluxation aids in making an estimation of the severity of instability. Level of Evidence: Level IV, systematic review.

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“…10 However, other studies did not confirm ISI score prediction. 5,6,13,14 The main advantage of the ISI score is its simplicity of use in the outpatient clinic with simple plain radiographs of the shoulder.…”

Section: Which Patients Are Likely To Undergomentioning

confidence: 99%

Editorial Commentary: Should We Condemn the Shoulder Instability Severity Index Scoring System? Not at All!... Can We Improve Its Radiographic Component? Yes, We Can!

Boileau¹,

Balg

2021

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Is patient selection necessary in shoulder instability surgery? Absolutely. The risk-benefit discussion that the surgeon must have with the patient before proposing an arthroscopic Bankart repair remains crucial to provide informed consent. The most important preoperative risk factors are incorporated in the instability severity index (ISI) score to assist surgeons in the decision-making process. This 10-point score is based on factors derived from a preoperative questionnaire, physical examination, and simple plain radiographs. Using this score at the first visit, the surgeon can explain to the patient and family why a Bankart repair may be contraindicated and why other surgical options may be more suitable. A recent study found that the ISI score has no limited predictive value when applied in a preselected population of military patients without severe bone loss or hyperlaxity. This is not surprising because the authors analyzed a preselected patient population with lower risk than the general population. The value of the ISI scoring system relies on the fact that this tool has been developed after evaluation of arthroscopic Bankart repair in an unselected patient population and that there is no need for sophisticated imaging studies to make the decision. This scoring system should not be condemned but complemented with preoperative advanced imaging studies (computed tomography [CT] scanning or magnetic resonance imaging) to assess the severity of the bone lesions more accurately. Today, the choice of the surgical procedure depends not only on the clinical risk factors included in the ISI score (age, type of sports, level of practice, hyperlaxity) but also on the presence, location and size of bony lesions, as identified and measured on advanced CT scanning images.

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Evaluation of the Instability Severity Index score in predicting failure following arthroscopic Bankart surgery in an active military population

Cited by 35 publications

References 38 publications

Double-loaded suture anchors in the treatment of anteroinferior glenohumeral instability

Double-loaded suture anchors in the treatment of anteroinferior glenohumeral instability

High Variability of the Definition of Recurrent Glenohumeral Instability: An Analysis of the Current Literature by a Systematic Review

Editorial Commentary: Should We Condemn the Shoulder Instability Severity Index Scoring System? Not at All!... Can We Improve Its Radiographic Component? Yes, We Can!

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