Objectives: The Pittsburgh Instability Tool (PIT) is a previously developed risk assessment tool that considers significant prognostic factors for recurrent shoulder instability following primary arthroscopic Bankart repair (ABR) and evaluate the role of remplissage augmentation (ABR+R) for on-track shoulders based on a patient’s risk profile, Table 1 (Charles et al. Arthroscopy 2025). The objective of this study was to evaluate if the PIT score could predict the short-term failure rates following primary ABR or ABR+R for patients with on-track Hill-Sachs lesions. Methods: This was a retrospective review of all patients aged 14-40 who underwent either primary ABR or ABR+R procedures between 2021 and 2023 for anterior glenohumeral instability at a single academic institution. Demographics, clinical history, physical exam, imaging, operative details, and postoperative course were reviewed. Failure of primary surgery was defined as either recurrent postoperative shoulder instability or return to the operating room for a subsequent procedure or revision surgery. Recurrent postoperative shoulder instability was defined as recurrent dislocation and/or subjective subluxation after the primary procedure. Patients were excluded if the indexed surgery was a revision procedure, an “off-track” shoulder, lack of follow-up data, or glenoid bone loss (GBL) >20%. Near-track lesions (Near track = 0mm < DTD < 10mm, Distance to Dislocation (DTD) = Glenoid Track – Hill Sachs Interval), hyperlaxity, younger age, and greater than 1 preoperative recurrent instability episode were utilized as variables in the PIT scoring tool. Patients were stratified into risk subgroups, including Low-risk (0 – 3), Moderate-risk (4 – 8), High-risk (9 – 13), Extreme-risk (14+), to highlight differences between patient risk categories and the potential benefit of moving into a lower-risk category with the addition of remplissage ( Figure 1 ). Results: One-hundred-and-twenty patients were included for analysis (ABR:81 | ABR+R:39) with an average age of 22.6±6.4 years and an average follow-up of 1.1 years. 18 patients (15.0%) experienced recurrent instability (ABR: 16 | ABR+R: 2, p = 0.036) while 12 patients (10.0%) underwent subsequent surgery (ABR: 12 | ABR+R: 0, p = 0.011). Logistic regression analysis showed that the PIT score predicted failure after arthroscopic stabilization surgery (OR: 1.09, 95% CI: 1.005-1.20, p = 0.037). The PIT score demonstrated fair predictive ability with an area under the ROC curve (AUC) of 0.6401 (95% CI: 0.50201- 0.77813, Figure 2 ). In this cohort, a PIT score greater than or equal to 11 was identified as an optimal threshold to predict failure, yielding a sensitivity of 89% and specificity of 66%. Conclusions: The PIT score was significantly associated with failure risk, and a PIT score greater than 11 was associated with a greater risk of failure, suggesting the potential value for guiding clinical decision-making. This score may be particularly helpful in evaluating higher-risk patients, especially when considering the need for remplissage augmentation. Further validation in larger, prospective cohorts with longer follow-up is warranted to refine the tool’s clinical utility and predictive accuracy.
Lin et al. (Fri,) studied this question.