TY - JOUR
T1 - Surgeons consider Rockwood classification the most important factor for decision-making in acute, high-grade acromioclavicular dislocations
AU - van Eecke, Eduard
AU - Macken Arno, Alexander
AU - AC Instability Collaborator Group
AU - van Deurzen, Derek
AU - Lafosse, Thibault
AU - van Raebroeckx, Antoon
AU - Buijze Geert, Alexander
AU - van den Bekerom, Michel
AU - Noll, Patrik
AU - Sanches, Jorge Villa
AU - Puah, Ken Lee
AU - Stanciugelu, Stefan
AU - Munji, Jeremy
AU - Lejeune, Etienne
AU - Piper, Kalman
AU - Rosso, Claudio
AU - Corbett, Steven
AU - Rojas, Daniel
AU - Romanowski, James
AU - Chauke, Nyiko
AU - Grosclaude, Sophie
AU - Reiland, Youri
AU - Kimmeyer, Michael
AU - Schwartz, Daniel
AU - Martin, Javiern
AU - Freehill, Michael Thomas
AU - Debeer, Philippe
AU - Defoort, Saartje
AU - Opsomer, Gaetan
AU - Geurts, Ghislain
AU - Hermans, Stijn
AU - Diederix, Leon
AU - Flamand, Olivier
AU - Harcha, Antonio
AU - Melebeck, François
AU - van Tongel, Alexander
AU - Bassens, David
AU - Mulpas, Florence
AU - van Parys, Justine Barbier Michiel
AU - van der Bracht, Hans
AU - De Keyzer, Pieter Bastiaan
AU - Petré, Dirk
AU - Jak, Wouter
AU - Houben, Rick
AU - Robijns, Filip
AU - Lambrecht, Delphine
AU - Banez, Luigi
AU - Castellani, Lorenzo
AU - Jany, Richard
AU - Wlodek, Vincent
AU - Visser, C. P.J.
N1 - Publisher Copyright:
© 2025 The Author(s). Journal of Experimental Orthopaedics published by John Wiley & Sons Ltd on behalf of European Society of Sports Traumatology, Knee Surgery and Arthroscopy.
PY - 2025/1
Y1 - 2025/1
N2 - Purpose: The aim of this study is to investigate the influence of patient-specific factors, including age, lifestyle considerations as well as the extent of injury according to the Rockwood classification (RW), on the surgeon's decision-making in the choice between operative and nonoperative treatment for acute, high-grade acromioclavicular (AC) joint dislocations. Methods: Orthopaedic and trauma surgeons were requested to complete an online questionnaire consisting of closed and open questions regarding the treatment of acute, high-grade AC joint dislocations and 24 fictive clinical scenarios. Results: A total of 133 answered questionnaires were collected. 27 different nationalities from five continents were represented. The included participants had a median experience of 12 years (interquartile range: 2–41). Overall, the treatment option for surgery (answer: YES) was chosen in 2426 answers (76% of cases) compared to ‘NO’ in 766 (24% of cases). RW classification was considered the most important factor influencing surgical decision-making for most surgeons (69%). Two thirds of the participants answered that smoking does not impact their decision towards surgery and as to the influence of body mass index (BMI) on decision-making, half of the respondents would not alter their preferred treatment based on BMI. Finally, there were no significant differences in decision-making regarding the influence of the participant's demographics. Conclusion: This study highlights that RW classification is the most important factor to consider in the surgeon's decision-making between operative and nonoperative treatment in acute, high-grade AC joint dislocations. Participants preferred operative treatment over nonoperative treatment in acute, high-grade AC joint dislocation in 76% of case scenarios, increasing up to 90% when RW Grade III lesions were not taken into account. These findings contrast with recent studies reporting good functional outcomes of conservatively treated acute, high-grade AC injuries and highlight the need to bridge the gap between evidence and practice. Level of Evidence: Level V.
AB - Purpose: The aim of this study is to investigate the influence of patient-specific factors, including age, lifestyle considerations as well as the extent of injury according to the Rockwood classification (RW), on the surgeon's decision-making in the choice between operative and nonoperative treatment for acute, high-grade acromioclavicular (AC) joint dislocations. Methods: Orthopaedic and trauma surgeons were requested to complete an online questionnaire consisting of closed and open questions regarding the treatment of acute, high-grade AC joint dislocations and 24 fictive clinical scenarios. Results: A total of 133 answered questionnaires were collected. 27 different nationalities from five continents were represented. The included participants had a median experience of 12 years (interquartile range: 2–41). Overall, the treatment option for surgery (answer: YES) was chosen in 2426 answers (76% of cases) compared to ‘NO’ in 766 (24% of cases). RW classification was considered the most important factor influencing surgical decision-making for most surgeons (69%). Two thirds of the participants answered that smoking does not impact their decision towards surgery and as to the influence of body mass index (BMI) on decision-making, half of the respondents would not alter their preferred treatment based on BMI. Finally, there were no significant differences in decision-making regarding the influence of the participant's demographics. Conclusion: This study highlights that RW classification is the most important factor to consider in the surgeon's decision-making between operative and nonoperative treatment in acute, high-grade AC joint dislocations. Participants preferred operative treatment over nonoperative treatment in acute, high-grade AC joint dislocation in 76% of case scenarios, increasing up to 90% when RW Grade III lesions were not taken into account. These findings contrast with recent studies reporting good functional outcomes of conservatively treated acute, high-grade AC injuries and highlight the need to bridge the gap between evidence and practice. Level of Evidence: Level V.
UR - https://www.scopus.com/pages/publications/105000821833
U2 - 10.1002/jeo2.70203
DO - 10.1002/jeo2.70203
M3 - Article
C2 - 40083813
AN - SCOPUS:105000821833
SN - 2197-1153
VL - 12
JO - Journal of Experimental Orthopaedics
JF - Journal of Experimental Orthopaedics
IS - 1
M1 - e70203
ER -