Department of Orthopaedic Surgery and Traumatology, Medisch Spectrum Twente, Enschede, The Netherlands.
Department of Epidemiology, Medisch Spectrum Twente, Enschede, The Netherlands.
Knee Surg Sports Traumatol Arthrosc. 2024 Aug;32(8):2152-2160. doi: 10.1002/ksa.12235. Epub 2024 May 8.
The 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.
This 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.
The 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%.
ISI 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 III.
不稳定严重程度指数（ISI）评分旨在术前评估关节镜下 Bankart 修复后复发性肩关节不稳定的风险。本研究旨在验证 ISI 评分在异质人群中预测关节镜下 Bankart 修复后复发风险的能力，并提出一个合适的截断值，用于治疗接受关节镜下 Bankart 修复或其他治疗的患者。
本研究分析了 99 例因创伤性脱位而行关节镜下 Bankart 修复的患者，随访时间至少 3 年。根据各自的 ISI 评分，患者被分为亚组。复发包括术后脱位或感知不稳定。
总复发率为 26.3%。ISI 评分与复发率之间存在显著相关性（比值比[OR]：1.545，95%置信区间[CI]：1.231-1.939，p<0.001）。此外，ISI 评分 4-6（OR：4.498，95%CI：1.866-10.842，p<0.001）和 ISI 评分>6（OR：7.076，95%CI：2.393-20.924，p<0.001）与 ISI 评分 0-3 相比，复发风险显著更高。在 ISI 评分亚组 0-3、4-6 和>6 中，复发率分别为 15.4%、40.7%和 71.4%。
ISI 评分在异质人群中对确定关节镜下 Bankart 修复后肩关节不稳定的复发风险具有预测价值。基于本研究的结果，我们建议在 ISI 评分 0-3 的患者中使用关节镜下 Bankart 修复。在 ISI 评分 4-6 的患者中，临床和共同决策至关重要，因为复发率明显高于 ISI 评分 0-3 的患者。对于 ISI 评分>6 的患者，不适合进行关节镜下 Bankart 修复。
III 级。
