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16.11.2014 | Shoulder | Ausgabe 7/2016

Knee Surgery, Sports Traumatology, Arthroscopy 7/2016

Inter- and intraobserver reliability of the Rockwood classification in acute acromioclavicular joint dislocations

Knee Surgery, Sports Traumatology, Arthroscopy > Ausgabe 7/2016
M. M. Schneider, M. Balke, P. Koenen, M. Fröhlich, A. Wafaisade, B. Bouillon, M. Banerjee



The reliability of the Rockwood classification, the gold standard for acute acromioclavicular (AC) joint separations, has not yet been tested. The purpose of this study was to investigate the reliability of visual and measured AC joint lesion grades according to the Rockwood classification.


Four investigators (two shoulder specialists and two second-year residents) examined radiographs (bilateral panoramic stress and axial views) in 58 patients and graded the injury according to the Rockwood classification using the following sequence: (1) visual classification of the AC joint lesion, (2) digital measurement of the coracoclavicular distance (CCD) and the horizontal dislocation (HD) with Osirix Dicom Viewer (Pixmeo, Switzerland), (3) classification of the AC joint lesion according to the measurements and (4) repetition of (1) and (2) after repeated anonymization by an independent physician. Visual and measured Rockwood grades as well as the CCD and HD of every patient were documented, and a CC index was calculated (CCD injured/CCD healthy). All records were then used to evaluate intra- and interobserver reliability.


The disagreement between visual and measured diagnosis ranged from 6.9 to 27.6 %. Interobserver reliability for visual diagnosis was good (0.72–0.74) and excellent (0.85–0.93) for measured Rockwood grades. Intraobserver reliability was good to excellent (0.67–0.93) for visual diagnosis and excellent for measured diagnosis (0.90–0.97). The correlations between measurements of the axial view varied from 0.68 to 0.98 (good to excellent) for interobserver reliability and from 0.90 to 0.97 (excellent) for intraobserver reliability.


Bilateral panoramic stress and axial radiographs are reliable examinations for grading AC joint injuries according to Rockwood’s classification. Clinicians of all experience levels can precisely classify AC joint lesions according to the Rockwood classification. We recommend to grade acute ACG lesions by performing a digital measurement instead of a sole visual diagnosis because of the higher intra- and interobserver reliability.

Level of evidence

Case series, Level IV.

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