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Acromioclavicular joint dislocations: radiological correlation between Rockwood classification system and injury patterns in human cadaver species

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

The classification system of Rockwood and Young is a commonly used classification for acromioclavicular joint separations subdividing types I−VI. This classification hypothesizes specific lesions to anatomical structures (acromioclavicular and coracoclavicular ligaments, capsule, attached muscles) leading to the injury. In recent literature, our understanding for anatomical correlates leading to the radiological-based Rockwood classification is questioned. The goal of this experimental-based investigation was to approve the correlation between the anatomical injury pattern and the Rockwood classification.

Materials and methods

In four human cadavers (seven shoulders), the acromioclavicular and coracoclavicular ligaments were transected stepwise. Radiological correlates were recorded (Zanca view) with 15-kg longitudinal tension applied at the wrist. The resulting acromio- and coracoclavicular distances were measured.

Results

Radiographs after acromioclavicular ligament transection showed joint space enlargement (8.6 ± 0.3 vs. 3.1 ± 0.5 mm, p < 0.05) and no significant change in coracoclavicular distance (10.4 ± 0.9 vs. 10.0 ± 0.8 mm). According to the Rockwood classification only type I and II lesions occurred. After additional coracoclavicular ligament cut, the acromioclavicular joint space width increased to 16.7 ± 2.7 vs. 8.6 ± 0.3 mm, p < 0.05. The mean coracoclavicular distance increased to 20.6 ± 2.1 mm resulting in type III−V lesions concerning the Rockwood classification.

Conclusions

Trauma with intact coracoclavicular ligaments did not result in acromioclavicular joint lesions higher than Rockwood type I and II. The clinical consequence for reconstruction of low-grade injuries might be a solely surgical approach for the acromioclavicular ligaments or conservative treatment. High-grade injuries were always based on additional structural damage to the coracoclavicular ligaments. Rockwood type V lesions occurred while muscle attachments were intact.

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References

  1. Adams FL (1886) The genuine work of Hippocrates. William Wood, New York, p 338

    Google Scholar 

  2. Turnbull JR (1998) Acromioclavicular joint disorders. Med Sci Sports Exerc 30:26–32

    Article  Google Scholar 

  3. Urist MR (1964) Complete dislocation of the acromioclavicular joint: the nature of the traumatic lesion and effective methods of treatment with an analysis of forty-one cases. J Bone Joint Surg 28:813–837

    Google Scholar 

  4. Rockwood CA, Green DP (eds) (1985) Fractures in adults. JB Lipincott, Philadelphia, pp 860–981

    Google Scholar 

  5. Barnes CJ, Higgins LD, Major NM, Basamania CJ (2004) Magnetic resonance imaging of the coracoclavicular ligaments: its role in defining pathoanatomy at the acromioclavicular joint. J Surg Orthop Adv 13:69–75

    PubMed  Google Scholar 

  6. Fraser-Moodie JA, Shortt NL, Robinson CM (2008) Injuries to the acromioclavicular joint. J Bone Joint Surg Br 90:697–707. doi:10.1302/0301-620X.90B6.20704

    Article  CAS  PubMed  Google Scholar 

  7. Cho CH, Hwang I, Seo JS, Choi CH, Ko SH, Park HB, Dan J (2014) Reliability of the classification and treatment of dislocations of the acromioclavicular joint. J Shoulder Elbow Surg 23:665–670. doi:10.1016/j.jse.2014.02.005.8

    Article  PubMed  Google Scholar 

  8. Zanca P (1971) Shoulder pain: involvement of the acromioclavicular joint. (Analysis of 1,000 cases). Am J Roentgenol Radium Ther Nucl Med 112:493–506

    Article  CAS  PubMed  Google Scholar 

  9. Murphy M, Connolly P, Murphy P, McElwain J (2004) Retrospective review of outcome post open reduction and k-wire fixation for grade III acromioclavicular joint subluxations. Eur J Orthop Surg Traumatol 14:147–150

    Google Scholar 

  10. Rockwood CA, Green DP (eds) (1984) Fractures in adults, vol 1, 2nd edn. JB Lippincott, Philadelphia, pp 1210–1244

    Google Scholar 

  11. Fukuda K, Craig EV, An K, Cofield RH, Chao EY (1986) Biomechanical study of the ligamentous system of the acromioclavicular joint. JBJS 68A:434–440

    Google Scholar 

  12. Tossy JD, Mead NC, Sigmond HM (1963) Acromioclavicular separations: useful and practical classification for treatment. Clin Orthop Relat Res 28:111–119

    CAS  PubMed  Google Scholar 

  13. Bannister GC, Wallace WA, Stableforth PG, Hutson MA (1992) A classification of acute acromioclavicular dislocation: a clinical, radiological and anatomical study. Injury 23:194–196

    Article  CAS  PubMed  Google Scholar 

  14. Gstettner C, Tauber M, Hitzl W, Resch H (2008) Rockwood type III acromioclavicular dislocation: surgical versus conservative treatment. J Shoulder Elbow Surg 17:220–225. doi:10.1016/j.jse.2007.07.017

    Article  CAS  PubMed  Google Scholar 

  15. Klonz A, Loitz D (2005) The acromioclavicular joint. Unfallchirurg 108:1049–1058

    Article  CAS  PubMed  Google Scholar 

  16. Larsen E, Bjerg-Nielsen A, Christensen P (1986) Conservative or surgical treatment of acromio-clavicular dislocation. A prospective, controlled, randomized study. J Bone Joint Surg Am 68:552–555

    CAS  PubMed  Google Scholar 

  17. Eschler A, Gradl G, Gierer P, Mittlmeier T, Beck M (2012) Hook plate fixation for acromioclavicular joint separations restores coracoclavicular distance more accurately than PDS augmentation, however presents with a high rate of acromial osteolysis. Arch Orthop Trauma Surg 132:33–39. doi:10.1007/s00402-011-1399-x

    Article  PubMed  Google Scholar 

  18. Langendorf HU (2004) AC-verletzungen: konservativ-funktionelle therapie und ergebnisse. Trauma Berufskrankh 6:329–333

    Article  Google Scholar 

  19. Greiner S, Braunsdorf J, Perka C, Herrmann S, Scheffler S (2009) Mid to long-term results of open acromioclavicular-joint reconstruction using polydioxansulfate cerclage augmentation. Arch Orthop Trauma Surg 129:735–740. doi:10.1007/s00402-008-0688-5

    Article  CAS  PubMed  Google Scholar 

  20. Pfahler M, Krodel A, Refior HJ (1994) Surgical treatment of acromioclavicular dislocation. Arch Orthop Trauma Surg 113:308–311

    Article  CAS  PubMed  Google Scholar 

  21. Prokop A, Helling HJ, Andermahr J, Monig S, Rehm KE (2003) Tossy III injuries of the acromio-clavicular joint. In what circumstances is surgery still justified? Personal results and literature review. Orthopäde 32:432–436

    Article  CAS  PubMed  Google Scholar 

  22. Guo HB, Xiao T (2014) Comment on Korsten et al. Operative or conservative treatment in patients with Rockwood type III acromioclavicular dislocation: a systematic review and update of current literature. Int Orthop 38:915. doi:10.1007/s00264-014-2288-z

    Article  PubMed  Google Scholar 

  23. Koukakis A, Manouras A, Apostolou CD, Lagoudianakis E, Papadima A, Triantafillou C, Korres D, Allen PW, Amini A (2008) Results using the ao hook plate for dislocations of the acromioclavicular joint. Expert Rev Med Devices 5:567–572. doi:10.1586/17434440.5.5.567

    Article  PubMed  Google Scholar 

  24. Leidel BA, Braunstein V, Pilotto S, Mutschler W, Kirchhoff C (2009) Mid-term outcome comparing temporary k-wire fixation versus pds augmentation of Rockwood grade III acromioclavicular joint separations. BMC Res Notes 2:84. doi:10.1186/1756-0500-2-84

    Article  PubMed Central  PubMed  Google Scholar 

  25. Tauber M, Koller H, Hitzl W, Resch H (2010) Dynamic radiologic evaluation of horizontal instability in acute acromioclavicular joint dislocations. Am J Sports Med 38:1188–1195. doi:10.1177/0363546510361951

    Article  PubMed  Google Scholar 

  26. Baldwin K, Namdari S, Anderson J, Lee B, Itamura J, Huffman G (2010) Luggage tag technique of anatomic fixation of displaced acromioclavicular joint separations. Clin Orthop Relat Res 468:259–265. doi:10.1007/s11999-009-0877-8

    Article  PubMed Central  PubMed  Google Scholar 

  27. DeBerardino TM, Pensak MJ, Ferreira J, Mazzocca AD (2010) Arthroscopic stabilization of acromioclavicular joint dislocation using the AC graftrope system. J Shoulder Elbow Surg 19:47–52. doi:10.1016/j.jse.2009.12.014

    Article  PubMed  Google Scholar 

  28. Jiang C, Wang M, Rong G (2008) Proximally based conjoined tendon transfer for coracoclavicular reconstruction in the treatment of acromioclavicular dislocation. Surgical technique. J Bone Joint Surg Am 2:299–308. doi:10.2106/JBJS.H.00438

    Google Scholar 

  29. Petersen W, Wellmann M, Rosslenbroich S, Zantop T (2010) Minimally invasive acromioclavicular joint reconstruction (minar). Oper Orthop Traumatol 22:52–61. doi:10.1007/s00064-010-3004-4

    Article  PubMed  Google Scholar 

  30. Shin SJ, Yun YH, Yoo JD (2009) Coracoclavicular ligament reconstruction for acromioclavicular dislocation using 2 suture anchors and coracoacromial ligament transfer. Am J Sports Med 37:346–351. doi:10.1177/0363546508324968

    Article  PubMed  Google Scholar 

  31. Tomlinson DP, Altchek DW, Davila J, Cordasco FA (2008) A modified technique of arthroscopically assisted AC joint reconstruction and preliminary results. Clin Orthop Relat Res 466:639–645. doi:10.1007/s11999-007-0085-3

    Article  PubMed Central  PubMed  Google Scholar 

  32. Horst K, Dienstknecht T, Andruszkow H, Gradl G, Kobbe P, Pape HC (2013) Radiographic changes in the operative treatment of acute acromioclavicular joint dislocation: tight rope technique vs. K-wire fixation. Pol J Radiol 78:15–20. doi:10.12659/PJR.889615

    PubMed Central  PubMed  Google Scholar 

  33. Dawson PA, Adamson GJ, Pink MM, Kornswiet M, Lin S, Shankwiler JA, Lee TQ (2008) Relative contribution of acromioclavicular joint capsule and coracoclavicular ligaments to acromioclavicular stability. J Shoulder Elbow Surg 18:237–244. doi:10.1016/j.jse.2008.08.003

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Trauma, Hand and Reconstructive Surgery, Medical Center, University of Rostock, Schillingallee 35, 18057, Rostock, Germany

    Anica Eschler, Robert Rotter, Georg Gradl, Thomas Mittlmeier & Philip Gierer

  2. Department of Diagnostic and Interventional Radiology, Medical Center, University of Rostock, Schillingallee 35, 18057, Rostock, Germany

    Klaus Rösler

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  1. Anica Eschler
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  2. Klaus Rösler
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Correspondence to Anica Eschler.

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Eschler, A., Rösler, K., Rotter, R. et al. Acromioclavicular joint dislocations: radiological correlation between Rockwood classification system and injury patterns in human cadaver species. Arch Orthop Trauma Surg 134, 1193–1198 (2014). https://doi.org/10.1007/s00402-014-2045-1

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