Proprioception after rehabilitation and reconstruction in knees with deficiency of the anterior cruciate ligament

Abstract

We assessed proprioception in the knee using the angle reproduction test in 20 healthy volunteers, ten patients with acute anterior instability and 20 patients with chronic anterior instability after reconstruction of the anterior cruciate ligament (ACL). In addition, the Lysholm-knee score, ligament laxity and patient satisfaction were determined. Acute trauma causes extensive damage to proprioception which is not restored by rehabilitation alone. Three months after operation, there remained a slight decrease in proprioception compared with the preoperative recordings, but six months after reconstruction, restoration of proprioception was seen near full extension and full flexion. In the mid-range position, proprioception was not restored. At follow-up, 3.7 +/- 0.3 years after reconstruction, there was further improvement of proprioception in the mid-range position. There was no difference between open and arthroscopic techniques. The highest correlation was found between proprioception and patient satisfaction. After reconstruction of the ACL reduced proprioception may explain the poor functional outcome in some patients, despite restoration of mechanical stability.

Somatosensory Function Influences Aberrant Gait Biomechanics Following Anterior Cruciate Ligament Reconstruction

“…This finding conflicts with Bonfim et al 12 and San Martin-Mohr et al 31 who reported poorer proprioception in the ACLR limb. Likewise, Fremerey et al 13 reported poorer proprioception in the ACLR limb 3 months post-ACLR, yet no differences existed at 6 months similar to Co et al 10 an average of 32 months post-ACLR. Each of these studies evaluated passive JPS in a non-weight bearing position with the exception of San Martin-Mohr et al who evaluated active JPS, but in a non-weight bearing position.…”

“…Deficits in somatosensory function have been reported following ACLR primarily evidenced by impaired sensations of joint position (proprioception) and motion (kinesthesia). [11][12][13] However, other investigators have reported that these sensory modalities do not differ between the surgical and contralateral limbs or compared to healthy controls following ACLR. 10,[14][15][16] Vibratory perception is also reportedly impaired in the ACLR limb compared to the contralateral limb, 11 but does not appear to differ from healthy controls.…”

Dynamic Assessment in Patients Following Bone-Patellar Tendon-Bone Autograft Anterior Cruciate Ligament Reconstruction

“…There are several studies that demonstrate impaired proprioception of the knee [8-10]. Proprioception is referred to as the conscious perception of limb position in space and is facilitated by receptors (Ruffini endings, Pacinian corpuscles, Golgi tendon organs and free nerve endings) [8-10]. These receptors are found in the skin, ligaments, capsule, tendons and menisci of the knee.…”

“…These receptors are found in the skin, ligaments, capsule, tendons and menisci of the knee. The majority of the joint mechanoreceptors are located at the tibial and femoral insertions of the ligaments, most of which are subsynovial [8-10]. Reproducing the passive range of motion to measure knee proprioception does not give as accurate results as the quantitative methods used in a motion analysis.…”

“…Significant reductions in joint flexion were found at the hip, knee and ankle during the stance phase six months after surgery compared with 3 weeks after surgery [11]. Neuromuscular adaptation can significantly influence dynamic function in subjects with ACL reconstruction (either BPTB or ST/G procedure) during activities such as walking, jumping, ascending the stairs or descending the stairs [8-10]. However, none of these studies have investigated gait adaptation in individuals near skeletal maturity following BPTB during stair ascending and descending.…”