Nonoperative instability severity index score identified to predict shoulder failure in high school athletes

NEW ORLEANS — Use of the nonoperative instability severity index showed high school athletes with anterior shoulder instability and specific factors were more likely to experience successful outcomes with nonoperative treatment, according to results presented at the American Academy of Orthopaedic Surgeons Annual Meeting.

John M. Tokish, MD, and colleagues used the nonoperative instability severity index score (NISIS) to determine the optimal score that predicted failure in nonoperative management among 57 scholastic athletes.

John M. Tokish

“We also defined success fairly critically,” Tokish said in his presentation. “We said that in order to be classified as successful, you had to return and complete the entire season subsequently without surgery or any time lost, either practice or game, due to an injury to the index shoulder.”

Tokish noted age older than 15 years, bone loss, type of instability, participation in collision sports, male gender and arm dominance led to a greater risk of recurrent shoulder instability after nonoperative treatment. Investigators placed these risk factors into the NISIS.

Results showed 79% of athletes had successful nonoperative treatment. Tokish said 97% of patients with a NISIS score of less than seven completed a subsequent season without loss of time.

“If your NISIS score, however, was greater than or equal to seven, you had a 40% failure rate,” Tokish said.

He noted a 12.2-times higher risk for failure among athletes with a high NISIS score vs. athletes with a low NISIS score. Among athletes with a high NISIS score, 60% had successful return to sport, according to Tokish, who noted the major risk factor was bone loss.

“In patients who had no bone loss or unipolar bone loss, they were able to return even with a high NISIS score,” Tokish said. “But if those patients had bipolar bone loss, 67% failed.” – by Casey Tingle

Reference:

Tokish JM, et al. Paper #696. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 6-10, 2018; New Orleans

Disclosure: Tokish reports he is a paid consultant for Arthrex Inc., DePuy and Mitek; is a paid presenter or speaker for Arthrex Inc.; is a board or committee member for the Arthroscopy Association of North American; and is on the editorial or governing board for the Journal of Shoulder and Elbow Surgery and Orthopedics Today.