RESUMO
BACKGROUND: The mechanism of injury (MoI) for a patellar dislocation has not been fully established. The aim of this study was to use systematic video analysis to determine the MoI of a patella dislocation. METHODS: A systematic search was conducted of three video sharing websites and three popular search engines to identify videos demonstrating a patellar dislocation. Videos were reviewed by three surgeons trained in systematic video analysis, who commented on the position of the lower limb and the situation in which the injury occurred. The results were reviewed to build a consensus of the MoI for each video. Statistical analysis was conducted for interobserver agreement (p < 0.05). RESULTS: Initial search yielded 603 videos with 13 meeting the inclusion criteria. The injuries were sustained performing a sporting activity (n = 9) or whilst dancing (n = 4). The injury was predominantly sustained during a non-contact situation (n = 10). The most common mechanism was an unbalanced individual with a flexed hip sustaining a valgus force to their flexed knee with the tibia externally rotated. CONCLUSIONS: This study provides some insight into the MoI for a patellar dislocation and the findings may assist in developing injury prevention programmes and rehabilitation protocols as well as guiding future research.
RESUMO
BACKGROUND: Patellar dislocations are a significant injury with the potential for long term problems. Little work has been done on establishing the mechanism by which this injury occurs. OBJECTIVES: To determine the mechanism of injury of a patella dislocation based on the available published literature and compare them to already proposed theories. METHODS: A systematic review of the literature was conducted following searches performed on MEDLINE, EMBASE and ProQuest from the earliest year of indexing using the following search terms in any combination: "patella", "dislocation", "mechanism of injury", "anatomy", "biomechanical" and "risk factor". A broad inclusion criteria was used that included studies that looked at patellar dislocations and instability with respect to the patellofemoral joint (PFJ) kinematics or altered kinematics of the PFJ. Studies that did not address the kinematics or biomechanics of the PFJ were excluded. Studies were appraised based on their methodology using a combination of the Critical Appraisal Skills Programme tool and the Quality Appraisal for Cadaveric Studies. RESULTS: 113 studies were identified from a search of MEDLINE, EMBASE and ProQuest databases. Following application of our inclusion criteria, a total of 23 studies were included in our review. 18 of these studies were cadaveric biomechanical studies. The remaining studies were anatomical, imaging based, and a computer simulation based study. CONCLUSIONS: These biomechanical and kinematic studies provide some evidence that a dislocation is likely to occur during early knee flexion with external rotation of the tibia and contraction of the quadriceps. There is limited evidence to support other elements of proposed mechanisms of dislocation.
RESUMO
Previous descriptions of the pattern of communication between the digital flexor tendon sheaths have been largely based on imaging studies. An anatomic study on 12 cadaveric hands was conducted using water soluble dye and directly observed patterns of communication between the digital flexor tendon sheaths and the radial and ulnar bursae. Four out of twelve specimens (33%) demonstrated a communication between the radial and ulnar bursae. The ulnar bursa communicated with the ring finger flexor sheath in two specimens, and the index finger flexor sheath in two specimens. One hand (8.3%) showed communication between the middle finger tendon sheath and radial bursa and between the index finger flexor tendon sheath and radial bursa. These findings show a considerable level of variation in communicating patterns between the synovial sheaths of the hand and wrist. Clinicians should be aware of the possibility of variations to the classical presentation of spread of infection through the digital flexor sheaths.
