Failure mode of suture anchors as a function of insertion depth.

BACKGROUND: Surgeons can control not only the angle but also the depth of suture anchor placement during arthroscopic rotator cuff repair, although the tendency may be to place suture anchors on the deep side to avoid damage from prominent anchor eyelets. However, little information is available regarding possible effects of suture anchor depth on construct failure mechanisms. HYPOTHESIS: Anchor depth affects the mode of suture failure with physiologically relevant cyclic loads. STUDY DESIGN: Controlled laboratory study. METHODS: Metallic screw-in suture anchors loaded with No. 2 braided polyester sutures were inserted into the bovine infra-spinatus footprint with the eyelet proud, standard, or deep. Sutures were hand tied to create a closed loop. Constructs were cyclically loaded from 10 to 90 N and, if still intact at 500 cycles, taken to ultimate failure (maximum load). RESULTS: When clinical failure was defined as greater than 3-mm construct elongation, anchors placed with the eyelet deep experienced statistically earlier clinical failure via cutting of the suture through the bone (P < .02). However, anchors placed at this level did not experience catastrophic failure during cyclic loading. The standard and proud anchors experienced 3 mm of elongation at a greater number of cycles, but the suture material degraded at the anchor eyelet, and a majority of these constructs broke during cyclic physiologic loading. At failure testing, the deep anchors had a significantly increased failure load (164 N) compared to standard (133 N) (P < .04) and proud (113 N) anchors (P < .005). CONCLUSION: Varying the depth of suture anchor insertion changes the mechanical properties and mode of failure of suture anchor constructs. CLINICAL RELEVANCE: Surgeons should be aware of the effects of suture anchor depth and abrasive eyelet wear on construct failure during arthroscopic rotator cuff repair.

Arthroscopic treatment of synovial disorders in the shoulder, elbow, and ankle.

A wide range of synovial conditions can affect patient function and often respond to conservative treatment. However, when symptoms do not respond, arthroscopic synovectomy is a useful tool for management. Pigmented villonodular synovitis, synovial chondromatosis, rheumatoid arthritis, adhesive capsulitis of the shoulder, and ankle impingement are the diseases that most often require synovectomy. Arthroscopic management offers the following advantages over open synovectomy: a more thorough evaluation of the joint and synovium, better access for surgical synovectomy, and decreased postoperative morbidity.

Survival analysis in quality improvement: the Diabetic Kidney Disease Project extrapolation group estimates.

Survival analysis is used in a wide variety of research settings to maximize the information extracted from a group of timed observations. Measures employed in continuous quality improvement (CQI) efforts often involve such observations. Yet to date, survival analysis has not been widely used to guide CQI efforts. This article presents the features of survival analysis that are most applicable to CQI efforts and illustrates the application of these techniques to a quality improvement project focused on diabetic kidney disease. Results are compared with those from a "standard" analysis. The interpretation of results is discussed in the context of constraints typical of CQI efforts. The article concludes with a recommendation for broader application of this valuable analytic methodology.

Perioperative antibiotics in nonemergency bowel surgery: a quality improvement project.

BACKGROUND: Guideline development has received considerable attention recently; guideline implementation less. For various reasons, reports of guideline implementations are not common in the published literature. In this paper, we report the results of a multisite quality improvement project undertaken as part of Health Care Financing Administration's Heath Care Quality Improvement Program. METHODS: Six acute care hospitals were selected for participation according to the number of procedures during the calendar year 1993. Baseline and postintervention data were abstracted from the medical records of patients having bowel surgery. Performance feedback, education, and process improvement facilitation were the principal interventions used by the investigators; quality improvement plans varied by participant. Baseline and postintervention indicators were calculated. RESULTS: Statistically significant and practically meaningful improvement was observed in the primary indicator and in 4 of 11 subindicators. Conservative estimates indicated modest cost savings. CONCLUSIONS: Administration of perioperative antibiotics in bowel surgery can be improved by guideline implementations based on a continuous quality improvement model.

The buddy volunteer commitment in AIDS care.

Buddy volunteers provide crucial assistance to people with HIV-related illnesses. Based on volunteers' self-administered questionnaires, our study describes the nature of buddy work. Volunteers indicated their satisfaction with both personal performance and buddy program administration. Several factors were associated with volunteer satisfaction. This report is a first attempt to describe this special relationship created in response to the human immunodeficiency virus (HIV) epidemic.