Reliability of the ISAKOS Modification to Subclassify Rockwood Type III Acromioclavicular Joint Injuries (original) (raw)
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Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2014
and the Upper Extremity Committee of ISAKOS Optimal treatment for the unstable acromioclavicular (AC) joint remains a highly debated topic in the field of orthopaedic medicine. In particular, no consensus exists regarding treatment of grade III injuries, which are classified according to the Rockwood classification by disruption of both the coracoclavicular and AC ligaments. The ISAKOS Upper Extremity Committee has provided a more specific classification of shoulder pathologies to enhance the knowledge on and clinical approach to these injuries. We suggest the addition of grade IIIA and grade IIIB injuries to a modified Rockwood classification. Grade IIIA injuries would be defined by a stable AC joint without overriding of the clavicle on the cross-body adduction view and without significant scapular dysfunction. The unstable grade IIIB injury would be further defined by therapy-resistant scapular dysfunction and an overriding clavicle on the cross-body adduction view.
The Rockwood classification in acute acromioclavicular joint injury does not correlate with symptoms
Journal of orthopaedic surgery (Hong Kong)
Rockwood classified acromioclavicular (AC) joint injuries by displacement of the joint on radiographs. This classification has driven the management dogma of acute AC dislocation. The correlation between Rockwood grade and symptoms has not been described in acute injury. This study assesses that relationship. This series included 77 patients with acute AC joint injury (<6 weeks), treated between 2006 and 2015. Objective and patient-reported measures enabled correlation between clinical measures and Rockwood grade. The mean age was 32 years (±11.86; range 17-59 years); 88% were male. Forty-four per cent were professional athletes and 43% suffered injury during rugby. The mean time from injury to presentation was 2 weeks (±1.64; range 0-5 weeks). There was poor correlation between Rockwood classification and pain (visual analogue scale) ( r = 0.05; p = 0.752). Poor correlation was noted between Rockwood grade and functional deficit (elevation ( r = 0.18; p = 0.275), abduction ( r =...
Journal of Shoulder and Elbow Surgery, 2020
Background: Accurate classification and subsequent management of acromioclavicular (AC) joint injuries remains a contentious topic. The updated Rockwood classification acknowledges ''stable IIIA'' and ''unstable IIIB'' injuries, a watershed accepted by ISA-KOS and important in guiding clinical management. Traditionally, the coracoclavicular distance is used to classify these injuries, despite well-documented limitations. This study aimed to evaluate displacement in AC joint injuries by measuring both coracoclavicular (CC) distance and the newly proposed acromial center line to dorsal clavicle (AC-DC) distance, in a cohort of patients, and correlate the results between the 2 measurements and relationship to Rockwood grade. Materials and Methods: Ninety consecutive cases of AC joint injury were evaluated radiographically for Rockwood classification, CC distance on anteroposterior radiographs, and AC-DC distance on Alexander view radiographs. Inter-and intraobserver reliability for each measurement was calculated as well as correlation between the 2 measurement types and the degree to which each measurement accurately represented the Rockwood classification. Results: Although both CC and AC-DC measurements showed very high inter-and intraobserver reliability, the CC distance systematically underestimated the degree of AC joint displacement when compared with the AC-DC measurement as the severity of injury increased, particularly in the presence of posterior horizontal displacement such as that seen in Rockwood IV injuries. Conclusion: The AC-DC measurement and use of the Alexander view provides the clinician with a more realistic appreciation of true AC joint displacement, especially in defining watershed cases (ie, IIIA/IIB/IV) and may better inform the decision-making process regarding management options and recommendations.
Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2018
To define the prevalence of associated articular injuries in patients with severe (Rockwood's III-VI) acute acromioclavicular joint injuries and to find out how many of these were associated with the traumatic event and required surgical treatment. Retrospective observational multicentric study performed in ten centres included patients who required surgery for acute acromioclavicular joint injuries between 2010 and 2017. The inclusion criteria were: presence of an acute acromioclavicular joint injury (grades III-IV-V-VI) and surgical treatment within 3 weeks of injury that included a full arthroscopic evaluation of the shoulder. Basic epidemiological data, severity of the original injury, prelesional sport level and prelesional work site requirements were recorded. The presence of intraarticular glenohumeral lesions and information of their characteristics, treatment, and whether each lesion was considered acute or pre-existing was also recorded. Two-hundred one subjects [mean ...
2019
Acromioclavicular joint (ACJ) injuries are relatively common, encompassing 3.2% of all shoulder girdle injuries. High grade (Type IV-VI) dislocation of the ACJ requires tear of both the coracoclavicular ligaments and acromioclavicular ligaments plus ACJ capsule and deltotrapezial fascia simultaneously. Surgery is the mainstay of treatment for high grade ACJ disruptions. High grade injuries are stabilized surgically via an open approach, arthroscopically, or a combination of both. The incidence of associated intraarticular lesions encountered during arthroscopic assisted ACJ stabilization has been reported to range from 43% to 53% in recent literature. In our study, more than half (65.9%) of our patients had an associated intraarticular injury. Of these, 74% required additional debridement or reconstructive surgery. We highly recommend the use of arthroscopic assisted ACJ stabilization to accurately diagnose and treat associated intraarticular lesions.
BMC musculoskeletal disorders, 2017
The management of acute acromioclavicular (AC) joint injuries depends on the degree of injury diagnosed by the Rockwood classification. Inadequate imaging and not selecting the most helpful imaging protocols can often lead to incorrect diagnosis of the injury. A consensus on a diagnostic imaging protocol for acute AC joint injuries does not currently exist. Therefore we conducted a systematic review of the literature considering three diagnostic parameters for patients with acromioclavicular (AC) joint injuries: 1) Assessment of vertical instability; 2) Assessment of horizontal instability; 3) Benefit of weighted panoramic views. Internet databases were searched in March 2016 using the terms ("AC joint" OR "acromioclavicular joint") AND (MRI OR MR OR radiograph OR X-ray OR Xray OR ultrasound OR "computer tomography" OR "computed tomography" OR CT). Diagnostic, prospective, retrospective, cohort and cross- sectional studies were included to com...
What Outcome Measures Are Reported in the Management of Acromioclavicular Joint Injuries?
Orthopaedic Journal of Sports Medicine, 2020
Background: Lack of uniformity in reported outcomes makes comparisons between acromioclavicular joint (ACJ) injury studies challenging. Knowledge of common outcome measures and standardization will help orthopaedic surgeons report and compare outcomes more consistently. Purpose: To identify the most commonly reported outcome measures for ACJ injuries. Study Design: Systematic review. Methods: A systematic review was performed to identify all English-language original articles assessing any type of management of ACJ injuries (acute and chronic) in PubMed and Scopus from 2007 to 2017. Review articles, meta-analyses, studies with less than 5 patients, pediatric studies, technique articles, and biomechanical studies were excluded. The 100 top orthopaedic journals in the English literature were selected for review. Included studies were assessed for patient characteristics and the use of outcome variables, including range of motion (ROM), strength, patient-reported outcomes (PROs), satis...