The ISAKOS subclassification of Rockwood type III AC joint dislocations in a stable type A and an unstable type B is not clinically relevant

Abstract

AbstractPurposeThe treatment of Rockwood type III AC joint dislocations has been debated for decades. In 2014, the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) Upper Extremity Committee suggested a subclassification of the injury into type A, considered stable and best treated nonsurgically, and type B, considered unstable and best treated surgically. Type B is defined by the presence of scapular dyskinesis and overriding of the clavicle to the acromion on a modified lateral radiograph. The objective of the study was to investigate if this subclassification is clinically relevant.MethodsThis was a prospective cohort study. Inclusion criteria were patients aged 18–60 years with acute AC joint dislocation and a baseline Zanca radiograph with an increase in the CC distance of >25% compared to the uninjured side. All patients were treated nonsurgically with 3 months of home‐based training and with the option of delayed surgical intervention. Patients were assessed at baseline and at follow‐ups 6 weeks, 3 months, 6 months and 1 year after the injury. At the 6‐week follow‐up, patients were graded as stable and unstable according to the ISAKOS criteria. Outcomes were the Western Ontario Shoulder Instability Index (WOSI) and referral for surgery.ResultsAt 6 weeks of follow‐up, 20 patients were classified as stable type A and 69 were classified as unstable type B. The ISAKOS subclassification was not clinically relevant, but patients graded as stable had statistically significantly better WOSI scores at 6 months compared to the unstable group (p = 0.03) but not at 3 months or 1 year. Nine patients (9.5%), all from the unstable group, were referred for surgery. No patients from the stable group underwent surgery (n.s).ConclusionThe ISAKOS subclassification of Rockwood type III in a stable type A and an unstable type B is not clinically applicable.Level of EvidenceLevel II.