Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
J ISAKOS. 2021 Sep;6(5):295-301. doi: 10.1136/jisakos-2020-000584. Epub 2021 Feb 10.
The Instability Severity Index (ISI) score was developed to evaluate a patient's risk of recurrent shoulder instability following arthroscopic Bankart repair. While patients with an ISI score of >6 were originally recommended to undergo an open procedure (ie, Latarjet) to minimise the risk of recurrence, recent literature has called into question the utility of the ISI score.
The purpose of this systematic review was to evaluate the efficacy of the ISI score as a tool to predict postoperative recurrence among patients undergoing arthroscopic Bankart procedures.
Articles were included if study participants underwent arthroscopic Bankart repair for anterior shoulder instability and reported postoperative recurrence by ISI score at a minimum of 2 years of follow-up. Methodological study quality was assessed using the Methodological Index for Non-Randomized Studies criteria. Pearson's χ test was used to compare recurrence rates among patients above and below an ISI score of 4. Sensitivity, specificity, mean ISI scores and predictive value of individual factors of the ISI score were qualitatively reviewed.
Four studies concluded the ISI score was effective in predicting postoperative recurrence following arthroscopic Bankart repair; however, these studies found threshold values lower than the previously proposed score of >6 may be more predictive of recurrent instability. A pooled analysis of these studies found patients with an ISI score <4 to experience significantly lower recurrence rates when compared with patients with a score ≥4 (6.3% vs 26.0, p<0.0001). The mean ISI score among patients who experienced recurrent instability was also significantly higher than those who did not.
The ISI score as constructed by Balg and Boileau may have clinical utility to help predict recurrent anterior shoulder instability following arthroscopic Bankart repair. However, this review found the threshold values published in their seminal article to be insufficient predictors of recurrent instability. Instead, a lower score threshold may provide as a better predictor of failure. The paucity of level I and II investigations limits the strength of these conclusions, suggesting a need for further large, prospective studies evaluating the predictive ability of the ISI score.
IV.
不稳定严重指数（ISI）评分旨在评估关节镜下 Bankart 修复后患者复发性肩不稳定的风险。最初建议 ISI 评分>6 的患者接受开放式手术（即 Latarjet）以最大程度降低复发风险，但最近的文献对 ISI 评分的实用性提出了质疑。
本系统评价旨在评估 ISI 评分作为预测关节镜下 Bankart 手术患者术后复发的工具的有效性。
如果研究参与者因前肩不稳定而行关节镜下 Bankart 修复，并在至少 2 年的随访中按 ISI 评分报告术后复发，则纳入研究。使用非随机研究方法学指数标准评估方法学研究质量。使用 Pearson χ 检验比较 ISI 评分>4 和 ISI 评分<4 的患者的复发率。定性回顾 ISI 评分的个体因素的敏感性、特异性、平均 ISI 评分和预测值。
四项研究表明 ISI 评分可有效预测关节镜下 Bankart 修复后术后复发；然而，这些研究发现阈值值低于先前提出的>6 分的评分可能更能预测不稳定的复发。这些研究的汇总分析发现，ISI 评分<4 的患者的复发率明显低于 ISI 评分≥4 的患者（6.3%与 26.0%，p<0.0001）。经历复发性不稳定的患者的平均 ISI 评分也明显高于未经历复发性不稳定的患者。
Balg 和 Boileau 构建的 ISI 评分可能具有临床实用性，有助于预测关节镜下 Bankart 修复后前肩不稳定的复发。然而，本综述发现他们的开创性文章中发表的阈值值不足以预测不稳定的复发。相反，较低的评分阈值可能是失败的更好预测指标。缺乏 I 级和 II 级调查限制了这些结论的强度，表明需要进一步进行大型前瞻性研究以评估 ISI 评分的预测能力。
IV。
