Properties of Knee Joint Position Sense Tests for Anterior Cruciate Ligament Injury: A Systematic Review and Meta-analysis

Abstract

Background: Knee proprioception is believed to be deficient after anterior cruciate ligament (ACL) injury. Tests of joint position sense (JPS) are commonly used to assess knee proprioception, but their psychometric properties (PMPs) are largely unknown. Purpose: To evaluate the PMPs (reliability, validity, and responsiveness) of existing knee JPS tests targeting individuals with ACL injury. Study Design: Systematic review; Level of evidence, 4. Methods: PubMed, Allied and Complementary Medicine, CINAHL, SPORTDiscus, Web of Science, Scopus, CENTRAL, and ProQuest databases were searched to identify studies that assessed PMPs of knee JPS tests in individuals with ACL injury. The risk of bias for each included study was assessed and rated at the outcome level for each knee JPS test. Overall quality and levels of evidence for each PMP were rated according to established criteria. Meta-analyses with mean differences were conducted using random effects models when adequate data were available. Results: Included were 80 studies covering 119 versions of knee JPS tests. Meta-analyses indicated sufficient quality for known-groups and discriminative validity (ACL-injured knees vs knees of asymptomatic controls and contralateral noninjured knees, respectively), owing to significantly greater absolute errors for ACL-injured knees based on a strong level of evidence. A meta-analysis showed insufficient quality for responsiveness, which was attributed to a lack of significant change over time after diverse interventions with a moderate level of evidence. Statistical heterogeneity ( I 2 > 40%) was evident in the majority of meta-analyses. All remaining PMPs (reliability, measurement error, criterion validity, convergent validity, and other PMPs related to responsiveness) were assessed qualitatively, and they failed to achieve a sufficient quality rating. This was a result of either the study outcomes not agreeing with the statistical cutoff values/hypotheses or the level of evidence being rated as conflicting/unknown or based on only a single study. Conclusion: Knee JPS tests appear to have sufficient validity in differentiating ACL-injured knees from asymptomatic knees. Further evidence of high methodologic quality is required to ascertain the reliability, responsiveness, and other types of validity assessed here. We recommend investigations that compare the modifiable methodologic components of knee JPS tests on their PMPs to develop standardized evidence-based tests.

Properties of tests for knee joint threshold to detect passive motion following anterior cruciate ligament injury: a systematic review and meta-analysis

“…Although one study by Roberts et al [ 22 ] reported the standard error of measurement (SEM; 0.003°to 0.24°) for their TTDPM outcomes, the overall RoB was rated “inadequate” (Additional file 4 : Table S4) because the study did not report whether the patients were stable between measurements (test–retest interval was one month). In our previous systematic review on the PMPs of knee joint position sense (JPS) tests [ 11 ] only three studies (with RoB ratings of “inadequate”) reported test–retest reliability and one study (with an RoB rating of “very good”) reported insufficient quality for intra-session reliability. In agreement with the current findings of the TTDPM tests, there is therefore a lack of evidence for the reliability of tests that attempt to assess kinesthesia, i.e.…”

“…Due to our search encompassing all tests of proprioception as part of our review series, further details of the study selection process are provided in our previous review [ 11 ]. Briefly, after removal of duplicates, two authors (AS, ET) independently screened all titles, abstracts and full texts of relevance according to the stated eligibility criteria.…”

Effects of Adding Aquatic-to-Land-Based Physiotherapy Programs for Shoulder Joint Position Sense Rehabilitation

“…Research on shoulder and knee JPS indicates that statistically larger errors are found while the active reproduction is performed compared with passive reproduction of joint position. [ 42 , 49 ] Regarding the positioning of the participant when assessing shoulder proprioception, it has been found that there are no statistically significant differences in outcome, regardless of whether the participant is in a supine, sitting, or standing position [ 50 , 51 ].…”

Brain Response To A Knee Proprioception Task Among Persons With Anterior Cruciate Ligament Reconstruction And Controls

“…It is therefore possible that de cits in proprioception were not present among the individuals of our ACLR group, who were active and participated on average 23 months after surgical reconstruction. Additionally, a recent meta-analysis found that only knee JPS tests with passive rather than active movements differentiate between ACL-injured knees and those of asymptomatic controls 9 . The active movements of the current test, which also incorporated the hip, may further have contributed to the lack of between-group difference seen here.…”

“…Outcomes are based on the difference in degrees between the target and reproduced angles, thus re ecting the kinematic errors. Meta-analyses have found signi cantly greater knee JPS errors for ACLinjured knees compared to both the contralateral non-injured knees of the same individuals [7][8][9] and to those of asymptomatic persons 8,9 . The clinical signi cance of these ndings is however unclear given the small absolute differences of < 1° knee exion angle.…”