# Surgeons consider Rockwood classification the most important factor for decision‐making in acute, high‐grade acromioclavicular dislocations

## TL;DR

Surgeons primarily use the Rockwood classification to decide on surgery for severe shoulder dislocations, often preferring surgery over non-surgery.

## Contribution

This study identifies Rockwood classification as the most influential factor in surgeons' treatment decisions for high-grade acromioclavicular dislocations.

## Key findings

- 76% of surgeons preferred surgery for acute, high-grade AC joint dislocations.
- Rockwood classification was the most important factor for 69% of surgeons.
- Findings contrast with recent studies showing good outcomes for non-surgical treatment.

## Abstract

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.

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.

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.

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 V.