Rockwood classification of acromioclavicular joint injury

Last revised by Sajanakan Sriselvakumar on 5 Aug 2023

The Rockwood classification (1998) is the most common (c.2020) classification system in use for acromioclavicular joint injuries 3,8

This well known 6-type system is a modification of the earlier 3-class classification system described by Allman (1967) 2 and Tossy (1963). The Rockwood classification system is limited to describing soft tissue injuries and does not assess osseous injuries 8

The Rockwood classification takes into account not only the acromioclavicular joint itself but also the coracoclavicular ligament, the deltoid, and trapezius muscles, whilst considering the direction of dislocation of the clavicle with respect to the acromion. Essentially types IV, V, and VI are variants of type III 6

  • type I: normal radiographic appearance with clavicle not elevated with respect to the acromion.

  • type II: widened acromioclavicular joint (>7mm) with <25% clavicular elevation.

    • AC ligament: ruptured

    • CC ligament: sprain

    • joint capsule: ruptured

    • deltoid muscle: minimally detached

    • trapezius muscle: minimally detached

  • type III: clavicle elevated above the superior border of the acromion but the coracoclavicular distance is less than twice normal (i.e. <25 mm) or 5mm greater than this distance on the contralateral side.

    • AC ligament: ruptured

    • CC ligament: ruptured

    • joint capsule: ruptured

    • deltoid muscle: detached

    • trapezius muscle: detached

  • type IV: clavicle displaced posterior into the trapezius, which is rare.

    • AC ligament: ruptured

    • CC ligament: ruptured

    • joint capsule: ruptured

    • deltoid muscle: detached

    • trapezius muscle: detached

  • type V: clavicle is markedly elevated and coracoclavicular distance is more than double normal (i.e. >25 mm) - bilateral weight-bearing projections are able to distinguish type V injuries.

    • AC ligament: ruptured

    • CC ligament: ruptured

    • joint capsule: ruptured

    • deltoid muscle: detached

    • trapezius muscle: detached

  • type VI: clavicle inferiorly displaced behind coracobrachialis and biceps tendons, which is rare.

    • AC ligament: ruptured

    • CC ligament: ruptured

    • joint capsule: ruptured

    • deltoid muscle: detached

    • trapezius muscle: detached

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Cases and figures

  • Figure 1: Rockwood classification of acromioclavicular joint injury
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  • Case 1: normal acromioclavicular joint
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  • Figure 2: illustration - Rockwood types 1 - 6
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  • Case 2: type I
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  • Figure 3: annotated radiographs
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  • Case 3: type II
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  • Case 4: type II
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  • Case 5: type III
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  • Case 6: type III
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  • Case 7: type III
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  • Case 8: type IV
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  • Case 9: type IV
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  • Case 10: type IV treated with coracoclavicular ligament reconstruction
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  • Case 11: type V
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  • Case 12: type V (MRI)
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  • Case 13: type III
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  • Case 14: type V, annotated
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