Improved identification of unstable acromioclavicular joint injuries in a clinical population using the acromial center line to dorsal clavicle radiographic measurement.
- Karargyris O Inselspital, Department of Orthopaedic Surgery and Traumatology, Shoulder, Elbow and Orthopaedic Sports Medicine, Bern University Hospital, University of Bern, Bern, Switzerland.
- Murphy RJ Shoulder, Elbow and Orthopaedic Sports Medicine, Orthopaedics Sonnenhof, Bern, Switzerland. Electronic address: richardjamesmurphy@icloud.com.
- Arenas A Inselspital, Department of Orthopaedic Surgery and Traumatology, Shoulder, Elbow and Orthopaedic Sports Medicine, Bern University Hospital, University of Bern, Bern, Switzerland.
- Bolliger L Inselspital, Department of Orthopaedic Surgery and Traumatology, Shoulder, Elbow and Orthopaedic Sports Medicine, Bern University Hospital, University of Bern, Bern, Switzerland.
- Zumstein MA Shoulder, Elbow and Orthopaedic Sports Medicine, Orthopaedics Sonnenhof, Bern, Switzerland; Stiftung Lindenhof I Campus SLB, Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland. Electronic address: matthiaszumstein@sonnenhof.ch.
- 2020-03-10
Published in:
- Journal of shoulder and elbow surgery. - 2020
English
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 ISAKOS 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.
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 ISAKOS 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.
- Language
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- English
- Open access status
- hybrid
- Identifiers
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- DOI 10.1016/j.jse.2019.12.014
- PMID 32147334
- Persistent URL
- https://sonar.ch/global/documents/45718
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