title: Utility of the Instability Severity Index Score in Predicting Failure After Arthroscopic Anterior Stabilization of the Shoulder.
abstract: BACKGROUND
  The redislocation rate after arthroscopic stabilization for anterior glenohumeral instability is up to 30%. The Instability Severity Index Score (ISIS) was developed to preoperatively rationalize the risk of failure, but it has not yet been validated by an independent group.
  
  
  OBJECTIVE
  To assess the utility of the ISIS in predicting failure of arthroscopic anterior shoulder stabilization and to identify other preoperative factors for failure.
  
  
  METHODS
  Case-control study; Level of evidence, 3.
  
  
  METHODS
  A case-control study was performed on 141 consecutive patients, comparing those who suffered failure of arthroscopic stabilization with those who had successful arthroscopic stabilization. The mean follow-up time was 47 months (range, 24-132 months). The ISIS was applied retrospectively, and an analysis was performed to establish independent risk factors for failure. A receiver operator coefficient curve was constructed to set a threshold ISIS for considering alternative surgery.
  
  
  RESULTS
  Of 141 patients, 19 (13.5%) suffered recurrent instability. The mean ISIS of the failed stabilization group was higher than that of the successful stabilization group (5.1 vs 1.7; P < .001). Independent risk factors for failure were Hill-Sachs lesion (P < .001), glenoid bone loss (P < .001), age <21 years at the time of surgery (P < .001), age at first dislocation (P = .01), competitive-level participation in sports (P < .001), and participation in contact or overhead sports (P = .03). The presence of glenoid bone loss carried the highest risk of failure (70%). There was a 70% risk of failure if the ISIS was ≥4, as opposed to a 4% risk of failure if the ISIS was <4.
  
  
  CONCLUSIONS
  This is the first completely independent study to confirm that the ISIS is a useful preoperative tool. It is recommended that surgeons consider alternative forms of stabilization if the ISIS is ≥4.
authors.affiliation: Royal Surrey County Hospital, Guildford, UK joideep@doctors.org.uk.
authors.forename: Joideep
authors.initials: J
authors.lastname: Phadnis
authors.affiliation: Royal Surrey County Hospital, Guildford, UK.
authors.forename: Christine
authors.initials: C
authors.lastname: Arnold
authors.affiliation: Royal Surrey County Hospital, Guildford, UK.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Elmorsy
authors.affiliation: Royal Surrey County Hospital, Guildford, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Flannery
mesh_terms: D000328:Adult; D001182:Arthroscopy / Q000009:adverse effects; D001265:Athletic Injuries / Q000150:complications / Q000601:surgery; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007593:Joint Instability / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D008297:Male; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012540:Scapula / Q000473:pathology; D012783:Shoulder Dislocation / Q000209:etiology / Q000601:surgery; D012785:Shoulder Joint / Q000601:surgery*; D017211:Treatment Failure
keywords: Instability Severity Index Score; failure; instability; shoulder