Reliability of the ISAKOS Modification to Subclassify Rockwood Type III Acromioclavicular Joint Injuries.

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Abstract

Conflict of interest statement: The authors declared that there are no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto. 13. Knee Surg Sports Traumatol Arthrosc. 2016 Jul;24(7):2192-6. doi: 10.1007/s00167-014-3436-0. Epub 2014 Nov 16. Inter- and intraobserver reliability of the Rockwood classification in acute acromioclavicular joint dislocations. Schneider MM(1)(2), Balke M(3), Koenen P(4), Fröhlich M(4), Wafaisade A(4), Bouillon B(4), Banerjee M(4). Author information: (1)Department of Orthopaedic Surgery, Traumatology and Sports Medicine, Cologne Merheim Medical Center (CMMC), University of Witten/Herdecke, Ostmerheimer Str. 200, 51109, Cologne, Germany. marco.schneider@orthopia.com. (2)Orthopaedic Surgery, Schulthess Clinic, Zurich, Switzerland. marco.schneider@orthopia.com. (3)Sportsclinic Cologne - Practice for Sportstraumatology, Cologne Merheim Medical Center (CMMC), Witten/Herdecke University, Ostmerheimer Str. 200, 51109, Cologne, Germany. (4)Department of Orthopaedic Surgery, Traumatology and Sports Medicine, Cologne Merheim Medical Center (CMMC), University of Witten/Herdecke, Ostmerheimer Str. 200, 51109, Cologne, Germany. PURPOSE: The reliability of the Rockwood classification, the gold standard for acute acromioclavicular (AC) joint separations, has not yet been tested. The purpose of this study was to investigate the reliability of visual and measured AC joint lesion grades according to the Rockwood classification. METHODS: Four investigators (two shoulder specialists and two second-year residents) examined radiographs (bilateral panoramic stress and axial views) in 58 patients and graded the injury according to the Rockwood classification using the following sequence: (1) visual classification of the AC joint lesion, (2) digital measurement of the coracoclavicular distance (CCD) and the horizontal dislocation (HD) with Osirix Dicom Viewer (Pixmeo, Switzerland), (3) classification of the AC joint lesion according to the measurements and (4) repetition of (1) and (2) after repeated anonymization by an independent physician. Visual and measured Rockwood grades as well as the CCD and HD of every patient were documented, and a CC index was calculated (CCD injured/CCD healthy). All records were then used to evaluate intra- and interobserver reliability. RESULTS: The disagreement between visual and measured diagnosis ranged from 6.9 to 27.6 %. Interobserver reliability for visual diagnosis was good (0.72-0.74) and excellent (0.85-0.93) for measured Rockwood grades. Intraobserver reliability was good to excellent (0.67-0.93) for visual diagnosis and excellent for measured diagnosis (0.90-0.97). The correlations between measurements of the axial view varied from 0.68 to 0.98 (good to excellent) for interobserver reliability and from 0.90 to 0.97 (excellent) for intraobserver reliability. CONCLUSION: Bilateral panoramic stress and axial radiographs are reliable examinations for grading AC joint injuries according to Rockwood's classification. Clinicians of all experience levels can precisely classify AC joint lesions according to the Rockwood classification. We recommend to grade acute ACG lesions by performing a digital measurement instead of a sole visual diagnosis because of the higher intra- and interobserver reliability. LEVEL OF EVIDENCE: Case series, Level IV. DOI: 10.1007/s00167-014-3436-0