Improved identification of unstable acromioclavicular joint injuries in a clinical population using the acromial center line to dorsal clavicle radiographic measurement

Karargyris, Orestis; Murphy, Richard; Arenas, Antonio; Bolliger, Lilianna; Zumstein, Matthias A.

doi:10.1016/j.jse.2019.12.014

Cited by 17 publications

(24 citation statements)

References 16 publications

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“…It is complex and time-consuming to perform and fails to show adequate discriminant validity to distinguish between Rockwood injury types IIIA and IIIB. 10,31…”

Section: Discussionmentioning

confidence: 99%

“…It is complex and timeconsuming to perform and fails to show adequate discriminant validity to distinguish between Rockwood injury types IIIA and IIIB. 10,31 The circles measurement was developed to address these limitations. The measurement is independent of displacement plane, judging total ACJ displacement in any direction rather than trying to quantify vertical and/or horizontal displacement.…”

Section: Discussionmentioning

confidence: 99%

“…22,27 The Alexander view, 1 a lateral stress radiograph taken with the hand of the arm being imaged placed in the contralateral axilla, facilitates evaluation of horizontal and vertical displacement on a single view. 10,18,31 Figure 1 shows a large cassette panoramic view, with comparative Alexander views from the same individual, illustrating the utility of the Alexander view in demonstrating both vertical and horizontal displacement. Figure 2 shows the method for obtaining an Alexander view radiograph in a clinical setting.…”

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confidence: 99%

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Evaluation of the Circles Measurement and the ABC Classification of Acromioclavicular Joint Injuries

Murphy

Moor²,

Lesniewski

et al. 2021

Am J Sports Med

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Background: Acromioclavicular joint (ACJ) injuries are common. Despite this, it remains unclear how best to assess, classify, and manage these cases. A simple, reliable, valid, and accurate radiographic parameter to measure ACJ displacement would allow improved consistency of diagnosis and subsequent treatment pathways. Purpose: To evaluate “the circles measurement” and associated “ABC classification” as a tool for assessing ACJ displacement and injury classification. Study Design: Descriptive laboratory study. Methods: The circles measurement is taken from a lateral Alexander radiograph of the shoulder. The measurement is the center-to-center distance between 2 circles drawn to define the lateral extent of the clavicle and the anteromedial extent of the acromion; it is independent of the displacement plane, judging total ACJ displacement in any direction rather than trying to quantify vertical and/or horizontal displacement. When utilized clinically, the circles measurement is a single measurement calculated as the difference between values recorded for the injured and uninjured sides. Validation of the circles measurement was performed using lateral Alexander radiographs (including ±20° projection error in all planes) and computed tomography of standardized ACJ injury simulations. We assessed inter- and intrarater reliability, convergent validity, and discriminant validity of the circles measurement and subsequently generated a classification of ACJ injury based on displacement. Results: Reliability and validity of the circles measurement was excellent throughout. Interrater reliability (ICC [intraclass correlation coefficient] [2,1], 95% CI; n = 78; 4 observers) was 0.976 (0.964-0.985). Intrarater reliability (ICC [2,1]; 95% CI; n = 78; 2 measures) was 0.998 (0.996-0.998). Convergent validity (Pearson correlation coefficient, r) was 0.970 for ideal radiographs and 0.889 with ±20° projection error in all planes. Discriminant validity, with 1-way analysis of variance, showed a P value of <.0001 and effect size ( η2) of 0.960, with the ability to distinguish between the previously defined stable (Rockwood IIIA) and unstable (Rockwood IIIB) injuries. The results permitted objective, statistically sound parameters for the proposed ABC classification system. Conclusion: The circles measurement is a simple, reliable, valid, accurate, and resilient parameter for assessing ACJ displacement and can be used in conjunction with the proposed ABC classification to define ACJ injuries more accurately and objectively than previously described. Clinical Relevance: This novel parameter has the potential to standardize the initial assessment and possibly the subsequent clinical management of ACJ injuries, in addition to providing a standardized measure for future research.

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“…It is complex and time-consuming to perform and fails to show adequate discriminant validity to distinguish between Rockwood injury types IIIA and IIIB. 10,31…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Evaluation of the Circles Measurement and the ABC Classification of Acromioclavicular Joint Injuries

Murphy

Moor²,

Lesniewski

et al. 2021

Am J Sports Med

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“…The well-documented C-C distance showed near perfect reduction of the joint in a vertical plane, compared to the contralateral side, which was maintained up to 2 years following surgery. The AC-DC measurement of vertical ACJ displacement, which has been shown to have greater reliability and resilience to radiographic projectional error than C-C distance [ 19 , 25 ], also demonstrated statistically and clinically significant restoration of ACJ position at 2 years. Loss of vertical reduction, with increasing C-C distance has been seen to occur with the majority of other stabilisation techniques [ 10 , 11 , 24 ], showing the BiPOD technique in a favourable light against the existing techniques for restoration of vertical stability.…”

Section: Discussionmentioning

confidence: 99%

BiPOD arthroscopically assisted bidirectional stabilisation technique for high-grade acromioclavicular joint injury: two-year clinical and radiological outcomes

Murphy

Ambuehl

Schaer

et al. 2021

Arch Orthop Trauma Surg

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Purpose The purpose of this study was to evaluate the intermediate-term clinical and radiological outcomes for acute, unstable acromioclavicular joint (ACJ) injuries treated with the arthroscopically assisted BiPOD stabilisation technique. Methods Twenty-three patients who sustained acute, unstable ACJ injuries were included in this prospective study. We recorded demographics, injury classification, time to surgery, clinical scores, radiological outcomes and complications; each patient completed a minimum of 2 years post-operative observation. Results Mean follow-up was 26 months (range, 24—34). Clinical outcomes scores demonstrated good 2-year results: relative Constant score, 97.9/100; ACJ Index, 89.4/100; Subjective Shoulder Value, 92.4/100 and Taft = 11.1/12. Final C–C distance showed a mean of 0.7 mm (SD ± 1.8 mm) at 2 years. Complication rate was 9%. Conclusion The BiPOD technique shows excellent, reliable intermediate-term results with a favourable complication rate compared to existing techniques; it provides a comprehensive surgical option for the stabilisation of acute ACJ injuries restoring both vertical and horizontal stability.

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“…Since clinical data has shown a vast number of persistent horizontal instability following modern arthroscopic AC joint reconstruction techniques [23,24], not only the surgical management but also the clinical assessment have been reconsidered. It has been claimed that parameters assessable on AP and Zanca view do not allow for quantification of horizontal instability, therefore, the use of new radiographic parameters in a single lateral Alexander view has been recently recommended [15,29]. Anyhow, the ESA panel agreed that a true AP view or a bilateral Zanca view without loading the arm are still adequate for a correct diagnosis, with no need of modified Alexander view to seek for horizontal instability.…”

Section: Discussionmentioning

confidence: 99%

High degree of consensus achieved regarding diagnosis and treatment of acromioclavicular joint instability among ESA-ESSKA members

Rosso

Martetschläger

Saccomanno

et al. 2020

Knee Surg Sports Traumatol Arthrosc

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Purpose To develop a consensus on diagnosis and treatment of acromioclavicular joint instability. Methods A consensus process following the modified Delphi technique was conducted. Panel members were selected among the European Shoulder Associates of ESSKA. Five rounds were performed between October 2018 and November 2019. The first round consisted of gathering questions which were then divided into blocks referring to imaging, classifications, surgical approach for acute and chronic cases, conservative treatment. Subsequent rounds consisted of condensation by means of an online questionnaire. Consensus was achieved when ≥ 66.7% of the participants agreed on one answer. Descriptive statistic was used to summarize the data. Results A consensus was reached on the following topics. Imaging: a true anteroposterior or a bilateral Zanca view are sufficient for diagnosis. 93% of the panel agreed on clinical override testing during body cross test to identify horizontal instability. The Rockwood classification, as modified by the ISAKOS statement, was deemed valid. The separation line between acute and chronic cases was set at 3 weeks. The panel agreed on arthroscopically assisted anatomic reconstruction using a suspensory device (86.2%), with no need of a biological augmentation (82.8%) in acute injuries, whereas biological reconstruction of coracoclavicular and acromioclavicular ligaments with tendon graft was suggested in chronic cases. Conservative approach and postoperative care were found similar Conclusion A consensus was found on the main topics of controversy in the management of acromioclavicular joint dislocation. Each step of the diagnostic treatment algorithm was fully investigated and clarified. Level of evidence Level V.

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Improved identification of unstable acromioclavicular joint injuries in a clinical population using the acromial center line to dorsal clavicle radiographic measurement

Cited by 17 publications

References 16 publications

Evaluation of the Circles Measurement and the ABC Classification of Acromioclavicular Joint Injuries

Evaluation of the Circles Measurement and the ABC Classification of Acromioclavicular Joint Injuries

BiPOD arthroscopically assisted bidirectional stabilisation technique for high-grade acromioclavicular joint injury: two-year clinical and radiological outcomes

High degree of consensus achieved regarding diagnosis and treatment of acromioclavicular joint instability among ESA-ESSKA members

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