This prospective case-control study of 131 patients with recurrent anterior shoulder instability identifies six preoperative risk factors for failure after arthroscopic Bankart repair with suture anchors. These factors are combined into the 10-point Instability Severity Index Score (ISIS) to guide the choice between arthroscopic and open stabilization. All inputs come from history, physical exam, and plain AP radiograph — no advanced imaging required.
Every attending has seen a young rugby player fail an arthroscopic Bankart repair — the question is whether you could have predicted it beforehand.
The ISIS gives you a structured answer. Calculate it from three inputs available in any clinic visit: history (age, sport level, sport type), physical exam (hyperlaxity testing), and a plain AP radiograph in external rotation (Hill-Sachs location, glenoid contour).
When the ISIS score is above 6, the data support offering Latarjet as the primary procedure rather than attempting arthroscopic repair. When it is 3 or below, arthroscopic Bankart repair carries only a 5% recurrence rate and is the appropriate choice.
One nuance the authors flag: patients who downgraded their sport before surgery due to pain or instability may score lower than their true risk warrants. Ask specifically about pre-injury sport level, not current activity.
This prospective case-control study of 131 patients with recurrent anterior shoulder instability identifies six preoperative risk factors for failure after arthroscopic Bankart repair with suture anchors. These factors are combined into the 10-point Instability Severity Index Score (ISIS) to guide the choice between arthroscopic and open stabilization. All inputs come from history, physical exam, and plain AP radiograph — no advanced imaging required.
Every attending has seen a young rugby player fail an arthroscopic Bankart repair — the question is whether you could have predicted it beforehand.
The ISIS gives you a structured answer. Calculate it from three inputs available in any clinic visit: history (age, sport level, sport type), physical exam (hyperlaxity testing), and a plain AP radiograph in external rotation (Hill-Sachs location, glenoid contour).
When the ISIS score is above 6, the data support offering Latarjet as the primary procedure rather than attempting arthroscopic repair. When it is 3 or below, arthroscopic Bankart repair carries only a 5% recurrence rate and is the appropriate choice.
One nuance the authors flag: patients who downgraded their sport before surgery due to pain or instability may score lower than their true risk warrants. Ask specifically about pre-injury sport level, not current activity.