title: Results of 45 arthroscopic Bankart procedures: Does the ISIS remain a reliable prognostic assessment after 5 years?
abstract: OBJECTIVE
  The Instability Severity Index Score (ISIS) includes preoperative clinical and radiological risk factors to select patients who can benefit from an arthroscopic Bankart procedure with a low rate of recurrence. Patients who underwent an arthroscopic Bankart for anterior shoulder instability with an ISIS lower than or equal to four were assessed after a minimum of 5-year follow-up.
  
  
  METHODS
  Forty-five shoulders were assessed at a mean of 79 months (range 60-118 months). Average age was 29.4 years (range 17-58 years) at the time of surgery. Postoperative functions were assessed by the Walch and Duplay and the Rowe scores for 26 patients; an adapted telephonic interview was performed for the 19 remaining patients who could not be reassessed clinically. A failure was defined by the recurrence of an anterior dislocation or subluxation. Patients were asked whether they were finally very satisfied, satisfied or unhappy.
  
  
  RESULTS
  The mean Walch and Duplay score at last follow-up was 84.3 (range 35-100). The final result for these patients was excellent in 14 patients (53.8 %), good in seven cases (26.9 %), poor in three patients (11.5 %) and bad in two patients (7.7 %). The mean Rowe score was 82.6 (range 35-100). Thirty-nine patients (86.7 %) were subjectively very satisfied or satisfied, and six (13.3 %) were unhappy. Four patients (8.9 %) had a recurrence of frank dislocation with a mean delay of 34 months (range 12-72 months). Three of them had a Hill-Sachs lesion preoperatively. Two patients had a preoperative ISIS at 4 points and two patients at 3 points.
  
  
  CONCLUSIONS
  The selection based on the ISIS allows a low rate of failure after an average term of 5 years. Lowering the limit for indication to 3 points allows to avoid the association between two major risk factors for recurrence, which are valued at 2 points. The existence of a Hill-Sachs lesion is a stronger indicator for the outcome of instability repair.
  
  
  METHODS
  Level IV, Retrospective Case Series, Treatment Study.
authors.affiliation: Department of Orthopaedic Surgery and Sports Medicine, Hôpital Privé Armand Brillard, 3 Avenue Watteau, 94130, Nogent-sur-Marne, France, Omar.Boughebri@gmail.com.
authors.forename: Omar
authors.initials: O
authors.lastname: Boughebri
authors.forename: Ali
authors.initials: A
authors.lastname: Maqdes
authors.forename: Constantina
authors.initials: C
authors.lastname: Moraiti
authors.forename: Choukry
authors.initials: C
authors.lastname: Dib
authors.forename: Franck Marie
authors.initials: FM
authors.lastname: Leclère
authors.forename: Philippe
authors.initials: P
authors.lastname: Valenti
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D001182:Arthroscopy / Q000379:methods*; D001265:Athletic Injuries / Q000503:physiopathology / Q000601:surgery; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D007593:Joint Instability / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D016059:Range of Motion, Articular; D012008:Recurrence; D012189:Retrospective Studies; D012783:Shoulder Dislocation / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult