Background
Rockwood classification | Type I | Type II | Type III | Type IV | Type V | Type VI |
---|---|---|---|---|---|---|
AC ligaments | sprained | disrupted | disrupted | disrupted | disrupted | disrupted |
CC ligaments | intact | sprained | disrupted | disrupted | disrupted | disrupted |
Deltoid and trapezius muscle | intact | intact | detached from clavicle | detached from clavicle | detached from clavicle | detached from clavicle |
Dislocation of the clavicle | none | AC joint widening, CC subluxation | AC joint dislocation, CC interspace 25–100% greater than compared to uninjured side | CC interspace may appear widened, clavicle horizontal unstable with posterior (sub-) luxation | AC joint dislocation, CC interspace more than 100% greater than compared to uninjured side | AC joint dislocation, clavicle displaced inferior to the coracoid |
Methods
Inclusion criteria
Exclusion criteria
Search strategy
Study selection
Data extraction
Results
Authors | Year of publication | Study design/level of evidence | Number of patients | Classification | Type of imaging | Results (according to classification of Landis/Koch [33]) |
---|---|---|---|---|---|---|
Kraeutler et al. [34] | 2012 | Diagnostic study/IV | 28 | Rockwood | Anteroposterior and axial views: visual classification | Visual (ICC out of 8 investigators): IeOR = moderate (0.60) IaOR = good (0.69) |
Cho et al. [15] | 2014 | Diagnostic study/I | 28 | Rockwood | Bilateral plain anteroposterior and axial views: visual classification. Bilateral plain anteroposterior and axial views and 3D–CT: visual classification. | Bilateral plain anteroposterior and axial views: visual (ICC out of 10 investigators): IeOR = slight (0.21) IaOR = moderate (0.47) Bilateral plain anteroposterior and axial views and 3D–CT: visual (ICC out of 10 investigators): IeOR = poor (0.18) IaOR = moderate (0.57) |
Schneider et al. [7] | 2014 | Retrospective case series/IV | 58 | Rockwood | Bilateral panoramic stress and axial views: visual and digitally measured (CCI and HD) classification | Visual (range out of 4 investigators): IeOR = good (0.72–0.74) IaOR = good to excellent (0.67–0.93) Digitally measured CCI: IeOR = excellent (0.85–0.93) IaOR = excellent (0.90–0.97) |
Gastaud et al. [9] | 2015 | Diagnostic study/I | 15 | Rockwood | Bilateral comparative anteroposterior views (Zanca-view [4]), axial views and dynamic axial views (Tauber [8]-protocol): digitally measured (CCI, D/A-ratio, X/Y-ratio, GACA) classification | Digitally measured CCI (range out of 4 investigators): IeOR = good to excellent (0.69–0.92) IaOR = good (0.60–0.77) Digitally measured D/A-ratio: IeOR = good (0.62–0.67) IaOR = good to excellent (0.66–0.95) |
Schmid and Schmid [23] | 1988 | Diagnostic study/IV | 22 | Tossy | Intra-operative findings vs. ultrasound | • Only Tossy III: 100% accordance in classification |
Fenkl and Gotzen [20] | 1992 | Diagnostic study/IV | 35 | Tossy | Weighted x-ray vs. ultrasound | • 97.2% accordance in classification • 2.8% underestimation of Tossy grade in ultrasound |
Matter et al. [16] | 1995 | Diagnostic study/IV | 20 | Tossy | Weighted x-ray vs. ultrasound | • Ultrasound: Tossy III: 8.8 ± 2.1 mm AC-distance • Weighted x-ray: Tossy III: 8.4 ± 3.7 mm AC-distance |
Kock et al. [35] | 1996 | Diagnostic study/IV | 29 | Tossy | Weighted x-ray vs. ultrasound | • Ultrasound: Tossy II: 0.48 ± 0.18 AC-Index Tossy III: 0.20 ± 0.03 AC-Index • Weighted x-ray: Tossy II: 0.50 ± 0.19 AC-Index Tossy III: 0.20 ± 0.03 AC-Index |
Iovane et al. [22] | 2004 | Diagnostic study/IV | 18 | Rockwood | Weighted x-ray vs. ultrasound | • 100% accordance in classification (only Rockwood I – III) |
Schaefer et al. [3] | 2006 | Diagnostic study/IV | 13 | Rockwood | Non-weighted x-ray vs. mri | • 84.6% accordance in classification • 15.4% underestimation of Rockwood grade in x-ray |
Takase [18] | 2011 | Diagnostic study/IV | 25 | Rockwood | Non-weighted x-ray vs. mri | • 92% accordance in classification • 8% overestimation of Rockwood grade in x-ray |
Nemec et al. [19] | 2011 | Diagnostic study/IV | 44 | Rockwood | Non-weighted x-ray vs. mri | • 52.2% accordance in classification • 36.4% overestimation of Rockwood grade in x-ray • 11.4% underestimation of Rockwood grade in x-ray |
Authors | Year of publication | Study design/level of evidence | Number of patients | Classification | Type of imaging | Results (according to classification of Landis / Koch [33]) |
---|---|---|---|---|---|---|
Schneider et al. [7] | 2014 | Retrospective case series/IV | 58 | Rockwood | Bilateral panoramic stress and axial views: visual and digitally measured (CCI and HD) classification | Digitally measured HD: IeOR = good to excellent (0.62–0.96) IaOR = good to excellent (0.67–0.98) |
Vaisman et al. [10] | 2014 | Diagnostic study/II | 40 | Rockwood | Introduction of the AC-width index | Width index of ≥60%: • sensitivity of 95.7% and specificity of 97.5% • positive predictive value of 96.7% and negative predictive value of 95.6% for detecting a Rockwood grade IV injury |
Tauber et al. [8] | 2010 | Diagnostic study/II | 25 | Rockwood | Introduction of the GACA | Cutoff value of 12.3°: • sensitivity of 93% and specificity of 92% • true-negative in 92% and false-negative in 8% for detecting a Rockwood grade IV injury |
Gastaud et al. [9] | 2015 | Diagnostic study/I | 15 | Rockwood | Bilateral comparative anteroposterior views (Zanca-view4), axial views and dynamic axial views (Tauber8-protocol): digitally measured (CCI, D/A-ratio, X/Y-ratio, GACA) classification | Digitally measured X/Y-ratio: IeOR = moderate to good (0.48–0.80) IaOR = moderate to good (0.49–0.72) Digitally measured GACA: IeOR = poor to fair (0.01–0.33) IaOR = poor to fair (0.09–0.38) |
Authors | Year of publication | Study design/level of evidence | Number of patients | Classification | Kind of imaging? Pro weighted or pro non-weighted? | Justification |
---|---|---|---|---|---|---|
Bossart et al. [11] | 1988 | Diagnostic study/IV | 83 | Tossy | Weighted vs. non-weighted bilateral comparative x-rays. Pro non-weighted. | „use of weighted radiographs lacks efficacy in unmasking grade III AC sprains on radiograph “ [11] |
Ibrahim et al. [12] | 2015 | Retrospective case series/IV | 59 | Rockwood | Weighted vs. non-weighted bilateral comparative x-rays. Pro weighted. | “value of bilateral weighted views is to ‘unmask’ a grade V injury“ [12] |
Izadpanah et al. [13] | 2013 | Diagnostic study/IV | 10 | Rockwood | Non-weighted x-ray vs. weighted x-ray and non-weighted mri vs. weighted mri Pro weighted. | “application of stress (...) enables a partial rupture to be dis-tinguished from a complete ligamental rupture“ [13] |