{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,15]],"date-time":"2026-03-15T19:47:25Z","timestamp":1773604045723,"version":"3.50.1"},"reference-count":22,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2021,5,27]],"date-time":"2021-05-27T00:00:00Z","timestamp":1622073600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2021,5,27]],"date-time":"2021-05-27T00:00:00Z","timestamp":1622073600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"},{"start":{"date-parts":[[2021,5,27]],"date-time":"2021-05-27T00:00:00Z","timestamp":1622073600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2021,5,27]],"date-time":"2021-05-27T00:00:00Z","timestamp":1622073600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2022,12,28]],"date-time":"2022-12-28T00:00:00Z","timestamp":1672185600000},"content-version":"am","delay-in-days":580,"URL":"http:\/\/www.elsevier.com\/open-access\/userlicense\/1.0\/"}],"funder":[{"DOI":"10.13039\/100000069","name":"National Institute of Arthritis and Musculoskeletal and Skin Diseases","doi-asserted-by":"publisher","award":["T32AR56950"],"award-info":[{"award-number":["T32AR56950"]}],"id":[{"id":"10.13039\/100000069","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["arthroscopyjournal.org","clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Arthroscopy"],"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To evaluate the effect of the Nonoperative Instability Severity Index Score (NISIS) criteria on an established US\u2010geographic population\u2010based cohort of patients with anterior shoulder instability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>An established geographically based medical record system was used to identify patients &lt;40 years of age with anterior shoulder instability between 1994 and 2016. Medical records were reviewed to obtain patient demographics and instability characteristics. Patient\u2010specific risk factors were individually incorporated into the 10\u2010point NISIS criteria: age (&gt;15 years), bone loss, type of instability (dislocation vs subluxation), type of sport (collision vs noncollision), male sex, and dominant arm involvement. High risk was considered a score of \u22657 points and low risk as &lt;7 points. Failure was defined as either progression to surgery or recurrent instability diagnosed by a consulting physician at any point after initial consultation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The study population consisted of 405 patients with a mean follow\u2010up time of 9.6 \u00b1 5.9 years. Failure was defined as recurrent instability or progression to surgery, and the overall failure rate was 52.8% (214\/405). The rate of\u00a0recurrent instability after initial consultation was 34.6% (140\/405), and the rate of conversion to surgery was 37.8% (153\/405). A total of 264 (65.2%) patients were considered low risk (NISIS &lt; 7), and 141 (34.8%) patients were considered high risk (NISIS \u2265 7). Patients in the high\u2010risk group were more likely to fail nonoperative management than those in the low\u2010risk group (60.3% vs 48.9%;\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0= .028).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The NISIS has been proposed as a potentially useful tool in clinical decision\u2010making regarding the appropriate use of nonoperative treatment in scholastic athletes. When applied to an established US\u2010geographic population\u2010based cohort consisting of competitive and recreational athletes under the age of 40 with longer\u2010term follow\u2010up, the NISIS high\u2010risk cutoff was able to predict overall failure with 60.3% accuracy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>III, retrospective observation trial<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1016\/j.arthro.2021.05.021","type":"journal-article","created":{"date-parts":[[2021,5,27]],"date-time":"2021-05-27T13:01:09Z","timestamp":1622120469000},"page":"22-27","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":5,"title":["The Nonoperative Instability Severity Index Score: Is It Predictive in a Larger Shoulder Instability Population at Long\u2010Term Follow\u2010Up?"],"prefix":"10.1002","volume":"38","author":[{"given":"Erick M.","family":"Marigi","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery Mayo Clinic Rochester Minnesota U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryan R.","family":"Wilbur","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery Mayo Clinic Rochester Minnesota U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bryant M.","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery Mayo Clinic Rochester Minnesota U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aaron J.","family":"Krych","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery Mayo Clinic Rochester Minnesota U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kelechi R.","family":"Okoroha","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery Mayo Clinic Rochester Minnesota U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher L.","family":"Camp","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery Mayo Clinic Rochester Minnesota U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,5,27]]},"reference":[{"key":"e_1_2_6_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2008.12.007"},{"key":"e_1_2_6_3_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.H.00514"},{"key":"e_1_2_6_4_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546518755752"},{"key":"e_1_2_6_5_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546513510391"},{"key":"e_1_2_6_6_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-016112"},{"key":"e_1_2_6_7_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.I.00450"},{"key":"e_1_2_6_8_2","doi-asserted-by":"publisher","DOI":"10.1177\/1941738116672161"},{"key":"e_1_2_6_9_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546514551149"},{"key":"e_1_2_6_10_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546519886861"},{"key":"e_1_2_6_11_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.89B11.18962"},{"key":"e_1_2_6_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0030-5898(20)31477-2"},{"key":"e_1_2_6_13_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-198769030-00011"},{"key":"e_1_2_6_14_2","first-page":"104","article-title":"Traumatic first time shoulder dislocation: Surgery vs non\u2010operative treatment","volume":"4","author":"Polyzois I.","year":"2016","journal-title":"Arch Bone Jt 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