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Table 2 Assessment of vertical instability

From: The acutely injured acromioclavicular joint – which imaging modalities should be used for accurate diagnosis? A systematic review

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
  1. ICC = intraclass correlation coefficient, IeOR = inter-observer reliability, IaOR = intraobserver Reliability, CCI = coracoclavicular index, AC-width index = acromioclavicular-width index [10], D/A-ratio = vertical displacement of the clavicle9