{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:08:54Z","timestamp":1789430934074,"version":"build-2803163510"},"reference-count":45,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2025,5,1]],"date-time":"2025-05-01T00:00:00Z","timestamp":1746057600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,5,1]],"date-time":"2025-05-01T00:00:00Z","timestamp":1746057600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100011594","name":"Sophies Minde Ortopedi","doi-asserted-by":"publisher","award":["Project 15-2021"],"award-info":[{"award-number":["Project 15-2021"]}],"id":[{"id":"10.13039\/501100011594","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Journal of Sports Medicine"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Previous radiographic reliability studies of the acromioclavicular (AC) joint are from smaller and\/or selective patient populations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>To investigate the inter- and intrarater reliability of the Rockwood classification of AC joint injuries on standard anteroposterior (AP) radiographs in an urban population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study design:<\/jats:title>\n                    <jats:p>Cohort study (diagnosis); Level of evidence, 2.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      All suspected shoulder injuries from May 2013 to April 2014 at the Department of Orthopedic Emergency, Oslo University Hospital, were registered by admittance. Patients with anteriosuperior shoulder pain and maximum point tenderness over the AC joint were assessed. In total, 287 consective AC joint injuries were registered of the 2650 shoulder injuries in residents. From the 287 patients with AC joint injury 268 were ultimately included in the present study. On 2 occasions &gt;6 weeks apart and blinded from each other, 2 orthopaedic consultants, 2 orthopaedic residents, and 2 musculoskeletal radiology consultants independently classified the cohort. In the interrater analyses, the raters were also stratified based on clinical experience and specialty. All raters evaluated 2 standardized nonweightbearing AP radiographs for each patient, performed by tilting the beam 15\u00b0 in the cephalic and caudal direction, respectively. Reliability was assessed based on Cohen kappa (\n                      <jats:italic toggle=\"yes\">k<\/jats:italic>\n                      ) values.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Interrater reliability for all raters and for the stratified groups in rounds 1 and 2 was substantial for the Rockwood classification. The interrater reliability improved from round 1 to round 2 for all raters (agreement: 92% vs 94%,\n                      <jats:italic toggle=\"yes\">k<\/jats:italic>\n                      = 0.66 vs 0.73, respectively), orthopaedic consultants (agreement: 90% vs 93%,\n                      <jats:italic toggle=\"yes\">k<\/jats:italic>\n                      = 0.61 vs 0.72, respectively), orthopaedic residents (agreement: 92% vs 94%,\n                      <jats:italic toggle=\"yes\">k<\/jats:italic>\n                      = 0.61 vs 0.76, respectively), and musculoskeletal radiology consultants (agreement: 93% vs 94%,\n                      <jats:italic toggle=\"yes\">k<\/jats:italic>\n                      = 0.70 vs 0.73, respectively). No significant differences in intrarater reliability between the groups were seen for orthopaedic consultants (\n                      <jats:italic toggle=\"yes\">k<\/jats:italic>\n                      = 0.72), orthopaedic residents (\n                      <jats:italic toggle=\"yes\">k<\/jats:italic>\n                      = 0.73), and musculoskeletal radiology consultants (\n                      <jats:italic toggle=\"yes\">k<\/jats:italic>\n                      = 0.79). One of the radiology consultants had the highest intrarater\n                      <jats:italic toggle=\"yes\">k<\/jats:italic>\n                      value (\n                      <jats:italic toggle=\"yes\">k<\/jats:italic>\n                      = 0.84), significantly higher than one of the orthopaedic consultants (\n                      <jats:italic toggle=\"yes\">k<\/jats:italic>\n                      = 0.67) and one of the orthopaedic residents (\n                      <jats:italic toggle=\"yes\">k<\/jats:italic>\n                      = 0.66). The three other raters had substantial intrarater agreement (\n                      <jats:italic toggle=\"yes\">k<\/jats:italic>\n                      = 0.75 to 0.80). The raters had a strong majority agreement (\u22654\/6 raters) of the Rockwood classification in 82% of the patients in round 1, and in 83% in round 2. Rockwood type II had low majority agreement, with no 5- or 6-raters (only \u22644\/6) agreement.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Nonweightbearing unilateral AP radiographs of AC joint injuries expressed substantial inter- and intrarater reliability. There was an improvement in interrater reliability for all groups from round 1 to round 2. One of the raters had an almost perfect intrarater reliability, and the rest had substantial reliability. The majority agreement for Rockwood type II injuries was low.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/23259671251337470","type":"journal-article","created":{"date-parts":[[2025,5,15]],"date-time":"2025-05-15T13:40:48Z","timestamp":1747316448000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Inter- and Intrarater Reliability of the Acromioclavicular Joint Injury Classification on Anteroposterior Radiographs"],"prefix":"10.1177","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8172-913X","authenticated-orcid":false,"given":"Stein Arve","family":"Skjaker","sequence":"first","affiliation":[{"name":"Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway"},{"name":"Institute of Clinical Medicine, University of Oslo, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2553-137X","authenticated-orcid":false,"given":"Martine","family":"Enger","sequence":"additional","affiliation":[{"name":"Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway"},{"name":"Institute of Clinical Medicine, University of Oslo, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1678-7309","authenticated-orcid":false,"given":"Are Hugo","family":"Pripp","sequence":"additional","affiliation":[{"name":"Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4642-5787","authenticated-orcid":false,"given":"Lars","family":"Nordsletten","sequence":"additional","affiliation":[{"name":"Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway"},{"name":"Institute of Clinical Medicine, University of Oslo, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6774-2194","authenticated-orcid":false,"given":"Berte","family":"B\u00f8e","sequence":"additional","affiliation":[{"name":"Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,5,15]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546519831013"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-196749040-00024"},{"key":"e_1_3_3_4_2","volume-title":"Practical Statistics for Medical Research","author":"Altman DG.","year":"1991","unstructured":"Altman DG. 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