Surgeons consider Rockwood classification the most important factor for decision-making in acute, high-grade acromioclavicular dislocations.

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Abstract

Conflict of interest statement: Michel van den Bekerom and Derek van Deurzen report grants for clinical and research fellowships supported by Smith & Nephew. Geert Alexander Buijze reports consultant fees from Stryker. Thibault Lafosse reports consultant fees from Stryker, Smith and Nephew, Depuy. The remaining authors declare no conflicts of interest. 10. J Shoulder Elbow Surg. 2018 Mar;27(3):538-544. doi: 10.1016/j.jse.2017.09.021. Epub 2017 Nov 22. Interobserver and intraobserver reliability of radiographic classification of acromioclavicular joint dislocations. Ringenberg JD(1), Foughty Z(2), Hall AD(3), Aldridge JM 3rd(4), Wilson JB(5), Kuremsky MA(5). Author information: (1)Indiana University School of Medicine, Indianapolis, IN, USA. Electronic address: jon.ringenberg@gmail.com. (2)Indiana University School of Medicine, Indianapolis, IN, USA. (3)Fort Wayne Orthopedics, Fort Wayne, IN, USA. (4)EmergeOrtho (Triangle Orthopaedic Associates, P.A.), Durham, NC, USA. (5)EmergeOrtho (Triangle Orthopaedic Associates, P.A.), Raleigh, NC, USA. Comment in J Shoulder Elbow Surg. 2018 Nov;27(11):e354-e355. doi: 10.1016/j.jse.2018.02.075. HYPOTHESIS AND BACKGROUND: The classification and treatment of acromioclavicular (AC) joint dislocations remain controversial. The purpose of this study was to determine the interobserver and intraobserver reliability of the Rockwood classification system. We hypothesized poor interobserver and intraobserver reliability, limiting the role of the Rockwood classification system in determining severity of AC joint dislocations and accurately guiding treatment decisions. METHODS: We identified 200 patients with AC joint injuries using the International Classification of Diseases, Ninth Revision code 831.04. Fifty patients met inclusion criteria. Deidentified radiographs were compiled and presented to 6 fellowship-trained upper extremity orthopedic surgeons. The surgeons classified each patient into 1 of the 6 classification types described by Rockwood. A second review was performed several months later by 2 surgeons. A κ value was calculated to determine the interobserver and intraobserver reliability. RESULTS: The interobserver and intraobserver κ values were fair (κ = 0.278) and moderate (κ = 0.468), respectively. Interobserver results showed that 4 of the 50 radiographic images had a unanimous classification. Intraobserver results for the 2 surgeons showed that 18 of the 50 images were rated the same on second review by the first surgeon and 38 of the 50 images were rated the same on second review by the second surgeon. CONCLUSION: We found that the Rockwood classification system has limited interobserver and intraobserver reliability. We believe that unreliable classification may account for some of the inconsistent treatment outcomes among patients with similarly classified injuries. We suggest that a better classification system is needed to use radiographic imaging for diagnosis and treatment of AC joint dislocations. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved. DOI: 10.1016/j.jse.2017.09.021