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Researchers caution using instability score as surgical management guide
Researchers have called into question whether the radiographic portion of the Instability Severity Index Score is useful as a decision-making tool for electing patients to surgery for recurrent shoulder instability, according to this study.
“In the present study, intra- and inter-rater reliability of the radiographic portion of the ISIS demonstrated limited kappa and accuracy,” Martin J. Bouliane, MD, FRCS(C), and colleagues stated in the abstract. “We suggest that the ISIS should be used with caution as a guide for surgical management.”
Using the score, Bouliane and colleagues evaluated radiographs of 49 patients for Hills-Sachs lesions or loss of glenoid contour in a blind study. The radiographs were randomly evaluated twice in two sessions, according to the abstract.
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Regarding Hills-Sachs lesions, the intra-rater agreement ranged from 71% to 94%, and 85% to 94% for glenoid lesions. Kappa values for intra-rater ranged from 0.41 and 0.86 for Hills-Sachs lesions and 0.56 to 0.74 for glenoid lesions, according to the abstract.
Bouliane and colleagues found the inter-rater agreement range for Hills-Sachs lesions was 78% to 90% for glenoid lesions and 63% to 78% for Hills-Sachs lesions, according to the abstract. Accuracy for Hills-Sachs lesions was low, ranging from 29% to 57%, while glenoid lesions ranged from 65% to 73%.