Joint position sense and rehabilitation in the anterior cruciate ligament deficient knee.

Abstract

Background-Impaired joint position sense (JPS) has been shown in anterior cruciate ligament (ACL) deficient and osteoarthritic knees. The relation between JPS and function is uncertain. The aim of this study was to determine further ifACL deficient knees show abnormal JPS and the effect of exercise therapy on JPS, and also to assess the relation between JPS, functional stability, and strength. Methods-Fifty patients (46 men and four women, mean age 26.3 years) with unilateral ACL deficient knees were assessed on admission and after rehabilitation (5 hours a day for four weeks). JPS was assessed by reproduction of passive positioning using a visual analogue incorporating a goniometer. Knee stability was analysed by self report questionnaire (score 0-280) and functional activity test (single leg hop and figure of eight run). Isokinetic dynamometry was performed to evaluate quadriceps and hamstring peak torque strength. Controls were either age and sex matched individuals or the contralateral knee. Statistical analysis was by Wilcoxon signed rank test and Spearman rank order correlation coefficient. Results-JPS was impaired in ACL deficient knees. The mean (SD) errors in reproducing angles were 9.4 (3.1)0 and 7.1 (2.3)0 for the ACL deficient knee and control knee respectively (P<0.0005). There was no improvement in JPS after rehabilitation (9.4 (3.1)°and 8.5 (3.2)0 before and after rehabilitation respectively, P = 0.14). There was improvement as ascertained from the questionnaire ( (Br J Sports Med 1997;31:209-212)

Early compensatory and anticipatory postural adjustments following anterior cruciate ligament reconstruction

“…Overall, these findings would strongly suggest that mechanosensitive nerve endings of the ACL are involved in providing the CNS with information about the knee joint position and movement. This is indirectly supported by an impaired ability to recognize the knee position in space, referred to as joint position sense, in individuals with ACLdeficient or reconstructed knees (Skinner and Barrack 1991;Carter et al 1997). In previous histological studies, it has been shown that sensory innervation of the patellar tendon autograft needs a minimum of 5 months to be fully recovered after surgery (Aune et al 1996).…”

Validity of Two Clinical Knee Strength Assessments Compared to the Reference Standard

“…The upper limbs as a swinging element, could therefore be one of the strongest influencing factors is the knee strength assessments. Interestingly, in a literature review 7 of 18 studies (39%) [6,15,19,21,22,23,24] relating to the hop test do not describe the use of the arms. Additionally, the method of measuring the distance of the hop differed considerably.…”

Laboratory Evaluation of the Pivot-Shift Phenomenon with Use of Kinetic Analysis

“…Also, we did not note a direct relationship between the reduction of quadriceps muscle strength (20%) and a significant reduction of the kinetic parameters in pivoting. We included only patients with normal proprioception because it has been reported that decreased proprioception in patients with an ACL deficiency reduced their functional ability 22,23 . Finally, we included only patients with isolated ACL tears so that associated lesions could not influence the kinetic parameters studied.…”