Velasquez Garcia Ausberto, Liendo Rodrigo, Ekdahl Max, Calvo Cristobal, Vidal Catalina
Department of Orthopedic Surgery, Clínica Universidad de los Andes, Santiago, Chile.
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Orthop J Sports Med. 2023 Feb 17;11(2):23259671221149391. doi: 10.1177/23259671221149391. eCollection 2023 Feb.
The Rockwood system for the classification of acute acromioclavicular (AC) joint dislocations has been associated with a lack of reliability. A novel system has been proposed (Kraus classification) that is based on dynamic posterior translation of these injuries.
To assess the interobserver and intraobserver reliability of the Rockwood and Kraus classification systems and also to examine the impact of surgeon experience on the assessments.
Cohort study (diagnosis); Level of evidence, 3.
Included were 45 patients with acute AC joint injuries who underwent a radiographic examination using standard bilateral AP and modified Alexander views. For interobserver reliability, 6 shoulder surgeons (expert group) and 6 orthopaedic residents (novice group) reviewed the radiographs to classify injuries according to the Rockwood and Kraus classifications; for each categorization, the participants chose between nonoperative management and surgical treatment. The evaluation was repeated 6 weeks later to determine intraobserver reliability. Kappa (κ) coefficients and their 95% CIs were used to compare interobserver and intraobserver reliability for each classification system according to assessor experience. Statistical differences were considered significant when the upper and lower boundaries of the 95% CI did not overlap.
The overall interobserver agreement for diagnosis (both novice and expert groups) was moderate (κ = 0.52 [95% CI, 0.51-0.54]) for the Rockwood classification and substantial (κ = 0.62 [95% CI, 0.53-0.65]) for the Kraus classification; however, no significant differences were observed between the κ values. The overall interobserver agreement for treatment selection was substantial when using both the Rockwood (κ = 0.78 [95% CI, 0.72-0.81]) and Kraus (κ = 0.77 [95% CI, 0.66-0.87]) classifications. The overall intraobserver agreement for diagnosis was substantial using both the Rockwood (κ = 0.65 [95% CI, 0.61-0.67]) and Kraus (κ = 0.73 [95% CI, 0.69-0.75]) classifications. There were no significant differences between the novice and expert groups on any of the evaluations.
The Kraus system was slightly more reliable than the Rockwood system for classifying AC joint injuries both between assessor groups and overall. The level of surgeon experience had no impact on the evaluations.
用于急性肩锁关节（AC）脱位分类的罗克伍德（Rockwood）系统存在可靠性不足的问题。一种基于这些损伤动态后向移位的新系统（克劳斯分类法）已被提出。
评估罗克伍德和克劳斯分类系统在观察者间和观察者内的可靠性，并研究外科医生经验对评估的影响。
队列研究（诊断）；证据等级，3级。
纳入45例急性肩锁关节损伤患者，他们接受了使用标准双侧前后位（AP）和改良亚历山大位的X线检查。为评估观察者间可靠性，6位肩外科医生（专家组）和6位骨科住院医师（新手组）对X线片进行阅片，根据罗克伍德和克劳斯分类法对损伤进行分类；对于每种分类，参与者要在非手术治疗和手术治疗之间做出选择。6周后重复评估以确定观察者内可靠性。使用卡帕（κ）系数及其95%置信区间（CI），根据评估者经验比较每个分类系统的观察者间和观察者内可靠性。当95%CI的上下限不重叠时，统计学差异被认为具有显著性。
罗克伍德分类法在诊断方面的总体观察者间一致性（新手组和专家组）为中等（κ = 0.52 [95%CI，0.51 - 0.54]），克劳斯分类法为实质性一致（κ = 0.62 [95%CI，0.53 - 0.65]）；然而，κ值之间未观察到显著差异。使用罗克伍德（κ = 0.78 [95%CI，0.72 - 0.81]）和克劳斯（κ = 0.77 [95%CI，0.66 - 0.87]）分类法时，在治疗选择方面的总体观察者间一致性均为实质性一致。使用罗克伍德（κ = 0.65 [95%CI，0.61 - 0.67]）和克劳斯（κ = 0.73 [95%CI，0.69 - 0.75]）分类法时，在诊断方面的总体观察者内一致性均为实质性一致。在任何一项评估中，新手组和专家组之间均未观察到显著差异。
在评估者组之间以及总体上，克劳斯系统在对肩锁关节损伤进行分类时比罗克伍德系统稍可靠。外科医生的经验水平对评估没有影响。
