Individual risk factors for failure after arthroscopic Bankart repair within the Instability severity Index Score (ISIS) and Glenoid Track Instability Management Score (GTIMS) frameworks: A systematic review and meta-analysis.

Abstract

Recurrent anterior shoulder instability after arthroscopic Bankart repair remains a relevant clinical challenge, with reported failure rates up to 30% at long-term follow-up. Several risk stratification tools, particularly the Instability Severity Index Score (ISIS) and the Glenoid Track Instability Management Score (GTIMS), have been widely adopted in clinical practice; however, the independent contribution of their individual prognostic factors has not been comprehensively evaluated using contemporary evidence. To systematically assess and quantify the associations between individual prognostic factors included within the ISIS and GTIMS frameworks and recurrence after arthroscopic Bankart repair. A systematic search of MEDLINE, Embase, LILACS, and Epistemonikos was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and meta-analysis of observational studies in epidemiologyguidelines. Observational analytical studies evaluating prognostic factors for failure after arthroscopic Bankart repair were included, with a specific focus on variables incorporated into the ISIS and GTIMS frameworks, which are commonly used to guide clinical decision-making. Data extraction followed Checklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies - Prognostic Factors recommendations and risk of bias was assessed using the Quality in Prognostic Studies tool . Meta-analyses using Mantel-Haenszel methods were conducted, reporting pooled odds ratios (ORs) with 95% confidence intervals (CIs). Twenty-nine studies involving 11,038 patients were included, with a pooled recurrence rate of 13.34% (1471 failures). Among the individual components incorporated into the ISIS and GTIMS frameworks, the factors most consistently and strongly associated with recurrence were age <20 years (odds ratio [OR]: 2.14; 95% CI: 1.23-3.39, p < 0.001), participation in competitive sports (OR: 2.73; CI: 95% 1.11-6.73, p: 0.002), contact sports (OR: 1.65; 95% CI: 1.14-2.83, p: 0.007), presence of Hill-Sachs lesions on radiographs (OR: 2.63; 95% CI: 1.66-4.16, p < 0.001), and off-track lesions (OR: 4.35; 95% CI: 2.18-8.69, p < 0.001). Hyperlaxity showed a non-significant association (OR: 1.76; 95% CI: 0.98-5.21), with substantial heterogeneity across studies. Radiographic glenoid bone loss did not reach statistical significance (OR: 2.97; 95% CI: 0.96-9.25). Overall methodological quality of the included studies was moderate, with recurrent concerns related to prognostic factor measurements, outcome definition, and adjustment for confounding. Recurrence after arthroscopic Bankart repair is influenced by multiple interacting factors. Among the individual components incorporated into the ISIS and GTIMS frameworks, age <20 years, competitive and contact sports, presence of radiographic Hill-Sachs lesions, and off-track status showed the most consistent and strongest associations with failure. These findings support a nuanced interpretation of existing instability scores, in which patient age, sports exposure, and bone loss characteristics are integrated into preoperative decision-making, rather than reliance on rigid score cutoffs alone. Level III-Systematic review of prognostic cohort and case-control studies.