Instability Severity Index Score predicts recurrent shoulder instability after arthroscopic Bankart repair

Author:

van Blommestein Matthijs Y. H.1ORCID,Govaert Lonneke H. M.1,van der Palen Job23,Verra Wiebe C.1,Koorevaar Rinco C. T.4,Schröder Femke F.156,Veen Egbert Jan D.1

Affiliation:

1. Department of Orthopaedic Surgery and Traumatology Medisch Spectrum Twente Enschede The Netherlands

2. Department of Epidemiology Medisch Spectrum Twente Enschede The Netherlands

3. Section Cognition, Data and Education, Faculty of Behavioral, Management and Social Sciences University of Twente Enschede Netherlands

4. Department of Orthopedic Surgery Bergman Clinics Rotterdam The Netherlands

5. Department of Biomechanical Engineering, Faculty of Engineering Technology, Technical Medical Centre University of Twente Enschede The Netherlands

6. Medical 3D Lab Medisch Spectrum Twente Enschede The Netherlands

Abstract

AbstractPurposeThe Instability Severity Index (ISI) Score was developed to preoperatively assess the risk of recurrent shoulder instability after an arthroscopic Bankart repair. This study aims to validate the use of ISI Score for predicting the risk of recurrence after an arthroscopic Bankart repair in a heterogeneous population and proposes an appropriate cut‐off point for treating patients with an arthroscopic Bankart repair or otherwise.MethodsThis study analysed 99 shoulders after a traumatic dislocation that underwent arthroscopic Bankart repair with at least 3 years follow‐up. Patients were divided into subcategories based on their respective ISI Score. Recurrence includes either a postoperative dislocation or perceived instability.ResultsThe overall recurrence rate was found to be 26.3%. A significant correlation was identified between ISI Score and the recurrence rate (odds ratio [OR]: 1.545, 95% confidence interval [CI]: 1.231–1.939, p < 0.001). Furthermore, ISI Score 4–6 (OR: 4.498, 95% CI: 1.866–10.842, p < 0.001) and ISI Score > 6 (OR: 7.076, 95% CI: 2.393–20.924, p < 0.001) both had a significantly higher risk of recurrence compared to ISI Score 0–3. In ISI Score subcategories 0–3, 4–6 and >6, the recurrence rate was, respectively, 15.4%, 40.7% and 71.4%.ConclusionISI Score has predictive value in determining the recurrence risk of shoulder instability following an arthroscopic Bankart repair in a heterogeneous population. Based on the findings of this study, we recommend using arthroscopic Bankart repair in patients with ISI Score 0–3. Clinical and shared decision‐making are essential in the group with ISI Score 4–6, since the recurrence rate is significantly higher than in patients with ISI Score 0–3. Arthroscopic Bankart repair is not suitable for patients with ISI Score > 6.Level of EvidenceLevel III.

Publisher

Wiley

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