Patient Outcomes after Surgical Repair of Acromioclavicular Joint Using Cerclage-Wire Figure of ‘8’ Technique at Kumi Orthopaedic Center; A Retrospective Consecutive Case Series

Introduction: Proposed surgical methods for the repair of Acromio-clavicular Joint (ACJ) vary widely. However, the currently available treatment modalities require high technology e.g. specialised sutures that impose a high financial burden to patients especially in low and middle income countries. A modified technique using cerclage wire figure of ‘8’ technique was innovated by the lead surgeon at Kumi-orthopaedic Center for the management of ACJ disruptions that would be suitable for use in low resource settings. However, there was no study done to assess the patient outcomes and quality of life hence this study. Methods: This study was a retrospective consecutive case series of 7 patients that had been managed for ACJ disruptions at KOC using the cerclage wire figure of ‘8’ technique. The outcomes were assessed using the participants’ shoulder constant score, radiological findings and the quality of life measured using the DASH and EQ-5D-5L scores following the surgical repair. Results: Of the 8 participants, the mean age was 37.8 years (SD±4.9). Majority of the participants were male 5 (62.5%) and the commonest mechanism of injury was Road Traffic Accidents (RTA) 6 (75.0%). The right hand was the dominant hand amongst all the participants with the right and left shoulders being affected equally. The median time to surgery following injury was 7 days. The mean number of years of follow up were 5.8 years. Only 1 participant reported history of having repeated injury to the affected shoulder after surgery. The mean shoulder score was 89.3 (SD ± 10.7) with a range of 68.5 to 100, the mean DASH score was 11.7 (SD ± 13.9) with a range of 0 to 41.67 and the mean EQ-5D score was 0.756 (SD ± 0.314) with a range of -0.152 to 1.0. On radiographic evaluation, 6 participants (75.0%) had normal AC joint with 2 (25.0%) still having a widened AC joint. 2 participants had osteoarthritis in the affected shoulder, 2 participants had re-displacement according to the study definition and all had wire breakage with 1 participant having a history of repeated surgery to remove the broken wire. Conclusion: Cerclage wire figure of 8 technique produces comparable results to other high technology surgical techniques used in the management of ACJ disruptions, especially in terms of the shoulder score. This technique could be recommended for use in low resource settings.