EVAR in octogenarians and nonagenarians is associated with a significantly higher but still low perioperative mortality compared to younger patients. Midterm survival in octogenarians and nonagenarians, although significantly lower than in younger patients, is still acceptable, indicating that age >80 years should not be an exclusion criteria for EVAR. Even high-risk patients >80 years can be treated safely with a low perioperative mortality and comparable midterm outcome to younger high-risk patients.

No abstract

Laboratory controlled study level 2.

The purpose of the study was to assess the fixation durability of the AperFix System (Cayenne Medical, Inc, Scottsdale, Arizona) used in arthroscopic reconstruction of the anterior cruciate ligament. The AperFix System consists of a femoral and tibial component designed to secure either allograft or autograft. The outcomes of 185 knees (180 patients) were retrospectively reviewed at a minimum of 2 years postoperatively. Mean age at surgery was 31±12 years (range, 16-68 years). Of these, a convenience sample was seen prospectively to obtain radiographs and to assess functional status. No cases occurred of fixation failure involving loss of graft positioning or pullout. No patients required revision anterior cruciate ligament reconstruction. In 2 knees, the tip of the central fixation pin had to be modified as a result of hardware prominence and soft tissue irritation at 434 and 159 days postoperatively, respectively. In 4 knees, tibial screw removal occurred secondary to local discomfort (mean, 239 days; range, 105-371 days). No other recurring adverse events or problems associated with the implants were identified. Forty-four patients were evaluated prospectively at a mean follow-up of 32±7 months. Lysholm scores and patient satisfaction scores were positively and significantly correlated with Tegner activity scores (r=0.61; P<.0001). Eighty-two (82%) patients had a KT-1000 (Medmetric Corp, San Diego, California) side-to-side difference of less than 3 mm (average, 0.4 mm). No indications of femoral device migration existed when comparing follow-up and immediate postoperative radiographs. The AperFix System provides durable femoral aperture fixation during anterior cruciate ligament reconstruction with excellent clinical outcome scores and a low complication rate.

Perilunate dislocations are a devastating injury to the carpus that carry a guarded long-term prognosis. Mayfield type 4 perilunate dislocations are rare, high-energy injuries that carry a risk for avascular necrosis (AVN) of the lunate. When AVN ensues and the carpus collapses, primary treatment with a proximal row carpectomy or arthrodesis has been advocated. This case reports a successful clinical result and revascularization of an extruded lunate with open reduction and internal fixation. This type 4, Gustilo grade 1 open perilunate dislocation exhibited complete avulsion of all lunate ligamentous attachments. Management included open reduction and internal fixation as well as carpal tunnel release through a combined dorsal and volar approach. Despite concerns for lunate AVN due to complete disruption of lunate vascularity, a 10-month postoperative clinical and radiographic examination demonstrated no pain with activities of daily living as well as a revascularized lunate.