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Related Experiment Video

Updated: Jul 8, 2026

Rat Model of Adhesive Capsulitis of the Shoulder
04:46

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Published on: September 28, 2018

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Approach to shoulder instability: a randomized, controlled trial.

Julien Caron1, Kellen Walsh1, Tinghua Zhang2

  • 1Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.

JSES International
|February 3, 2025
PubMed
Summary

The Instability Severity Index Score (ISI score) and conventional treatment algorithms show similar shoulder instability outcomes after 24 months. Neither approach demonstrated superior results in functional scores or recurrence rates for shoulder stabilization surgery.

Keywords:
Arthroscopic BankartLatarjetRandomized controlled trialShoulder instabilityShoulder jointTreatment algorithm

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Area of Science:

  • Orthopedic Surgery
  • Sports Medicine
  • Shoulder Instability Research

Background:

  • Recurrent shoulder instability after arthroscopic stabilization necessitates evidence-based treatment strategies.
  • The Instability Severity Index Score (ISI score) is a proposed algorithm to guide treatment selection.
  • Validation of the ISI score against conventional treatment algorithms (CTA) is lacking.

Purpose of the Study:

  • To compare the efficacy of the ISI score algorithm versus a CTA for shoulder instability treatment.
  • To evaluate functional outcomes and recurrence rates between the two treatment algorithms.

Main Methods:

  • A prospective, randomized controlled trial comparing ISI score and CTA.
  • Patients were randomized, with treatment guided by ISI score (>3 Latarjet; ≤3 Bankart repair) or CTA (>25% glenoid bone loss Latarjet).
  • Primary outcome: Western Ontario Shoulder Instability Index; Secondary outcomes: ASES score, apprehension, redislocation, revision rates over 24 months.

Main Results:

  • No significant differences in Western Ontario Shoulder Instability Index scores at 24 months (ISI: 84.1 vs. CTA: 85.7, P=.70).
  • Similar American Shoulder and Elbow Surgeons (ASES) scores (ISI: 93.2 vs. CTA: 92.6, P=.89) and apprehension rates (ISI: 18.5% vs. CTA: 20%, P=1.00).
  • Redislocation rates (ISI: 1 vs. CTA: 0, P=.48) and revision surgeries (ISI: 2 vs. CTA: 2) were comparable between groups.

Conclusions:

  • The ISI score and CTA demonstrated similar functional outcomes at 24-month follow-up.
  • No significant differences were observed in apprehension, redislocation, or revision rates between the two algorithms.
  • Current evidence does not support one algorithm over the other for shoulder instability treatment.