Does the Grade correlate with clinical symptoms for acromioclavicular joint dislocations?
Lennard Funk1, Chee Chung Low2, Tanya Mackenzie3, Emma Torrance4
1HCA Hospitals, Wrightington Hospital & University of Salford, UK
2Univeristy of Manchester, UK
3University of Salford, UK
4HCA Hospitals, UK
BACKGROUND: Acromioclavicular joint (ACJ) injuries are typically classified according to the Rockwood classification. It is often applied using radiographs and treatment decisions based on this. Recent studies have shown that the classification system has poor agreement, but no study has correlated the radiographic appearance with the patient symptoms.
AIMS: To assess the radiographic displacement and patient’s symptoms for ACJ injuries, as well as determining intra-observer reliability of ACJ displacement by radiography.
METHODS: Forty three patients fulfilled the inclusion criteria. The average patient age was 38 years (range: 18-70). Measurements were taken on standardised AP Zanca view radiographs. These measurements were performed on three separate occasions to determine intra-observer reliability. Clinical measures included: the Constant-Murley score (CMS), Oxford Shoulder Score (OSS), QuickDASH, visual analogue scale (VAS) for pain and patient satisfaction.
RESULTS: Pearson’s correlation coefficients (r) between clinical scores and ACJ displacement ratio showed a poor correlation for all measures with: CMS (0.10), OSS (0.21), QuickDASH (0.01), VAS pain (0.17) and patient satisfaction (-0.10). Intra-class correlation (ICC) for measuring ACJ ratio on radiographs was 0.90.
CONCLUSION: Considering the poor correlation between patient’s clinical scores and degree of displacement of the AC joint, treatment of these injuries should not be dictated by radiographic classification alone. This study has formed the pilot for a larger study, including MRI evaluation.