Glenoid track and shoulder instability scoring system

Please see the article from 2022 as a prelude to this one: CLICK HERE

The ISIS score (instability severity index score – Balg and Boileau), rates patients on a 10-point scale based on preoperative risk factors to identify those who are at high risk for recurrent instability after an arthroscopic Bankart repair. If you score more than 6 it is felt that the failure rate of arthroscopic surgery is unacceptably high at about 70%. The authors of the study only proposed one other solution which was a Laterjet procedure.

A key question remains whether the Latarjet technique can reliably convert all off-track Hill-Sachs lesions into on-track lesions. A Hill-Sachs interval that is >7.45 mm wider than the glenoid track has been identified as a risk factor for residual postoperative off-track lesions.

The Glenoid Track Instability Management (GTIM) score has been introduced as a tool to guide the selection of treatment but includes other treatment options such as an open Bankart repair or capsular shift rather than only doing a Laterjet procedure (if you decide not to do an arthroscopic one). This scoring system integrates multiple risk factors, such as the patient’s age at the time of surgery, the type and intensity of sport participation, and shoulder hyperlaxity, alongside the glenoid track concept.

The most important finding of the GTIMS study is that incorporating the glenoid track concept into the proposed GTIM score results in a significantly more conservative treatment algorithm than when using ISIS alone. ISIS relies on plain xrays  but in GTIMS, glenohumeral bone loss is evaluated with CT which is more accurate.

When using GTIMS,  fewer Latarjets, and more arthroscopic Bankart were performed than if the patients had been treated according to ISIS alone. Recently in the Journal of Isakos the algorithm shown below was proposed which is comprehensive and offers more than just the option of arthroscopy versus Laterjet and seems likely to stand the test of time.