Is the Instability Severity Index Score a Valid Tool for Predicting Failure After Primary Arthroscopic Stabilization for Anterior Glenohumeral Instability?

Loppini, Mattia; Rose, Giacomo Delle; Borroni, Mario; Morenghi, Emanuela; Pitino, Dario; Zamora, C; Castagna, Alessandro

doi:10.1016/j.arthro.2018.09.027

Cited by 48 publications

(55 citation statements)

References 23 publications

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“…It is interesting to note that the study of Loppini et al 13 confirms what has been found in the original publication: the higher the score, the higher the risk of recurrence of instability. They divided their patients into 3 groups according to the preoperative ISI Score: 3 points or less (group A), between 4 and 6 points (group B), and greater than 6 points (group C).…”

Section: Validity Of Isi Scoresupporting

confidence: 76%

“…6 The ISI scoring system is a strategic tool. Hence, the study of Loppini et al 13 is important because it validates this scoring system.…”

Section: Three Levels Of Competencementioning

confidence: 94%

“…To assess the validity of the ISI scoring system in predicting the rate of recurrent instability after arthroscopic Bankart repair, Loppini et al 13 contacted, by telephone interview, 670 patients (572 men and 98 women, with an average age of 27 years) who underwent an arthroscopic Bankart repair between 2002 and 2009 and who were followed up for a minimum of 5 years. The overall recurrence rate of instability in this retrospective cohort was 17% (95% confidence interval, 14.2%-19.9%).…”

Section: Validity Of Isi Scorementioning

confidence: 99%

“…Predicting the risk of recurrence of anterior dislocation in patients undergoing arthroscopic Bankart repair is of paramount importance, given that this risk has been clearly underestimated until now. [1][2][3] The study by Loppini et al 13 shows that, in a series of unselected patients undergoing an arthroscopic Bankart procedure, about 2 of 10 patients will have a recurrence of instability at a minimum of 5 years. Furthermore, this failure rate does not even consider the number of patients who have no recurrence but who have persistent anterior apprehension or consider their shoulder too weak to continue practicing sports.…”

Section: Selecting the Right Procedures For The Right Patientmentioning

confidence: 99%

“…There is excitement in the literature regarding the treatment of the first-time acute shoulder dislocation. The study by Loppini et al 13 clearly states that these patients were treated nonoperatively and thus not included in their series. As such, the ISI Score has not been validated in this population and could be considered in future studies.…”

Section: Selecting the Right Procedures For The Right Patientmentioning

confidence: 99%

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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!

Boileau¹,

Lemmex²

2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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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.

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Section: Validity Of Isi Scoresupporting

confidence: 76%

“…6 The ISI scoring system is a strategic tool. Hence, the study of Loppini et al 13 is important because it validates this scoring system.…”

Section: Three Levels Of Competencementioning

confidence: 94%

Section: Validity Of Isi Scorementioning

confidence: 99%

Section: Selecting the Right Procedures For The Right Patientmentioning

confidence: 99%

Section: Selecting the Right Procedures For The Right Patientmentioning

confidence: 99%

See 3 more Smart Citations

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!

Boileau¹,

Lemmex²

2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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

van Blommestein,

Govaert,

van der Palen

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe 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.

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Methodology and development of a machine learning probability calculator: Data heterogeneity limits ability to predict recurrence after arthroscopic Bankart repair

van Spanning,

Verweij,

Hendrickx

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe aim of this study was to develop and train a machine learning (ML) algorithm to create a clinical decision support tool (i.e., ML‐driven probability calculator) to be used in clinical practice to estimate recurrence rates following an arthroscopic Bankart repair (ABR).MethodsData from 14 previously published studies were collected. Inclusion criteria were (1) patients treated with ABR without remplissage for traumatic anterior shoulder instability and (2) a minimum of 2 years follow‐up. Risk factors associated with recurrence were identified using bivariate logistic regression analysis. Subsequently, four ML algorithms were developed and internally validated. The predictive performance was assessed using discrimination, calibration and the Brier score.ResultsIn total, 5591 patients underwent ABR with a recurrence rate of 15.4% (n = 862). Age <35 years, participation in contact and collision sports, bony Bankart lesions and full‐thickness rotator cuff tears increased the risk of recurrence (all p < 0.05). A single shoulder dislocation (compared to multiple dislocations) lowered the risk of recurrence (p < 0.05). Due to the unavailability of certain variables in some patients, a portion of the patient data had to be excluded before pooling the data set to create the algorithm. A total of 797 patients were included providing information on risk factors associated with recurrence. The discrimination (area under the receiver operating curve) ranged between 0.54 and 0.57 for prediction of recurrence.ConclusionML was not able to predict the recurrence following ABR with the current available predictors. Despite a global coordinated effort, the heterogeneity of clinical data limited the predictive capabilities of the algorithm, emphasizing the need for standardized data collection methods in future studies.Level of EvidenceLevel IV, retrospective cohort study.

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Is the Instability Severity Index Score a Valid Tool for Predicting Failure After Primary Arthroscopic Stabilization for Anterior Glenohumeral Instability?

Cited by 48 publications

References 23 publications

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!

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!

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

Methodology and development of a machine learning probability calculator: Data heterogeneity limits ability to predict recurrence after arthroscopic Bankart repair

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