Skip to main content
SpringerLink
Log in

The Hill–Sachs interval to glenoid track width ratio is comparable to the instability severity index score for predicting risk of recurrent instability after arthroscopic Bankart repair

  • SHOULDER
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study was to clinically validate the Hill–Sachs interval to glenoid track width ratio (H/G ratio) compared with the instability severity index (ISI) score for predicting an increased risk of recurrent instability after arthroscopic Bankart repair.

Methods

A retrospective evaluation was performed using data from patients with anteroinferior shoulder instability who underwent arthroscopic Bankart repair with a follow-up period of at least 24 months. A receiver operating characteristic (ROC) curve was used to determine the optimal cut-off values for the H/G ratio and the ISI score to predict an increased risk of recurrent instability. The area under the ROC curve (AUC) of the two methods and the sensitivity and specificity of their optimal cut-off values were compared.

Results

A total of 222 patients were included, among whom 31 (14.0%) experienced recurrent instability during the follow-up period. The optimal cut-off values for predicting an increased risk of recurrent instability were an H/G ratio of ≥ 0.7 and ISI score of ≥ 4. There were no significant differences between the AUC of the two methods (H/G ratio AUC = 0.821, standard error = 0.035 and ISI score AUC = 0.792, standard error = 0.04; n.s.) nor between the sensitivity and specificity of the optimal cut-off values (n.s. and n.s., respectively).

Conclusions

The H/G ratio is comparable to the ISI score for predicting an increased risk of recurrent instability after arthroscopic Bankart repair. Surgeons are recommended to consider other strategies to treat anterior shoulder instability if H/G ratio is ≥ 0.7.

Level of evidence

III.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Ahmed I, Ashton F, Robinson CM (2012) Arthroscopic Bankart repair and capsular shift for recurrent anterior shoulder instability: functional outcomes and identification of risk factors for recurrence. J Bone Joint Surg Am 94:1308–1315

    Article  Google Scholar 

  2. Balg F, Boileau P (2007) The instability severity index score. A simple pre-operative score to select patients for arthroscopic or open shoulder stabilisation. J Bone Joint Surg Br 89:1470–1477

    Article  CAS  Google Scholar 

  3. Boileau P, Villalba M, Hery JY, Balg F, Ahrens P, Neyton L (2006) Risk factors for recurrence of shoulder instability after arthroscopic Bankart repair. J Bone Joint Surg Am 88:1755–1763

    Article  Google Scholar 

  4. Boughebri O, Maqdes A, Moraiti C, Dib C, Leclere FM, Valenti P (2015) Results of 45 arthroscopic Bankart procedures: Does the ISIS remain a reliable prognostic assessment after 5 years? Eur J Orthop Surg Traumatol 25:709–716

    Article  Google Scholar 

  5. Burkhart SS, De Beer JF (2000) Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs: significance of the inverted-pear glenoid and the humeral engaging Hill-Sachs lesion. Arthroscopy 16:677–694

    Article  CAS  Google Scholar 

  6. Chung SW, Han SS, Lee JW, Oh KS, Kim NR, Yoon JP et al (2018) Automated detection and classification of the proximal humerus fracture by using deep learning algorithm. Acta Orthop 89:468–473

    Article  Google Scholar 

  7. Di Giacomo G, Peebles LA, Pugliese M, Dekker TJ, Golijanin P, Sanchez A et al (2020) Glenoid track instability management score: radiographic modification of the instability severity index score. Arthroscopy 36:56–67

    Article  Google Scholar 

  8. Di Giacomo G, Piscitelli L, Pugliese M (2018) The role of bone in glenohumeral stability. EFORT Open Rev 3:632–640

    Article  Google Scholar 

  9. Faul F, Erdfelder E, Lang AG, Buchner A (2007) G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 39:175–191

    Article  Google Scholar 

  10. Gagey OJ, Gagey N (2001) The hyperabduction test. J Bone Joint Surg Br 83:69–74

    Article  CAS  Google Scholar 

  11. Gyftopoulos S, Beltran LS, Bookman J, Rokito A (2015) MRI evaluation of bipolar bone loss using the on-track off-track method: a feasibility study. AJR Am J Roentgenol 205:848–852

    Article  Google Scholar 

  12. Hatta T, Yamamoto N, Shinagawa K, Kawakami J, Itoi E (2019) Surgical decision making based on the on-track/off-track concept for anterior shoulder instability: a case-control study. JSES Open Access 3:25–28

    Article  Google Scholar 

  13. Lee SH, Lim KH, Kim JW (2018) Risk factors for recurrence of anterior-inferior instability of the shoulder after arthroscopic bankart repair in patients younger than 30 years. Arthroscopy 34:2530–2536

    Article  Google Scholar 

  14. Locher J, Wilken F, Beitzel K, Buchmann S, Longo UG, Denaro V et al (2016) Hill-Sachs off-track lesions as risk factor for recurrence of instability after arthroscopic bankart repair. Arthroscopy 32:1993–1999

    Article  Google Scholar 

  15. Loppini M, Delle Rose G, Borroni M, Morenghi E, Pitino D, Dominguez Zamora C et al (2019) Is the instability severity index score a valid tool for predicting failure after primary arthroscopic stabilization for anterior glenohumeral instability? Arthroscopy 35:361–366

    Article  Google Scholar 

  16. Mandrekar JN (2010) Receiver operating characteristic curve in diagnostic test assessment. J Thorac Oncol 5:1315–1316

    Article  Google Scholar 

  17. Marshall T, Vega J, Siqueira M, Cagle R, Gelber JD, Saluan P (2017) Outcomes after arthroscopic bankart repair: patients with first-time versus recurrent dislocations. Am J Sports Med 45:1776–1782

    Article  Google Scholar 

  18. Momaya AM, Tokish JM (2017) Applying the glenoid track concept in the management of patients with anterior shoulder instability. Curr Rev Musculoskelet Med 10:463–468

    Article  Google Scholar 

  19. Ono Y, Davalos Herrera DA, Woodmass JM, Lemmex DB, Carroll MJ, Yamashita S et al (2019) Long-term outcomes following isolated arthroscopic Bankart repair: a 9- to 12-year follow-up. JSES Open Access 3:189–193

    Article  Google Scholar 

  20. Phadnis J, Arnold C, Elmorsy A, Flannery M (2015) Utility of the instability severity index score in predicting failure after arthroscopic anterior stabilization of the shoulder. Am J Sports Med 43:1983–1988

    Article  Google Scholar 

  21. Porcellini G, Campi F, Pegreffi F, Castagna A, Paladini P (2009) Predisposing factors for recurrent shoulder dislocation after arthroscopic treatment. J Bone Joint Surg Am 91:2537–2542

    Article  Google Scholar 

  22. Rouleau DM, Hebert-Davies J, Djahangiri A, Godbout V, Pelet S, Balg F (2013) Validation of the instability shoulder index score in a multicenter reliability study in 114 consecutive cases. Am J Sports Med 41:278–282

    Article  Google Scholar 

  23. Ruiz Iban MA, Asenjo Gismero CV, Moros Marco S, Ruiz Diaz R, Del Olmo HT, Del Monte BG et al (2019) Instability severity index score values below 7 do not predict recurrence after arthroscopic Bankart repair. Knee Surg Sports Traumatol Arthrosc 27:3905–3911

    Article  Google Scholar 

  24. Shaha JS, Cook JB, Rowles DJ, Bottoni CR, Shaha SH, Tokish JM (2016) Clinical validation of the glenoid track concept in anterior glenohumeral instability. J Bone Joint Surg Am 98:1918–1923

    Article  Google Scholar 

  25. Shanmugaraj A, Chai D, Sarraj M, Gohal C, Horner NS, Simunovic N et al (2020) Surgical stabilization of pediatric anterior shoulder instability yields high recurrence rates: a systematic review. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-020-05913-w

    Article  PubMed  Google Scholar 

  26. Thomazeau H, Courage O, Barth J, Pelegri C, Charousset C, Lespagnol F et al (2010) Can we improve the indication for Bankart arthroscopic repair? A preliminary clinical study using the ISIS score. Orthop Traumatol Surg Res 96:S77–83

    Article  CAS  Google Scholar 

  27. Thomazeau H, Langlais T, Hardy A, Curado J, Herisson O, Mouton J et al (2019) Long-term, prospective, multicenter study of isolated bankart repair for a patient selection method Based on the instability severity index score. Am J Sports Med 47:1057–1061

    Article  Google Scholar 

  28. van der Linde JA, van Kampen DA, Terwee CB, Dijksman LM, Kleinjan G, Willems WJ (2011) Long-term results after arthroscopic shoulder stabilization using suture anchors: an 8- to 10-year follow-up. Am J Sports Med 39:2396–2403

    Article  Google Scholar 

  29. van Gastel ML, Willigenburg NW, Dijksman LM, Lindeboom R, van den Bekerom MPJ, van der Hulst VPM et al (2019) Ten percent re-dislocation rate 13 years after the arthroscopic Bankart procedure. Knee Surg Sports Traumatol Arthrosc 27:3929–3936

    Article  Google Scholar 

  30. Voos JE, Livermore RW, Feeley BT, Altchek DW, Williams RJ, Warren RF et al (2010) Prospective evaluation of arthroscopic bankart repairs for anterior instability. Am J Sports Med 38:302–307

    Article  Google Scholar 

  31. Yamamoto N, Itoi E, Abe H, Minagawa H, Seki N, Shimada Y et al (2007) Contact between the glenoid and the humeral head in abduction, external rotation, and horizontal extension: a new concept of glenoid track. J Shoulder Elbow Surg 16:649–656

    Article  Google Scholar 

  32. Yang TC, Chen KH, Chiang ER, Chang MC, Ma HL (2018) Using the "Hill–Sachs interval to glenoid track width ratio" for prediction of recurrent instability after arthroscopic Bankart repair. Orthop Traumatol Surg Res 104:797–801

    Article  Google Scholar 

  33. Yian EH, Weathers M, Knott JR, Sodl JF, Spencer HT (2020) Predicting failure after primary arthroscopic Bankart repair: analysis of a statistical model using anatomic risk factors. Arthroscopy. https://doi.org/10.1016/j.arthro.2019.11.109

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The author thanks the Biostatistics Task Force of Taipei Veterans General Hospital for their assistance with the statistical analysis.

Funding

No external funding was received.

Author information

Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan

    Kun-Hui Chen, Tzu-Cheng Yang, En-Rung Chiang & Hsiao-Li Ma

  2. Department of Anaesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan

    Hsin-Yi Wang

  3. Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan

    Kun-Hui Chen, Tzu-Cheng Yang, En-Rung Chiang, Hsin-Yi Wang & Hsiao-Li Ma

  4. Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan

    Kun-Hui Chen

Authors
  1. Kun-Hui Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tzu-Cheng Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. En-Rung Chiang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hsin-Yi Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hsiao-Li Ma
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hsiao-Li Ma.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest regarding the issues presented in this article.

Ethical approval

The study was approved by the local Ethics committee (number: 2017-01-017AC).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chen, KH., Yang, TC., Chiang, ER. et al. The Hill–Sachs interval to glenoid track width ratio is comparable to the instability severity index score for predicting risk of recurrent instability after arthroscopic Bankart repair. Knee Surg Sports Traumatol Arthrosc 29, 250–256 (2021). https://doi.org/10.1007/s00167-020-05955-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-020-05955-0

Keywords

Search

Navigation