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Ma X, Lu L, Zhou Z, Sun W, Chen Y, Dai G, Wang C, Ding L, Fong DTP, Song Q. Correlations of strength, proprioception, and tactile sensation to return-to-sports readiness among patients with anterior cruciate ligament reconstruction. Front Physiol 2022; 13:1046141. [PMID: 36569757 PMCID: PMC9768442 DOI: 10.3389/fphys.2022.1046141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
Objectives: Anterior cruciate ligament reconstruction (ACLR) is the most common surgery for anterior cruciate ligament (ACL) injuries, and the relationships between patients' return to sports (RTS) readiness and different physical functions are inconclusive among patients with ACLR. This study aimed to investigate the correlations of strength, proprioception, and tactile sensation to the RTS readiness among patients with ACLR. Methods: Forty-two participants who received ACLR for at least 6 months were enrolled in this study. Their strength, proprioception, and tactile sensation were tested, and their RTS readiness was measured with the Knee Santy Athletic Return to Sports (K-STARTS) test, which consists of a psychological scale [Anterior Cruciate Ligament Return to Sports after Injury scale (ACL-RSI)] and seven functional tests. Partial correlations were used to determine their correlations while controlling for covariates (age, height, weight, and postoperative duration), and factor analysis and multivariable linear regressions were used to determine the degrees of correlation. Results: Knee extension strength was moderately correlated with K-STARTS total, ACL-RSI, and functional scores. Knee flexion strength, knee flexion and extension proprioception, and tactile sensation at the fifth metatarsal were moderately correlated with K-STARTS total and functional scores. Strength has higher levels of correlation with functional scores than proprioception. Conclusion: Rehabilitation to promote muscle strength, proprioception and tactile sensation should be performed among patients with ACLR, muscle strength has the highest priority, followed by proprioception, with tactile sensation making the least contribution.
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Affiliation(s)
- Xiaoli Ma
- College of Sports and Health, Shandong Sport University, Jinan, China
| | - Lintao Lu
- Department of Orthopedic Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Zhipeng Zhou
- College of Sports and Health, Shandong Sport University, Jinan, China
| | - Wei Sun
- College of Sports and Health, Shandong Sport University, Jinan, China
| | - Yan Chen
- College of Sports and Health, Shandong Sport University, Jinan, China
| | - Guofeng Dai
- Department of Orthopedic Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Cheng Wang
- Department of Orthopedic Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Lijie Ding
- College of Sports and Health, Shandong Sport University, Jinan, China
| | - Daniel Tik-Pui Fong
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Qipeng Song
- College of Sports and Health, Shandong Sport University, Jinan, China,*Correspondence: Qipeng Song,
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Strong A, Arumugam A, Tengman E, Röijezon U, Häger CK. Properties of tests for knee joint threshold to detect passive motion following anterior cruciate ligament injury: a systematic review and meta-analysis. J Orthop Surg Res 2022; 17:134. [PMID: 35246192 PMCID: PMC8895768 DOI: 10.1186/s13018-022-03033-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Threshold to detect passive motion (TTDPM) tests of the knee joint are commonly implemented among individuals with anterior cruciate ligament (ACL) injury to assess proprioceptive acuity. Their psychometric properties (PMPs), i.e. reliability, validity and responsiveness, are however unclear. This systematic review aimed to establish the PMPs of existing knee joint TTDPM tests among individuals with ACL injury. METHODS The databases PubMed, AMED, CINAHL, SPORTDiscus, Web of Science, Scopus, CENTRAL and ProQuest were searched to identify studies that assessed the properties of knee joint TTDPM tests in individuals with ACL injury. The risk of bias for each included study was assessed at the outcome level for each test. Overall quality and levels of evidence for each property were rated according to established criteria. Meta-analyses with mean differences were conducted using random-effects models when adequate data were available. RESULTS Fifty-one studies covering 108 TTDPM tests and 1632 individuals with unilateral ACL injury were included. A moderate-to-strong level of evidence indicated insufficient quality for all of the following: convergent validity, known-groups validity, discriminative validity, responsiveness between subgroups, and responsiveness to intervention. Subgroup meta-analyses for known-groups validity did however find that a starting angle of 15° resulted in significantly worse TTDPM for knees with ACL injury compared to those of asymptomatic persons (mean difference 0.28°; 95% CI 0.03 to 0.53; P = 0.03), albeit based on only three studies. Due to the lack of evidence, it was not possible to estimate the quality of reliability, measurement error, and criterion validity, nor responsiveness from a criterion and construct approach. CONCLUSIONS Among persons with ACL injury, existing tests of knee joint TTDPM lack either sufficient quality or evidence for their reliability, validity and responsiveness. Significantly worse thresholds for ACL-injured knees compared to those of asymptomatic controls from a 15° starting angle and trends towards significance for some validity measures nevertheless encourage the development of standardised tests. Further research investigating the influence of modifiable test components (e.g. starting angle and motion direction) on the PMPs of knee joint TTDPM tests following ACL injury is warranted.
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Affiliation(s)
- Andrew Strong
- Department of Community Medicine and Rehabilitation, Physiotherapy Section, Umeå University, Umeå, Sweden.
| | - Ashokan Arumugam
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Eva Tengman
- Department of Community Medicine and Rehabilitation, Physiotherapy Section, Umeå University, Umeå, Sweden
| | - Ulrik Röijezon
- Department of Health, Learning and Technology, Physiotherapy Section, Luleå University of Technology, Luleå, Sweden
| | - Charlotte K Häger
- Department of Community Medicine and Rehabilitation, Physiotherapy Section, Umeå University, Umeå, Sweden
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Fleming JD, Ritzmann R, Centner C. Effect of an Anterior Cruciate Ligament Rupture on Knee Proprioception Within 2 Years After Conservative and Operative Treatment: A Systematic Review with Meta-Analysis. Sports Med 2021; 52:1091-1102. [PMID: 34854058 PMCID: PMC9023382 DOI: 10.1007/s40279-021-01600-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The anterior cruciate ligament (ACL) plays a major role in knee proprioception and is thus responsible for maintaining knee joint stability and functionality. The available evidence suggests that ACL reconstruction diminishes somatosensory feedback and proprioceptive functioning, which are vital for adequate joint positioning and movement control. OBJECTIVE The aim of this systematic review and meta-analysis was to investigate the effect of an ACL rupture on knee proprioception after arthroscopic ACL repair surgery or conservative treatment. METHODS A systematic review with meta-analysis was conducted according to the Preferred Reporting Guidelines for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The literature search was performed in the following databases from inception to 10th October 2020: PubMed, Web of Science, SPORTDiscus, Cochrane Library and Scopus. Randomized and non-randomized studies that evaluated proprioception using the joint position sense (JPS) and threshold to detection of passive motion (TTDPM) techniques at 15°-30° knee flexion with an external healthy control group in a time period between 6 and 24 months post injury or operation were included in the analysis. RESULTS In total, 4857 studies were identified, from which 11 were included in the final quantitative analysis. The results demonstrated that proprioception after arthroscopic ACL repair surgery was significantly lower than in the healthy control group (JPS: standardized mean difference [SMD] 0.57, 95% confidence interval [CI] 0.27-0.87, p < 0.01, n = 6 studies; TTDPM: SMD 0.77, 95% CI 0.20-1.34, p < 0.01, n = 4 studies). There were no significant differences in proprioception between the conservative treatment group and the healthy control group (JPS: SMD 0.57, 95% CI - 0.69 to 1.84, p = 0.37, n = 4 studies; TTDPM: SMD 0.82, 95% CI - 0.02 to 1.65, p = 0.05, n = 2 studies), although measures for TTDPM were close to statistical significance. CONCLUSION The findings of the present systematic review and meta-analysis revealed that knee proprioception is persistently compromised 6-24 months following surgical treatment of ACL tears compared with healthy controls. The reduced kinesthetic awareness after ACL surgery is of high relevance for optimizing individual treatment plans in these patients. As the current literature is still scarce about the exact underlying mechanisms, further research is needed. TRIAL REGISTRATION The present systematic review was registered in PROSPERO (CRD42021198617).
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Affiliation(s)
- John Dick Fleming
- Department of Sport and Sport Science, University of Freiburg, Schwarzwaldstraße 175, 79117, Freiburg, Germany
| | | | - Christoph Centner
- Department of Sport and Sport Science, University of Freiburg, Schwarzwaldstraße 175, 79117, Freiburg, Germany. .,Praxisklinik Rennbahn, Muttenz, Switzerland.
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Strong A, Arumugam A, Tengman E, Röijezon U, Häger CK. Properties of Knee Joint Position Sense Tests for Anterior Cruciate Ligament Injury: A Systematic Review and Meta-analysis. Orthop J Sports Med 2021; 9:23259671211007878. [PMID: 34350298 PMCID: PMC8287371 DOI: 10.1177/23259671211007878] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 01/01/2021] [Indexed: 12/29/2022] Open
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 (I2 > 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.
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Affiliation(s)
- Andrew Strong
- Department of Community Medicine and Rehabilitation, Physiotherapy Section, Umeå University, Umeå, Sweden
| | - Ashokan Arumugam
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Eva Tengman
- Department of Community Medicine and Rehabilitation, Physiotherapy Section, Umeå University, Umeå, Sweden
| | - Ulrik Röijezon
- Department of Health, Learning and Technology, Physiotherapy Section, Luleå University of Technology, Luleå, Sweden
| | - Charlotte K Häger
- Department of Community Medicine and Rehabilitation, Physiotherapy Section, Umeå University, Umeå, Sweden
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Karuc J, Mišigoj-Duraković M, Šarlija M, Marković G, Hadžić V, Trošt-Bobić T, Sorić M. Can Injuries Be Predicted by Functional Movement Screen in Adolescents? The Application of Machine Learning. J Strength Cond Res 2021; 35:910-919. [PMID: 33555832 DOI: 10.1519/jsc.0000000000003982] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
ABSTRACT Karuc, J, Mišigoj-Duraković, M, Šarlija, M, Marković, G, Hadžić, V, Trošt-Bobić, T, and Sorić, M. Can injuries be predicted by functional movement screen in adolescents? The application of machine learning. J Strength Cond Res 35(4): 910-919, 2021-This study used machine learning (ML) to predict injuries among adolescents by functional movement testing. This research is a part of the CRO-PALS study conducted in a representative sample of adolescents and analyses for this study are based on nonathletic (n = 364) and athletic (n = 192) subgroups of the cohort (16-17 years). Sex, age, body mass index (BMI), body fatness, moderate-to-vigorous physical activity (MVPA), training hours per week, Functional Movement Screen (FMS), and socioeconomic status were assessed at baseline. A year later, data on injury occurrence were collected. The optimal cut-point of the total FMS score for predicting injury was calculated using receiver operating characteristic curve. These predictors were included in ML analyses with calculated metrics: area under the curve (AUC), sensitivity, specificity, and odds ratio (95% confidence interval [CI]). Receiver operating characteristic curve analyses with associated criterium of total FMS score >12 showed AUC of 0.54 (95% CI: 0.48-0.59) and 0.56 (95% CI: 0.47-0.63), for the nonathletic and athletic youth, respectively. However, in the nonathletic subgroup, ML showed that the Naïve Bayes exhibited highest AUC (0.58), whereas in the athletic group, logistic regression was demonstrated as the model with the best predictive accuracy (AUC: 0.62). In both subgroups, with given predictors: sex, age, BMI, body fat percentage, MVPA, training hours per week, socioeconomic status, and total FMS score, ML can give a more accurate prediction then FMS alone. Results indicate that nonathletic boys who have lower-body fat could be more prone to suffer from injury incidence, whereas among athletic subjects, boys who spend more time training are at a higher risk of being injured. Conclusively, total FMS cut-off scores for each subgroup did not successfully discriminate those who suffered from those who did not suffer from injury, and, therefore, our research does not support FMS as an injury prediction tool.
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Affiliation(s)
- Josip Karuc
- Department of Sport and Exercise Medicine, Faculty of Kinesiology, University of Zagreb, Zagreb, Croatia
| | - Marjeta Mišigoj-Duraković
- Department of Sport and Exercise Medicine, Faculty of Kinesiology, University of Zagreb, Zagreb, Croatia
| | - Marko Šarlija
- Department of Electric Machines, Drives and Automation, Faculty of Electrical Engineering and Computing, University of Zagreb, Zagreb, Croatia
| | - Goran Marković
- Department of Kinesiology of Sport, Faculty of Kinesiology, University of Zagreb, Zagreb, Croatia
| | - Vedran Hadžić
- Department of Sport and Exercise Medicine, Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia; and
| | - Tatjana Trošt-Bobić
- Department of General and Applied Kinesiology, Faculty of Kinesiology, University of Zagreb, Zagreb, Croatia
| | - Maroje Sorić
- Department of Sport and Exercise Medicine, Faculty of Kinesiology, University of Zagreb, Zagreb, Croatia
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Matsuo T, Koyanagi M, Okimoto R, Moriuchi T, Ikeda K, Nakae N, Nakagawa S, Shino K. Quantitative Evaluation of Functional Instability Due to Anterior Cruciate Ligament Deficiency. Orthop J Sports Med 2020; 8:2325967120933885. [PMID: 32733975 PMCID: PMC7370573 DOI: 10.1177/2325967120933885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 02/21/2020] [Indexed: 11/23/2022] Open
Abstract
Background: A safe and simple procedure to evaluate functional instability due to anterior cruciate ligament (ACL) deficiency (ACLD) has not been established. The angle of trunk backward tilting, which is known as a posture at risk for ACL injuries, could be used as a parameter to evaluate functional instability due to ACLD. Purpose: To measure the backward tilt angle of the trunk with participants standing upright on 1 leg and to investigate its usefulness to quantitatively evaluate functional instability due to ACLD. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Our cohort included 50 participants with unilateral ACLD and 40 participants with bilateral healthy knees. The trunk backward tilt (TBT) test was conducted as follows: the participant was asked to maximally tilt the trunk backward in a single-leg standing position, while forward tilt of the index leg was blocked with a custom-made device. The TBT angle was measured using a side-view photograph. Subjective knee instability during the test was recorded using a visual analog scale (VAS). The relative and absolute reliability of the TBT test were verified in a sample of healthy participants and those with ACLD, and comparisons between indicators were performed. Multiple regression analysis was performed with the injured/uninjured side ratio (I/U ratio) of the TBT angle as the dependent variable and the following independent variables: (1) I/U ratio of knee extension muscle strength, (2) I/U ratio of knee flexion muscle strength, (3) side-to-side difference (SSD) of the KT-1000 arthrometer measurement, (4) sex, and (5) SSD of the VAS score. Results: The TBT test had high reliability among healthy participants and those with ACLD. The TBT angle was significantly smaller and the VAS score was significantly higher on the injured side compared with the uninjured side and with healthy knees (P < .001 for all). Among the independent variables, the SSD of the VAS score had a negative influence on the I/U ratio of the TBT angle (R2 = 0.59; P < .001). Conclusion: The TBT test is a simple, safe, and reliable method for quantitatively evaluating functional instability due to ACLD under weightbearing conditions that reflect subjective knee instability. The test will provide an index of treatment outcomes and return to sports through additional objective measurements before and after ACL reconstruction.
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Affiliation(s)
- Takayuki Matsuo
- Faculty of Health Science, Osaka Yukioka College of Health Science, Ibaraki, Japan
| | - Maki Koyanagi
- Faculty of Biomedical Engineering, Osaka Electro-Communication University, Shijonawate, Japan
| | - Ryo Okimoto
- Department of Rehabilitation, Yukioka Hospital, Osaka, Japan
| | | | - Koji Ikeda
- Faculty of Health Science, Osaka Yukioka College of Health Science, Ibaraki, Japan
| | - Naruhiko Nakae
- Department of Rehabilitation, Kansai Medical Hospital, Toyonaka, Japan
| | | | - Konsei Shino
- Faculty of Health Science, Osaka Yukioka College of Health Science, Ibaraki, Japan
- Sports Orthopaedic Center, Yukioka Hospital, Osaka, Japan
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Laboute E, Verhaeghe E, Ucay O, Minden A. Evaluation kinaesthetic proprioceptive deficit after knee anterior cruciate ligament (ACL) reconstruction in athletes. J Exp Orthop 2019; 6:6. [PMID: 30729340 PMCID: PMC6367489 DOI: 10.1186/s40634-019-0174-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 01/17/2019] [Indexed: 11/10/2022] Open
Abstract
PURPOSE The objective of this study was to evaluate kinaesthetic proprioceptive deficit after knee anterior cruciate ligament (ACL) reconstruction in two populations of athletes, those in the post-surgery period and those in re-training during the intensive program-training phase. METHODS We performed a prospective study in ACL-operated athletes without previous knee injuries, with 32 athletes in each group. Time since surgery in the operated athletes in the post-surgery group was 21 to 35 days, and between three and 9 months in the re-training group. We also analysed a control group of 32 uninjured non-operated subjects with a similar sporting level. Proprioception was evaluated using the threshold to detection of passive motion (TDPM) test with Biodex-type isokinetic equipment comparing operated knees, non-operated knees and control uninjured non-operated group. The control group was tested twice, 1 day apart to control reproducibility, using the intraclass correlation coefficient (ICC). The p-value threshold for statistical significance between different groups in hypothesis testing was <.05. RESULTS TDPM reproducibility was excellent (right knee: ICC = 0.80, left knee: ICC =0.72). We found a bilateral kinaesthetic deficit in post-surgery patients compared to the control group (p < 0.001 and p = 0.011), which was significantly higher on the operated side (p = 0.001). Re-training patients had no significant difference between operated and uninjured knees, but had a kinaesthetic deficit on operated limbs (p = 0.036) compared to the control group. CONCLUSION There was a bilateral deficit in post-surgery athletes with a significant difference between injured and healthy knees, which could be explained by a change in the central nervous system. Compared to the control group, a proprioceptive deficit was only seen for re-training patients on the operated side and not in the healthy limb. Kinaesthetic recovery may be faster for the uninjured side as initial deficit is lower. Level of evidence II.
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Affiliation(s)
- E Laboute
- C.E.R.S, Ramsay Générale de Santé, 83 av Maréchal de Lattre de Tassigny, 40130 Capbreton, Capbreton, France.
| | - E Verhaeghe
- C.E.R.S, Ramsay Générale de Santé, 83 av Maréchal de Lattre de Tassigny, 40130 Capbreton, Capbreton, France
| | - O Ucay
- C.E.R.S, Ramsay Générale de Santé, 83 av Maréchal de Lattre de Tassigny, 40130 Capbreton, Capbreton, France
| | - A Minden
- Université Catholique de Louvain, Place P. de Coubertin, 1348, Louvain-la-Neuve, Belgium
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Kuszewski MT, Gnat R, Szlachta G, Kaczyńska M, Knapik A. Passive stiffness of the hamstrings and the rectus femoris in persons after an ACL reconstruction. PHYSICIAN SPORTSMED 2019; 47:91-95. [PMID: 30247085 DOI: 10.1080/00913847.2018.1527171] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVES The aim of the article is to investigate the passive stiffness (PS) of rectus femoris and hamstring muscles working for the knee joint in persons after anterior cruciate ligament (ACL) reconstruction surgery. METHODS Thirty subjects (8 women and 22 men) aged 19-46 (x = 28.2 ± 7) participated in the investigation; an experimental group comprised 15 persons (4 women and 11 men) who underwent ACL reconstruction surgery. The other persons had no knee injury and described themselves as healthy. All the subjects underwent an investigation of the PS of the hamstrings and the rectus femoris on the injured as well as on the healthy leg. RESULTS The data shows vital difference in the PS of the hamstring muscles between the healthy and injured limb (p < 0.05), a significant difference in the PS of the rectus femoris (p < 0.001) was noted. Furthermore, the PS level of the hamstring muscles of the operated limb in the experimental group is significantly different to the both legs in control group (p < 0.001). CONCLUSIONS Injury of the ACL results in a considerable increase in passive stiffness of the hamstring and rectus femoris muscles in both the injured leg and the healthy leg.
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Affiliation(s)
- Michał T Kuszewski
- a Department of Basics of Physiotherapy , Academy of Physical Education , Katowice , Poland
| | - Rafał Gnat
- a Department of Basics of Physiotherapy , Academy of Physical Education , Katowice , Poland.,b Motion Analysis Laboratory , Academy of Physical Education , Katowice , Poland
| | - Grzegorz Szlachta
- a Department of Basics of Physiotherapy , Academy of Physical Education , Katowice , Poland.,b Motion Analysis Laboratory , Academy of Physical Education , Katowice , Poland
| | | | - Andrzej Knapik
- d Healthcare Department , Silesian Medical University , Katowice , Poland
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9
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Yoon JR, Lee DH, Ko SN, Shin YS. Proprioception in patients with posterior cruciate ligament tears: A meta-analysis comparison of reconstructed and contralateral normal knees. PLoS One 2017; 12:e0184812. [PMID: 28922423 PMCID: PMC5603168 DOI: 10.1371/journal.pone.0184812] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 08/31/2017] [Indexed: 12/02/2022] Open
Abstract
Posterior cruciate ligament (PCL) reconstruction for patients with PCL insufficiency has been associated with postoperative improvements in proprioceptive function due to mechanoreceptor regeneration. However, it is unclear whether reconstructed PCL or contralateral normal knees have better proprioceptive function outcomes. This meta-analysis was designed to compare the proprioceptive function of reconstructed PCL or contralateral normal knees in patients with PCL insufficiency. All studies that compared proprioceptive function, as assessed with threshold to detect passive movement (TTDPM) or joint position sense (JPS) in PCL reconstructed or contralateral normal knees were included. JPS was calculated by reproducing passive positioning (RPP). Five studies met the inclusion/exclusion criteria for the meta-analysis. The proprioceptive function, defined as TTDPM (95% CI: 0.25 to 0.51°; P<0.00001) and RPP (95% CI: 0.19 to 0.45°; P<0.00001), was significantly different between the reconstructed PCL and contralateral normal knees. The mean difference in angle of error between the reconstructed PCL and contralateral normal knees was 0.06° greater in TTDPM than by RPP. In addition, results from subgroup analyses, based on the starting angles and the moving directions of the knee, that evaluated TTDPM at 15° flexion to 45° extension, TTDPM at 45° flexion to 110° flexion, RPP in flexion, and RPP in extension demonstrated that mean angles of error were significantly greater, by 0.38° (P = 0.0001), 0.36° (P = 0.02), 0.36° (P<0.00001), and 0.23° (P = 0.04), respectively, in reconstructed PCL than in contralateral normal knees. The proprioceptive function of PCL reconstructed knees was decreased, compared with contralateral normal knees, as determined by both TTDPM and RPP. In addition, the amount of loss of proprioception was greater in TTDPM than in RPP, even with minute differences. Results from subgroup analysis, that evaluated the mean angles of error in moving directions through RPP, suggested that the moving direction of flexion has a significantly greater mean for angles of error than the moving direction of extension. Although the level of differences between various parameters were statistically significant, further studies are needed to determine whether the small differences (>1°) of the loss of proprioception are clinically relevant.
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Affiliation(s)
- Jung-Ro Yoon
- Department of Orthopedic Surgery, Veterans Health Service Medical Center, Seoul, Korea
| | - Dae-Hee Lee
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Nam Ko
- Department of Orthopedic Surgery, Veterans Health Service Medical Center, Seoul, Korea
| | - Young-Soo Shin
- Department of Orthopedic Surgery, Veterans Health Service Medical Center, Seoul, Korea
- * E-mail:
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10
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Godinho P, Nicoliche E, Cossich V, de Sousa EB, Velasques B, Salles JI. Proprioceptive deficit in patients with complete tearing of the anterior cruciate ligament. Rev Bras Ortop 2015; 49:613-8. [PMID: 26229870 PMCID: PMC4487426 DOI: 10.1016/j.rboe.2014.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 08/05/2013] [Indexed: 01/15/2023] Open
Abstract
Objective To investigate the existence of proprioceptive deficits between the injured limb and the uninjured (i.e. contralateral normal) limb, in individuals who suffered complete tearing of the anterior cruciate ligament (ACL), using a strength reproduction test. Methods Sixteen patients with complete tearing of the ACL participated in the study. A voluntary maximum isometric strength test was performed, with reproduction of the muscle strength in the limb with complete tearing of the ACL and the healthy contralateral limb, with the knee flexed at 60°. The meta-intensity was used for the procedure of 20% of the voluntary maximum isometric strength. The proprioceptive performance was determined by means of absolute error, variable error and constant error values. Results Significant differences were found between the control group and ACL group for the variables of absolute error (p = 0.05) and constant error (p = 0.01). No difference was found in relation to variable error (p = 0.83). Conclusion Our data corroborate the hypothesis that there is a proprioceptive deficit in subjects with complete tearing of the ACL in an injured limb, in comparison with the uninjured limb, during evaluation of the sense of strength. This deficit can be explained in terms of partial or total loss of the mechanoreceptors of the ACL.
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Affiliation(s)
- Pedro Godinho
- Motor Control and Exercise Physiology Laboratory, National Institute of Traumatology and Orthopedics (INTO), Rio de Janeiro, RJ, Brazil
| | - Eduardo Nicoliche
- Motor Control and Exercise Physiology Laboratory, National Institute of Traumatology and Orthopedics (INTO), Rio de Janeiro, RJ, Brazil
| | - Victor Cossich
- Motor Control and Exercise Physiology Laboratory, National Institute of Traumatology and Orthopedics (INTO), Rio de Janeiro, RJ, Brazil
| | - Eduardo Branco de Sousa
- Motor Control and Exercise Physiology Laboratory, National Institute of Traumatology and Orthopedics (INTO), Rio de Janeiro, RJ, Brazil
| | - Bruna Velasques
- Motor Control and Exercise Physiology Laboratory, National Institute of Traumatology and Orthopedics (INTO), Rio de Janeiro, RJ, Brazil ; Attention Neuropsychology and Neurophysiology Laboratory, Institute of Psychiatry, Federal University of Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, RJ, Brazil ; Institute of Applied Neurosciences (INA), Rio de Janeiro, RJ, Brazil ; Department of Biosciences, School of Physical Education and Sports (EEFD), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - José Inácio Salles
- Motor Control and Exercise Physiology Laboratory, National Institute of Traumatology and Orthopedics (INTO), Rio de Janeiro, RJ, Brazil
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Cappello L, Elangovan N, Contu S, Khosravani S, Konczak J, Masia L. Robot-aided assessment of wrist proprioception. Front Hum Neurosci 2015; 9:198. [PMID: 25926785 PMCID: PMC4396514 DOI: 10.3389/fnhum.2015.00198] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 03/25/2015] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Impaired proprioception severely affects the control of gross and fine motor function. However, clinical assessment of proprioceptive deficits and its impact on motor function has been difficult to elucidate. Recent advances in haptic robotic interfaces designed for sensorimotor rehabilitation enabled the use of such devices for the assessment of proprioceptive function. PURPOSE This study evaluated the feasibility of a wrist robot system to determine proprioceptive discrimination thresholds for two different DoFs of the wrist. Specifically, we sought to accomplish three aims: first, to establish data validity; second, to show that the system is sensitive to detect small differences in acuity; third, to establish test-retest reliability over repeated testing. METHODOLOGY Eleven healthy adult subjects experienced two passive wrist movements and had to verbally indicate which movement had the larger amplitude. Based on a subject's response data, a psychometric function was fitted and the wrist acuity threshold was established at the 75% correct response level. A subset of five subjects repeated the experimentation three times (T1, T2, and T3) to determine the test-retest reliability. RESULTS Mean threshold for wrist flexion was 2.15°± 0.43° and 1.52°± 0.36° for abduction. Encoder resolutions were 0.0075°(flexion-extension) and 0.0032°(abduction-adduction). Motor resolutions were 0.2°(flexion-extension) and 0.3°(abduction-adduction). Reliability coefficients were r T2-T1 = 0.986 and r T3-T2 = 0.971. CONCLUSION We currently lack established norm data on the proprioceptive acuity of the wrist to establish direct validity. However, the magnitude of our reported thresholds is physiological, plausible, and well in line with available threshold data obtained at the elbow joint. Moreover, system has high resolution and is sensitive enough to detect small differences in acuity. Finally, the system produces reliable data over repeated testing.
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Affiliation(s)
- Leonardo Cappello
- Department of Robotics Brain and Cognitive Sciences, Istituto Italiano di Tecnologia , Genova , Italy
| | - Naveen Elangovan
- School of Kinesiology, University of Minnesota , Minneapolis, MN , USA
| | - Sara Contu
- School of Mechanical and Aerospace Engineering, Nanyang Technological University , Singapore , Singapore
| | - Sanaz Khosravani
- School of Kinesiology, University of Minnesota , Minneapolis, MN , USA
| | - Jürgen Konczak
- School of Kinesiology, University of Minnesota , Minneapolis, MN , USA
| | - Lorenzo Masia
- School of Mechanical and Aerospace Engineering, Nanyang Technological University , Singapore , Singapore
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Aman JE, Elangovan N, Yeh IL, Konczak J. The effectiveness of proprioceptive training for improving motor function: a systematic review. Front Hum Neurosci 2015; 8:1075. [PMID: 25674059 PMCID: PMC4309156 DOI: 10.3389/fnhum.2014.01075] [Citation(s) in RCA: 180] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 12/30/2014] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Numerous reports advocate that training of the proprioceptive sense is a viable behavioral therapy for improving impaired motor function. However, there is little agreement of what constitutes proprioceptive training and how effective it is. We therefore conducted a comprehensive, systematic review of the available literature in order to provide clarity to the notion of training the proprioceptive system. METHODS Four major scientific databases were searched. The following criteria were subsequently applied: (1) A quantified pre- and post-treatment measure of proprioceptive function. (2) An intervention or training program believed to influence or enhance proprioceptive function. (3) Contained at least one form of treatment or outcome measure that is indicative of somatosensory function. From a total of 1284 articles, 51 studies fulfilled all criteria and were selected for further review. RESULTS Overall, proprioceptive training resulted in an average improvement of 52% across all outcome measures. Applying muscle vibration above 30 Hz for longer durations (i.e., min vs. s) induced outcome improvements of up to 60%. Joint position and target reaching training consistently enhanced joint position sense (up to 109%) showing an average improvement of 48%. Cortical stroke was the most studied disease entity but no clear evidence indicated that proprioceptive training is differentially beneficial across the reported diseases. CONCLUSIONS There is converging evidence that proprioceptive training can yield meaningful improvements in somatosensory and sensorimotor function. However, there is a clear need for further work. Those forms of training utilizing both passive and active movements with and without visual feedback tended to be most beneficial. There is also initial evidence suggesting that proprioceptive training induces cortical reorganization, reinforcing the notion that proprioceptive training is a viable method for improving sensorimotor function.
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Affiliation(s)
- Joshua E Aman
- Human Sensorimotor Control Laboratory, School of Kinesiology, University of Minnesota Minneapolis, MN, USA ; Center for Clinical Movement Science, University of Minnesota Minneapolis, MN, USA
| | - Naveen Elangovan
- Human Sensorimotor Control Laboratory, School of Kinesiology, University of Minnesota Minneapolis, MN, USA
| | - I-Ling Yeh
- Human Sensorimotor Control Laboratory, School of Kinesiology, University of Minnesota Minneapolis, MN, USA
| | - Jürgen Konczak
- Human Sensorimotor Control Laboratory, School of Kinesiology, University of Minnesota Minneapolis, MN, USA ; Center for Clinical Movement Science, University of Minnesota Minneapolis, MN, USA
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Godinho P, Nicoliche E, Cossich V, de Sousa EB, Velasques B, Salles JI. Déficit proprioceptivo em pacientes com ruptura total do ligamento cruzado anterior. Rev Bras Ortop 2014. [DOI: 10.1016/j.rbo.2013.08.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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Relph N, Herrington L, Tyson S. The effects of ACL injury on knee proprioception: a meta-analysis. Physiotherapy 2014; 100:187-95. [DOI: 10.1016/j.physio.2013.11.002] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 11/25/2013] [Indexed: 11/26/2022]
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Louw Q, Gillion N, van Niekerk SM, Morris L, Baumeister J. The effect of vision on knee biomechanics during functional activities - A systematic review. J Sci Med Sport 2014; 18:469-74. [PMID: 25035122 DOI: 10.1016/j.jsams.2014.06.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 05/16/2014] [Accepted: 06/15/2014] [Indexed: 01/04/2023]
Abstract
OBJECTIVES The objective of this study was to assess the effect of occluded vision on lower limb kinematics and kinetics of the knee joint during functional tasks including drop landing (single or double leg), squatting (single or double leg), stepping down, cutting movement and hopping in healthy individuals, or individuals who had an ACL reconstruction or deficiency with no vision impairments. DESIGN A systematic review was conducted. METHODS A systematic review was conducted and electronic databases were searched between March 2012 and April 2013 for eligible papers. Methodological quality of each study was assessed using the Downs and Black revised checklist. RESULTS Six studies met the eligibility criteria and a wide variation in methodological approaches was reported. This small evidence base indicated equivocal evidence about the effect of vision on knee biomechanics in individuals with healthy and compromised somatosensory function post an ACL reconstruction or injury. CONCLUSIONS Clinicians should consider innovative, individualised ACL rehabilitation strategies when prescribing exercises which involve visual occlusion. Further research to increase the relatively small evidence base for the effect of vision on knee biomechanics is warranted.
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Affiliation(s)
- Quinette Louw
- Division of Physiotherapy/FNB 3D Movement Analysis Laboratory, Department of Interdisciplinary Health Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa.
| | - Nadia Gillion
- Division of Physiotherapy/FNB 3D Movement Analysis Laboratory, Department of Interdisciplinary Health Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - Sjan-Mari van Niekerk
- Division of Physiotherapy/FNB 3D Movement Analysis Laboratory, Department of Interdisciplinary Health Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - Linzette Morris
- Division of Physiotherapy/FNB 3D Movement Analysis Laboratory, Department of Interdisciplinary Health Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - Jochen Baumeister
- Division of Physiotherapy/FNB 3D Movement Analysis Laboratory, Department of Interdisciplinary Health Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa; Institute of Sports Medicine, Department Exercise & Health, University of Paderborn, Germany; Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Norway
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Assessing proprioceptive function: evaluating joint position matching methods against psychophysical thresholds. Phys Ther 2014; 94:553-61. [PMID: 24262599 PMCID: PMC6281037 DOI: 10.2522/ptj.20130103] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The importance of assessing proprioceptive function for rehabilitation after neurological or orthopedic injury has long been recognized. Yet, neither the validity nor the accuracy of the available tests is firmly established. Testing typically involves repeated matching of a given joint position with the same or opposite limb where the difference between the 2 positions indicates proprioceptive acuity. OBJECTIVES The aim of this study was to compare position sense acuity between ipsilateral and contralateral matching methods against a psychophysical threshold method to establish the accuracy and relationships between these models. DESIGN A repeated-measures design was used. METHOD Assessment of forearm position sense for a 10-degree reference position in 27 young adults who were healthy. RESULTS Psychophysical thresholds were revealed to be the most precise and least variable acuity measure. The mean (±SD) threshold (1.05°±0.47°) was significantly lower than mean position errors obtained by both joint position matching tasks (ipsilateral: 1.51°±0.64°; contralateral: 1.84°±0.73°)-a 44% to 75% difference in measurement accuracy. Individual participant position errors correlated poorly with respective thresholds, indicating a lack of concurrent validity. Position errors for both matching methods correlated only mildly with each other. LIMITATIONS The data represent performance of a healthy, young adult cohort. Differences between methods will likely be more pronounced in aging and clinical populations. CONCLUSIONS Threshold testing and joint position matching methods examine different physiological aspects of proprioceptive function. Because threshold testing is based on passive motion, it most closely reflects afferent sensory feedback processing (ie, proprioception). Matching methods require active motion and are consequently influenced by additional sensorimotor processes. Factors such as working memory and transmission between brain hemispheres also influence joint matching task outcomes.
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Age-related differences in postural control: effects of the complexity of visual manipulation and sensorimotor contribution to postural performance. Exp Brain Res 2013; 232:493-502. [DOI: 10.1007/s00221-013-3756-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Accepted: 10/27/2013] [Indexed: 10/26/2022]
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Baltaci G, Kohl HW. Does Proprioceptive Training During Knee and Ankle Rehabilitation Improve Outcome? PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/108331903225001363] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Oddsdottir GL, Kristjansson E. Two different courses of impaired cervical kinaesthesia following a whiplash injury. A one-year prospective study. ACTA ACUST UNITED AC 2012; 17:60-5. [DOI: 10.1016/j.math.2011.08.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 08/16/2011] [Accepted: 08/30/2011] [Indexed: 10/17/2022]
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Angoules AG, Mavrogenis AF, Dimitriou R, Karzis K, Drakoulakis E, Michos J, Papagelopoulos PJ. Knee proprioception following ACL reconstruction; a prospective trial comparing hamstrings with bone-patellar tendon-bone autograft. Knee 2011; 18:76-82. [PMID: 20149662 DOI: 10.1016/j.knee.2010.01.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2009] [Revised: 01/13/2010] [Accepted: 01/21/2010] [Indexed: 02/07/2023]
Abstract
We prospectively studied knee proprioception following ACL reconstruction in 40 patients (34 men and six women; mean age 31 years). The patients were allocated into two equal groups; group A underwent reconstruction using hamstrings autograft, and group B underwent reconstruction using bone-patellar tendon-bone autograft. Proprioception was assessed in flexion and extension by the joint position sense (JPS) at 15°, 45° and 75°, and time threshold to detection of passive motion (TTDPM) at 15° and 45°, preoperatively and at 3, 6 and 12 months postoperatively. The contralateral healthy knee was used as internal control. No statistical difference was found between the ACL-operated and the contralateral knees in JPS 15°, 45° and 75° at 6 and 12 months, in both study groups. No statistical difference was found between the ACL-operated and the contralateral knees in TTDPM 15° at 6 and 12 months, nor regarding TTDPM 45° at 3, 6 and 12 months, in group A. No statistical difference was found in JPS and TTDPM between the two grafts, at any time period. Knee proprioception returned to normal with ACL reconstruction at 6 months postoperatively, without any statistically significant difference between the autografts used.
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Affiliation(s)
- A G Angoules
- Department of Orthopaedics, Asclepeion Hospital of Voula, Greece.
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Muaidi QI, Nicholson LL, Refshauge KM, Adams RD, Roe JP. Effect of anterior cruciate ligament injury and reconstruction on proprioceptive acuity of knee rotation in the transverse plane. Am J Sports Med 2009; 37:1618-26. [PMID: 19439759 DOI: 10.1177/0363546509332429] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Studies assessing proprioceptive acuity in anterior cruciate ligament (ACL)-deficient knees have only considered proprioception for knee movements in the sagittal plane rather than in the transverse plane (ie, rotation), despite the fact that the ACL plays a critical role in knee rotational stability and that the ACL is injured almost exclusively with a rotation mechanism. Therefore a test of proprioception is needed that involves movements similar to the mechanism of injury, in this case, rotation. PURPOSE To determine whether proprioceptive acuity in rotation changes after ACL injury and reconstruction, and to examine differences in proprioceptive acuity, range, laxity, and activity level among injured knees, contralateral knees, and healthy controls. DESIGN Cohort study; Level of evidence, 2. METHODS Proprioceptive acuity for active knee rotation movements, passive rotation range of motion, anterior knee laxity, and knee function were measured in 20 consecutive participants with unilateral ACL rupture and 20 matched controls. Reconstruction was performed using a single-incision technique with a 4-strand hamstring tendon autograft. Thirty participants (15 control and 15 ACL reconstructed) were retested at 3 months, and 14 with ACL reconstruction were tested at 6 months. RESULTS A deficit was found in preoperative knee rotation proprioception compared with healthy controls (P = .031). Three months after reconstruction, there was a significant improvement (P = .049) in proprioceptive acuity, single-plane anterior laxity (P = .01), and self-reported knee function (P = .001). At 3 months after reconstruction, proprioceptive acuity of the ACL-reconstructed knee was correlated with reported activity level (r = .63; P = .021). CONCLUSION Knee rotation proprioception is reduced in ACL-deficient participants compared with healthy controls. Three to 6 months after reconstruction, rotation proprioceptive acuity, laxity, and function were improved. While these findings are consistent with a return to previous activity level 6 months after reconstruction, the extent of graft maturation and restoration of kinematics should also inform the decision about return to sport.
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Affiliation(s)
- Qassim Ibrahim Muaidi
- King Faisal University, College of Applied Medical Sciences, Department of Physiotherapy, PO Box 2435, Dammam 31451, Saudi Arabia.
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Bonfim TR, Grossi DB, Paccola CAJ, Barela JA. Efeito de informação sensorial adicional na propriocepção e equilíbrio de indivíduos com lesão do LCA. ACTA ORTOPEDICA BRASILEIRA 2009. [DOI: 10.1590/s1413-78522009000500008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVO: Investigar o efeito da utilização de informação sensorial adicional na propriocepção e no equilíbrio de indivíduos com lesão do Ligamento Cruzado Anterior (LCA). MÉTODOS: Participaram deste estudo 28 indivíduos com lesão unilateral do LCA e 28 indivíduos com joelhos sadios. A propriocepção foi avaliada por meio do limiar para detecção de movimento passivo da articulação do joelho nas posições de 15 e 45 graus, para as direções de flexão e de extensão. O equilíbrio foi avaliado em posição unipodal sem visão, sobre uma plataforma de força e investigado por meio da amplitude e da velocidade média de oscilação do centro de pressão. As condições de informação sensorial utilizadas foram: informação normal, bandagem infra-patelar e faixa infra-patelar. RESULTADOS: Indivíduos com lesão do LCA apresentam um prejuízo na propriocepção e no equilíbrio quando comparados a indivíduos com joelhos sadios (p<0,05). Entretanto, com adição de informação sensorial, tanto a capacidade proprioceptiva quanto o equilíbrio de indivíduos com lesão do LCA é melhorado (p<0,05). Indivíduos com joelhos sadios não apresentam benefício na utilização de informação sensorial adicional (p>0,05). CONCLUSÃO: A lesão do LCA acarreta um prejuízo da propriocepção e do equilíbrio, porém estes efeitos são minimizados com utilização de informação sensorial adicional.
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Ingersoll CD, Grindstaff TL, Pietrosimone BG, Hart JM. Neuromuscular Consequences of Anterior Cruciate Ligament Injury. Clin Sports Med 2008; 27:383-404, vii. [DOI: 10.1016/j.csm.2008.03.004] [Citation(s) in RCA: 163] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Fatoye FA, Palmer ST, Macmillan F, Rowe PJ, van der Linden ML. Repeatability of joint proprioception and muscle torque assessment in healthy children and in children diagnosed with hypermobility syndrome. Musculoskeletal Care 2008; 6:108-123. [PMID: 18348137 DOI: 10.1002/msc.127] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Impairment of joint proprioception in patients with hypermobility syndrome (HMS) has been well documented. Both joint proprioception and muscle torque are commonly assessed in patients with musculoskeletal complaints. It is unknown, however, if these measures change significantly on repeated application in healthy children and in children with HMS. AIM To investigate the between-days repeatability of joint proprioception and muscle torque in these groups. METHODS Twenty children (10 healthy and 10 with HMS), aged eight to 15 years, were assessed on two separate occasions (one week apart) for joint kinaesthesia (JK), joint position sense (JPS), and the extensor and knee flexor muscle torque of the knee. JK was measured using threshold to detection of passive movement. JPS was measured using the absolute angular error (AAE; the absolute difference between the target and perceived angles). Knee extensor and flexor muscle torque was normalized to body weight. RESULTS Intra-class correlation coefficients (ICC) for JK, extensor and flexor muscle torque were excellent in both groups (range 0.83 to 0.98). However, ICC values for JPS tests were poor to moderate in the two groups (range 0.18 to 0.56). 95% limits of agreement (LOA) were narrow in both cohorts for JK and muscle torque (indicating low systematic error) but wide for the JPS tests. 95% LOA also demonstrated that the measuring instruments used in this study had low between-days systematic error. CONCLUSIONS Based on ICC and 95% LOA, the repeatability of JK and muscle torque measurements was excellent in both healthy children and those with HMS. The JPS test can only be assessed with poor to moderate repeatability. The use of the JPS test in these children should be undertaken with caution.
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Affiliation(s)
- Francis A Fatoye
- Physiotherapy Department, Manchester Metropolitan University, Manchester, UK.
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Ageberg E, Fridén T. Normalized motor function but impaired sensory function after unilateral non-reconstructed ACL injury: patients compared with uninjured controls. Knee Surg Sports Traumatol Arthrosc 2008; 16:449-56. [PMID: 18305924 DOI: 10.1007/s00167-008-0499-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2007] [Accepted: 01/22/2008] [Indexed: 01/09/2023]
Abstract
Improvement in motor function after anterior cruciate ligament (ACL) injury is achieved by appropriate rehabilitation. However, it has been questioned whether training after injury can lead to sensory improvement. We hypothesized that motor function can be restored after unilateral non-reconstructed ACL injury, whereas the sensory function cannot, i.e., there would be no difference in functional performance or knee muscle strength between subjects with ACL injury and uninjured controls, but the subjects with ACL injury would have poorer kinesthesia than the uninjured controls. This is a Cross-Sectional Study, wherein 56 (20 women and 36 men) individuals with unilateral non-reconstructed ACL injury were assessed at a mean of 15 years (SD 1.4 years) after the initial injury. All patients initially underwent rehabilitation and were advised to modify their activity level, in order to cope with the ACL insufficiency. At 15 years, they had good subjective function and acceptable activity level. Twenty-eight (14 women and 14 men) uninjured subjects served as controls. Patients and controls were assessed with the one-leg hop test for distance, isometric and isokinetic knee muscle strength, and kinesthesia (the threshold to detection of passive motion). The individuals with ACL injury had the same or better functional performance, measured by the one-leg hop test for distance, and knee muscle strength compared with the uninjured controls. Kinesthesia was poorer in the patient group than in the control group. The results indicate that motor function can be restored but that the sensory function is persistently disturbed after ACL injury.
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Affiliation(s)
- Eva Ageberg
- Department of Health Sciences, Division of Physiotherapy, Lund University, Lasarettsgatan 7, 221 85 Lund, Sweden.
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Ozenci AM, Inanmaz E, Ozcanli H, Soyuncu Y, Samanci N, Dagseven T, Balci N, Gur S. Proprioceptive comparison of allograft and autograft anterior cruciate ligament reconstructions. Knee Surg Sports Traumatol Arthrosc 2007; 15:1432-7. [PMID: 17828525 DOI: 10.1007/s00167-007-0404-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2006] [Accepted: 08/14/2007] [Indexed: 12/24/2022]
Abstract
The aim of this study is to search if there is any proprioceptive difference between auto and allograft anterior cruciate ligament (ACL) reconstructions, and also to determine if there is any relationship between instrumented anterior knee laxity and proprioception after an ACL reconstruction. The following four groups were constituted for this purpose: group I, control group; group II, autograft reconstructions; group III, allograft reconstructions and group IV, people with injured ACLs. Each group consisted of 20 patients/volunteers. Two subgroups were constituted according to the findings of KT-1,000 laxity testing in group II and III; patients/volunteers found to have a laxity of 3 mm or less were enrolled in the normal subgroup and those with a laxity of more than 3 mm were enrolled in the lax subgroup. Two proprioceptive tests were used: threshold to detect passive motion (TDPM) and joint position sense (JPS) by using Cybex Norm dynamometer. Patients underwent ten tests and the discrepancy in degrees was averaged for ten trials. Comparisons were made to evaluate the proprioceptive differences between groups/subgroups; ANOVA and t test was used for comparisons where appropriate, and the significance was set at P < 0.05. There was a significant difference in degrees between patients with injured ACLs and the other three groups in TDPM evaluations (injured: 1.93 degrees vs. control: 1.03 degrees , autograft: 1.01 degrees , allograft: 0.96 degrees ; P < 0.001). Auto and allograft reconstructions were not different from each other and controls. Allo and autograft ACL reconstructions are not different from each other according to proprioceptive measurements. Also, proprioception is not correlated to postoperative anterior knee laxity; many variables involve joint proprioception and mostly the anterior knee laxity may not be the sole determining element, and a lax ACL still may fulfill some of its afferent arc functions as long as it bridges the femur and tibia.
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Affiliation(s)
- A Merter Ozenci
- Department of Orthopaedics and Traumatology, Akdeniz University School of Medicine, 07070, Antalya, Turkey.
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Muaidi QI, Nicholson LL, Refshauge KM, Herbert RD, Maher CG. Prognosis of conservatively managed anterior cruciate ligament injury: a systematic review. Sports Med 2007; 37:703-16. [PMID: 17645372 DOI: 10.2165/00007256-200737080-00004] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Anterior cruciate ligament (ACL) rupture is a common sporting injury, often managed surgically with patella-tendon or hamstrings-gracilis autograft. Some people who sustain the injury, request information about their prognosis if they choose to forgo surgery and opt for conservative management. Numerous studies provide data on the prognosis of conservatively managed ACL injuries. These studies have not been systematically reviewed. Thus, the aims of this systematic review are to describe the natural history and clinical course of function and proprioception in the conservatively managed ACL-deficient knee, and to identify prognostic factors. We searched MEDLINE, CINAHL, EMBASE, SportDiscus, PEDro and the Cochrane Central Register of Clinical Trials without language restrictions from the earliest record available up to July 2006. We also searched the Science Citation Index, and iteratively searched bibliographies for prospective studies of outcomes (>6 months follow-up) of conservatively managed complete ACL tears. Six criteria were used to assess the methodological quality of included studies. The main outcome measures were self-reported measures of knee function, activity level, performance in functional tasks and knee proprioception. Fifteen studies of variable methodological quality were included in the review. On average, patients with mixed or isolated ACL-deficient knees reported good knee function (87/100 Lysholm knee scale) at follow-up duration of 12-66 months. On average, functional performance assessed with the hop-for-distance test, was in the normal range. From pre-injury to follow-up there was a reduction in Tegner activity level of 21.3%. According to the methods used in the assessed studies, conservatively managed ACL-deficient knees have a good short- to mid-term prognosis in terms of self-reported knee function and functional performance. However, subjects reduced their activity levels on average by 21% following injury.
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Affiliation(s)
- Qassim I Muaidi
- School of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia.
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Ageberg E, Flenhagen J, Ljung J. Test-retest reliability of knee kinesthesia in healthy adults. BMC Musculoskelet Disord 2007; 8:57. [PMID: 17608920 PMCID: PMC1933427 DOI: 10.1186/1471-2474-8-57] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2006] [Accepted: 07/03/2007] [Indexed: 11/10/2022] Open
Abstract
Background Sensory information from mechanoreceptors in the skin, muscles, tendons, and joint structures plays an important role in joint stability. A joint injury can lead to disruption of the sensory system, which can be measured by proprioceptive acuity. When evaluating proprioception, assessment tools need to be reliable. The aim of this study was to assess the test-retest reliability of a device designed to measure knee proprioception. Methods Twenty-four uninjured individuals (14 women and 10 men) were examined with regard to test-retest reliability of knee kinesthesia, measured by the threshold to detection of passive motion (TDPM). Measurements were performed towards extension and flexion from the two starting positions, 20 degrees and 40 degrees knee joint flexion, giving four variables. The mean difference between test and retest together with the 95% confidence interval (test 2 minus test 1), the intraclass correlation coefficient (ICC2,1), and Bland and Altman graphs with limits of agreement, were used as statistical methods for assessing test-retest reliability. Results The intraclass correlation coefficients ranged from 0.59 to 0.70 in all variables except one. No difference was found between test and retest in three of the four TDPM variables. TDPM would need to decrease between 10% and 38%, and increase between 17% and 24% in groups of uninjured subjects to be 95% confident of detecting a real change. The limits of agreement were rather wide in all variables. The variables associated with the 20-degree starting position tended to have higher intraclass correlation coefficients and narrower limits of agreement than those associated with 40 degrees. Conclusion Three TDPM variables were considered reliable for observing change in groups of subjects without pathology. However, the limits of agreement revealed that small changes in an individual's performance cannot be detected. The higher intraclass correlation coefficients and the narrower limits of agreement in the variables associated with the starting position of 20 degrees knee joint flexion, indicate that these variables are more reliable than those associated with 40 degrees. We, therefore, recommend that the TDPM be measured with a 20-degree starting position.
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Affiliation(s)
- Eva Ageberg
- Division of Physiotherapy, Department of Health Sciences, Lund University, Lund Sweden
| | - Johan Flenhagen
- Department of Physiotherapy, Blekinge Hospital, Karlskrona, Sweden
| | - Jonatan Ljung
- Department of Physiotherapy, Samrehab Skene Hospital, Skene, Sweden
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Roberts D, Ageberg E, Andersson G, Fridén T. Clinical measurements of proprioception, muscle strength and laxity in relation to function in the ACL-injured knee. Knee Surg Sports Traumatol Arthrosc 2007; 15:9-16. [PMID: 16791634 DOI: 10.1007/s00167-006-0128-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2005] [Accepted: 02/14/2006] [Indexed: 02/06/2023]
Abstract
A knee injury with anterior cruciate ligament (ACL) rupture may cause deficits in proprioception, increased laxity and decreased muscle strength. Although it may be common knowledge that these factors affect knee function, only a few studies have been performed where this has been investigated in the clinical situation, and the results are not conclusive. The purpose of this study was therefore to investigate how and to what extent proprioception, laxity and strength affect knee joint function and evaluate if the methods commonly used for estimating these factors clinically seem to be relevant. The study encompassed 36 patients with ACL deficiency. A single-leg hop test for distance and subjective rating of knee function were defined as dependent variables and analyzed separately in stepwise linear regression models where proprioception, knee joint laxity, hamstrings and quadriceps strength, age and sex were defined as independent variables. Higher threshold values (poorer proprioception), increased side-to-side difference of anterior laxity and poorer strength significantly predicted shorter length of the hop test. Higher rating of subjective function corresponded to female gender, lesser side-to-side difference of anterior laxity and better proprioception.
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Affiliation(s)
- D Roberts
- Department of Orthopedics, University Hospital, 221 85, Lund, Sweden.
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Fong SM, Ng GY. The effects on sensorimotor performance and balance with Tai Chi training. Arch Phys Med Rehabil 2006; 87:82-7. [PMID: 16401443 DOI: 10.1016/j.apmr.2005.09.017] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2005] [Accepted: 09/20/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To compare the effects of short-term and long-term Tai Chi training on the sensorimotor and balance performance of able-bodied subjects. DESIGN A nonrandomized cross-sectional controlled trial. SETTING Sport laboratory. PARTICIPANTS Forty-eight healthy subjects, 16 with 3 months of experience in Tai Chi training, 16 with 1 to 3 years of experience in Tai Chi training, and 16 with no experience in Tai Chi training. INTERVENTION Experimental. MAIN OUTCOME MEASURES The reflex contraction latencies (reaction time) of medial hamstrings and gastrocnemius after perturbation, the active knee joint angle-repositioning error, and the balance time on a tilt board were measured and analyzed with 1-way analysis of covariance. Significant results were further analyzed with post hoc linear contrasts. RESULTS Long-term Tai Chi practitioners had a significantly faster reflex reaction time in hamstrings (P<.000) and gastrocnemius (P=.043) muscles and a longer balance time on a tilt board (P<.000) than short-term Tai Chi practitioners and nonpractitioners. Both long- and short-term Tai Chi practitioners had significantly less knee joint angle-repositioning error than nonpractitioners (P=.001 and P=.027, respectively). CONCLUSIONS Tai Chi training of more than 1 year might have the benefits of faster hamstrings and gastrocnemius reflex reaction and improved knee joint position sense (JPS). These changes might be associated with an improved dynamic standing balance. Better knee JPS was shown in subjects with 3 months of Tai Chi practice, but this had not led to a significant improvement in balance.
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Affiliation(s)
- Siu-Ming Fong
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hung Hom, Hong Kong, China
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Okuda T, Ochi M, Tanaka N, Nakanishi K, Adachi N, Kobayashi R. Knee joint position sense in compressive myelopathy. Spine (Phila Pa 1976) 2006; 31:459-62. [PMID: 16481958 DOI: 10.1097/01.brs.0000199956.11646.5b] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN The knee joint position sense (JPS) and kinesthesia were measured in patients with compressive myelopathy. OBJECTIVES To find out how the knee JPS and kinesthesia are useful to evaluate lower limb function in patients with compressive myelopathy. SUMMARY OF BACKGROUND DATA No previous reports have been written on the quantitative analysis of knee joint proprioception in myelopathy patients. METHODS Twenty-one compressive myelopathy patients with a mean age of 64 years were studied. The measured values of JPS and kinesthesia were examined in relation to the following: lower limb function and central motor conduction time (CMCT). RESULTS Inaccurate angles of the knee JPS in patients with severe walking disability were significantly larger than those in patients with mild disability. Inaccurate angles of the knee JPS in patients with severe sensory disturbance were significantly larger than those in patients with mild disturbance. CMCT showed a significant correlation to the knee JPS. CONCLUSIONS The knee JPS was useful to evaluate lower limb function in patients with compressive myelopathy.
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Affiliation(s)
- Teruaki Okuda
- Department of Orthopaedic Surgery, Division of Clinical Medical Science, Programs for Applied Biomedicine, Faculty of Medicine, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.
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de Jong A, Kilbreath SL, Refshauge KM, Adams R. Performance in Different Proprioceptive Tests Does Not Correlate in Ankles With Recurrent Sprain. Arch Phys Med Rehabil 2005; 86:2101-5. [PMID: 16271555 DOI: 10.1016/j.apmr.2005.05.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2004] [Revised: 05/02/2005] [Accepted: 05/14/2005] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine the relation between 2 proprioceptive tests, movement detection and movement discrimination, at the ankle. DESIGN A cross-sectional descriptive study. SETTING Research laboratory. PARTICIPANTS Eighteen subjects with recurrent ankle inversion sprain. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Threshold to detection of movement was tested for inversion and eversion movements at 3 velocities (0.1 degrees , 0.5 degrees , 2.5 degrees /s). Movement discrimination was tested for plantarflexion and inversion movements. The tests were performed in random order, and the velocity and movements were randomized within each test paradigm. Correlations (Pearson r) were calculated between movement detection and movement discrimination. RESULTS Correlation within each proprioceptive paradigm was poor to moderate: for movement detection, correlations among movement directions at each velocity ranged from r equal to .53 to r equal to .54; for movement discrimination correlation was r equal to .49. There was poor correlation between the scores for the 2 tasks in 10 of the 12 comparisons (r range, -.02 to -.36). CONCLUSIONS These findings show that performance in different proprioceptive tests is not well correlated and, therefore, that general proprioceptive status cannot be inferred from assessment of a single proprioceptive test.
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Affiliation(s)
- Arienne de Jong
- School of Physiotherapy, University of Sydney, Lidcombe, NSW, Australia
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Ageberg E, Roberts D, Holmström E, Fridén T. Balance in single-limb stance in patients with anterior cruciate ligament injury: relation to knee laxity, proprioception, muscle strength, and subjective function. Am J Sports Med 2005; 33:1527-35. [PMID: 16009987 DOI: 10.1177/0363546505274934] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND It has been shown previously that an anterior cruciate ligament injury may affect postural control, measured by balance in single-limb stance. To our knowledge, no studies have reported the influence of measures of impairment on postural control after such an injury. PURPOSE To assess the influence of knee laxity, proprioception, and muscle strength on balance in single-limb stance and to study the correlation between balance in single-limb stance and subjective estimation of extremity function. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS A total of 36 patients with a unilateral, nonoperated, nonacute anterior cruciate ligament injury were examined with regard to anterior knee laxity, proprioception, muscle strength, and stabilometry (amplitude and average speed of the center of pressure movements). Subjective estimation of extremity function was measured on a visual analog scale. RESULTS The multiple regression analysis showed that high knee laxity values were associated with high amplitude values and low average speed. Poor proprioception and high muscle strength values were associated with low average speed among the women only. Low amplitude values correlated with better subjective function. CONCLUSION Anterior knee laxity, proprioception, and muscle strength seem to play a role in maintaining balance in single-limb stance. Patients with low amplitude values in stabilometry were those with better subjective function.
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Affiliation(s)
- Eva Ageberg
- Department of Rehabilitation, Lund University, Lasarettsgatan 7, SE-221 85 Lund, Sweden.
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Bressel E, Larsen BT, McNair PJ, Cronin J. Ankle joint proprioception and passive mechanical properties of the calf muscles after an Achilles tendon rupture: a comparison with matched controls. Clin Biomech (Bristol, Avon) 2004; 19:284-91. [PMID: 15003344 DOI: 10.1016/j.clinbiomech.2003.12.008] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2003] [Accepted: 12/11/2003] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To examine if ankle joint proprioception, passive stiffness, and torque relaxation responses of the involved and uninvolved limbs of persons with a previous history of an Achilles tendon rupture were different from matched controls. DESIGN Quasi-experimental mixed design. BACKGROUND The influence of an Achilles tendon rupture on the proprioceptive and kinetic performance of the involved and uninvolved ankle is not known. METHODS Twenty persons (mean age, 44.8 years) with a unilateral rupture and 20 matched controls (mean age, 44.2 years) volunteered. Proprioception was tested with a position-matching protocol from which absolute errors were quantified. A dynamometer was used to measure ankle joint angle and passive torque from which stiffness and torque relaxation were calculated. RESULTS AND CONCLUSIONS Proprioception absolute errors for the involved and uninvolved limbs of the experimental group were 27% and 31% greater respectively, than values for the control group. Torque relaxation values were greater in the involved limb versus the uninvolved limb or the control group (P=0.003-0.04). In conclusion, participants with a previous history of an Achilles tendon rupture display proprioception deficits in both limbs and greater torque relaxation in the involved limb in comparison to matched controls. RELEVANCE Bilateral deficits in ankle joint proprioception, as reported in this study, suggest the uninvolved limb may not serve as an effective control and because proprioception deficits influence some functional tests, Achilles tendon rupture patients may benefit from proprioception training.
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Affiliation(s)
- Eadric Bressel
- Department of Health, Physical Education, and Recreation, Utah State University, Logan, UT 84322, USA.
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Abstract
STUDY DESIGN A cross-sectional comparison of spinal position sense in 50 patients with mild ankylosing spondylitis and 50 healthy controls. OBJECTIVES To determine if spinal position sense is impaired in patients with mild ankylosing spondylitis. SUMMARY OF BACKGROUND DATA Pathologic processes in ankylosing spondylitis target sites in the spine where joint capsules, ligaments, and tendons attach into bone. Because these sites contain receptors conveying position sense, proprioception may become impaired, and this may contribute to the spinal deformity that often develops in the more advanced stages of the disease. If deficits in proprioception are apparent then specialized exercise regimes aimed at improving proprioception in ankylosing spondylitis patients could prove beneficial. METHODS Position sense was assessed in patients and controls by determining the absolute error in reproducing upright and flexed postures in the coronal and sagittal planes using an electromagnetic tracking device, the 3-Space Fastrak (Polhemus, Colchester, VT). Measurements were taken from sensors placed on the skin overlying T1, T7, L1, and S2. In patients, the association between position sense and validated radiographic, disease activity, and functional scores was explored. RESULTS No deficits in spinal position sense were found in patients with mild ankylosing spondylitis. In these subjects, repositioning errors were < or = 3.88 degrees in flexed postures and < or = 2.76 in upright postures. Corresponding results for controls were < or = 4.86 degrees and < or = 3.42 degrees, respectively. Weak correlations were found between position sense and other ankylosing spondylitis outcome measures, which included indexes of function, disease activity, and posture and mobility, but in all cases, the overall trend was for position sense acuity to improve slightly with more advanced disease. CONCLUSION Spinal position sense is unaffected in patients with mild ankylosing spondylitis and is therefore unlikely to be a useful outcome measure in this condition.
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Affiliation(s)
- Annette Swinkels
- Faculty of Health and Social Care, University of the West of England, Bristol, United Kingdom
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Roberts D, Ageberg E, Andersson G, Fridén T. Effects of short-term cycling on knee joint proprioception in healthy young persons. Am J Sports Med 2003; 31:990-4. [PMID: 14623668 DOI: 10.1177/03635465030310064001] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Criteria are needed for measuring the effects of exercise and fatigue on proprioception. PURPOSE To measure knee joint proprioception in healthy subjects before and after exercise and to establish a reference for further comparisons of patients with knee injuries. STUDY DESIGN Controlled laboratory study. METHODS We tested proprioception in the knees of 24 healthy subjects with a mean age of 24 years and median Tegner score of 5. Subjects were tested to estimate their thresholds for detecting slow passive motion, from starting positions of 20 degrees and 40 degrees before and after cycling on an ergometer bicycle until the pulse rate reached a steady state level and they reached a score of 14 to 17 on Borg's Ratio of Perceived Exertion scale. RESULTS After cycling, significantly higher threshold values were found for perception of movement toward flexion from both 20 degrees and 40 degrees. No significant differences were seen in measurements of movement toward extension. CONCLUSIONS Knee joint proprioception seems to be impaired by exercise or training. CLINICAL RELEVANCE This impairment may lead to defective dynamic stabilization of the joint, leading to an increased risk of injuries.
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Affiliation(s)
- David Roberts
- Department of Orthopedics, University Hospital Lund, Lund, Sweden
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Bonfim TR, Jansen Paccola CA, Barela JA. Proprioceptive and behavior impairments in individuals with anterior cruciate ligament reconstructed knees. Arch Phys Med Rehabil 2003; 84:1217-23. [PMID: 12917863 DOI: 10.1016/s0003-9993(03)00147-3] [Citation(s) in RCA: 107] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess sensory deficits and their effects on proprioceptive and motor function in patients who had undergone unilateral anterior cruciate ligament (ACL) reconstruction. DESIGN Four evaluations were conducted: (1) joint position perception of the knee for predetermined angles (0 degrees, 15 degrees, 30 degrees, 45 degrees, 60 degrees ); (2) threshold for detection of passive knee motion at 0 degrees, 15 degrees, 30 degrees, 45 degrees, and 60 degrees moving into flexion and at 15 degrees, 30 degrees, 45 degrees, and 60 degrees moving into extension; (3) latency onset of hamstring muscles; and (4) postural control during upright double- and single-leg stance. SETTING Movement laboratory in Brazil. PARTICIPANTS Ten participants who had surgical reconstruction of the ACL (reconstructed group) and 10 participants without knee injury (control group). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Absolute error, angular displacement, hamstring muscles latency, and mean sway amplitude. RESULTS Individuals with a reconstructed knee showed decreased joint position perception, a higher threshold for detection of passive knee motion, longer latency of hamstring muscles, and decreased performance in postural control. CONCLUSIONS After lesion and ACL reconstruction, sensory and motor behavior changes were still observed. This may be because of the lack of proprioceptive information resulting from the ACL lesion and/or substitution of ACL by the graft.
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Affiliation(s)
- Thátia R Bonfim
- Laboratório para Estudos do Movimento, Departamento de Educacão Fisica-Instituto de Biociências, Universidade Estadual Paulista, Rio Claro, Brasil.
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Ageberg E. Consequences of a ligament injury on neuromuscular function and relevance to rehabilitation - using the anterior cruciate ligament-injured knee as model. J Electromyogr Kinesiol 2002; 12:205-12. [PMID: 12086815 DOI: 10.1016/s1050-6411(02)00022-6] [Citation(s) in RCA: 129] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
The purpose of this article is to survey current knowledge concerning the consequences of a ligament injury on neuromuscular function and its relevance to rehabilitation, in relation to clinical practice. Although it deals with the ACL-injured knee, these views may also apply to other joints. The effects of a ligament injury on neuromuscular function are first considered - i.e., proprioception, postural control, muscle strength, functional performance, movement and activation pattern, central mechanisms, motor control and learning. The treatment and effects of rehabilitation on neuromuscular function are then discussed. The survey is concluded by discussing the clinical significance.
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Affiliation(s)
- Eva Ageberg
- Department of Rehabilitation, University Hospital, Lund, Sweden.
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Beynnon BD, Good L, Risberg MA. The effect of bracing on proprioception of knees with anterior cruciate ligament injury. J Orthop Sports Phys Ther 2002; 32:11-5. [PMID: 11787904 DOI: 10.2519/jospt.2002.32.1.11] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This paper is a comprehensive review on the effect of bandaging, bracing, and neoprene sleeves on knee proprioception following anterior cruciate ligament (ACL) injury and reconstruction with a focus on studies that have measured joint position sense and threshold to detection of passive knee motion. Disruption of the ACL does not appear to alter joint position sense soon after injury, although there is evidence that in some subjects deterioration may occur over time. An ACL tear creates a deficit in the threshold to detection of passive knee motion soon after injury and in those with chronic tears. The magnitude of worsening is less then 1.0 degree of movement in flexion-extension and of questionable concern from a clinical and functional perspective. Application of a functional brace or neoprene sleeve to the ACL-deficient limb does not improve the threshold to detection of passive knee motion; however, application of an elastic bandage to a knee with an ACL tear improves joint position sense. Reconstruction of a torn ACL is associated with a deficit in the threshold to detection of passive knee motion, and during the first year of healing the use of a neoprene sleeve provides improvement. Two years following ACL reconstruction there is no deficit in the threshold to detection of passive knee motion and the use of a brace has no effect on this outcome.
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Affiliation(s)
- Bruce D Beynnon
- Department of Orthopaedics and Rehabilitation, University of Vermont College of Medicine, McClure Musculoskeletal Research Center, Burlington 05405-0084, USA.
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Ageberg E, Zätterström R, Moritz U, Fridén T. Influence of supervised and nonsupervised training on postural control after an acute anterior cruciate ligament rupture: a three-year longitudinal prospective study. J Orthop Sports Phys Ther 2001; 31:632-44. [PMID: 11720296 DOI: 10.2519/jospt.2001.31.11.632] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Prospective randomized longitudinal clinical trial with matched controls. OBJECTIVES To investigate the long-term effect of training on postural control and extremity function after an acute anterior cruciate ligament (ACL) injury. BACKGROUND ACL injuries may cause severe problems with recurrent giving way of the knee and reduced functional capacity. The effect of an acute ACL injury and the effect of various training programs on postural control, as well as the relation between postural control and extremity function after such an injury, have not been studied longitudinally. METHODS Sixty-three consecutive patients, 35 men and 28 women (median age 24 years, quartiles 19-33 years), with an acute nonoperated ACL injury, randomized to neuromuscular supervised or self-monitored training, were examined with stabilometry (amplitude and average speed of center of pressure movements) and a one-leg hop test for distance after 6 weeks (stabilometry only), and after 3, 12, and 36 months, and were compared to a control group. RESULTS Regardless of treatment, center of pressure amplitude was persistently higher in both the injured and uninjured legs during the 3-year follow-up, but average speed was less affected or unaffected compared to the control group. The one-leg hop had normalized in the neuromuscular group at the 12-month follow-up, but was shorter in both legs throughout the 3-year period in the self-monitored group. The median value (quartiles) for injured/uninjured legs at 3 months was 150 cm (120-174 cm)/177 cm (140-199 cm), at 12 months was 174 cm (140-200 cm)/180 cm (150-202 cm), and at 36 months was 172 cm (146-200 cm)/178 cm (150-200 cm) in the self-monitored group, compared to the control group (median 186 cm, quartiles 177-216 cm). CONCLUSIONS The higher center of pressure amplitude in both legs over the 3-year period indicate persistently impaired postural control in single-limb stance. However, functional performance, as measured with the one-leg hop test, was restored by neuromuscular training, but not by self-monitored training.
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Affiliation(s)
- E Ageberg
- Department of Rehabilitation, University Hospital, Lund, Sweden.
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Fridén T, Roberts D, Ageberg E, Waldén M, Zätterström R. Review of knee proprioception and the relation to extremity function after an anterior cruciate ligament rupture. J Orthop Sports Phys Ther 2001; 31:567-76. [PMID: 11665744 DOI: 10.2519/jospt.2001.31.10.567] [Citation(s) in RCA: 120] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Several tests of human conscious knee proprioception have been described, but there is no consensus or reference standard established. Difficulties remain in the separation of information originating from muscles, tendons, and joints, and the tests cannot discriminate between loss of afferent signals or altered activity in the remaining receptors. There is convincing evidence from several descriptive studies that the afferent information is altered after a knee ligament injury and severely disturbed in some patients with anterior cruciate ligament (ACL) injuries. However, an inherent inferior proprioceptive ability may also exist in some individuals, which makes them vulnerable to injuries. The deficits in proprioception have mostly been studied and related to the consciously registered sense, whereas the extent of possible disturbances of the unconscious or reflectory mechanisms is largely unknown. The latter may, at least from a theoretical point of view, be predominantly contributing to the overall afferent regulation, and a possibility for major defects thus exists, since there is no knowledge of the quantified relation between the conscious and unconscious part. The clinical importance of the altered afferent information has not been evaluated properly, and the role of proprioception that contributes to function has yet to be investigated. A higher physiological sensitivity to detecting a passive joint motion closer to full extension has been found both experimentally and clinically, which may protect the joint due to the close proximity to the limit of joint motion. Proprioception has been found to have a relation to subjective knee function, and patients with symptomatic ACL deficiency seem to have larger deficits than asymptomatic individuals. Little is known about whether training can restore defects in sensory information or by which mechanisms possible compensatory pathways are established. In rehabilitation, each patient must, however, create muscle strength, alertness, and stiffness in harmony with the disturbed mechanics of the knee, which are present both after nonoperative treatment of the ACL and after a reconstruction of the ACL.
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Affiliation(s)
- T Fridén
- Department of Orthopedics, University Hospital, Lund, Sweden.
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Williams GN, Chmielewski T, Rudolph K, Buchanan TS, Snyder-Mackler L. Dynamic knee stability: current theory and implications for clinicians and scientists. J Orthop Sports Phys Ther 2001; 31:546-66. [PMID: 11665743 DOI: 10.2519/jospt.2001.31.10.546] [Citation(s) in RCA: 130] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We will discuss the mechanisms by which dynamic knee stability may be achieved and relate this to issues that interest clinicians and scientists concerned with dynamic knee stability. Emphasis is placed on the neurophysiologic evidence and theory related to neuromuscular control. Specific topics discussed include the ensemble firing of peripheral mechanoreceptors, the potential for muscle stiffness modulation via force and length feedback, postural control synergies, motor programs, and the neural control of gait. Factors related to answering the difficult question of whether or not knee ligament injuries can be prevented during athletic activities are discussed. Prevention programs that train athletes to perform their sport skills in a safe fashion are put forth as the most promising prospect for injury prevention. Methods of assessing neuromuscular function are reviewed critically and the need for future research in this area is emphasized. We conclude with a brief review of the literature regarding neuromuscular training programs.
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Affiliation(s)
- G N Williams
- Biomechanics and Movement Science Program, University of Delaware, Newark, 19716, USA.
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Hiemstra LA, Lo IK, Fowler PJ. Effect of fatigue on knee proprioception: implications for dynamic stabilization. J Orthop Sports Phys Ther 2001; 31:598-605. [PMID: 11665747 DOI: 10.2519/jospt.2001.31.10.598] [Citation(s) in RCA: 116] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The high incidence of injuries that occur later during a session of sports or recreational activities suggests that fatigue may contribute to altered neuromuscular control of the lower limb and an individual's subsequent altered ability to dynamically stabilize the knee joint. One possible mechanism is a fatigue-mediated alteration in proprioception. This paper reviews experimental evidence of fatigue-induced changes in knee joint position sense and movement sense, or kinesthesia. We will discuss the possible physiological mechanisms behind these changes, including the role of joint and muscle receptors in proprioception and neuromuscular control of the knee, and the role of fatigue in changes in afferent output from muscle and joint receptors. We will then explore the implications that alteration in proprioception may have for dynamic stabilization of the knee joint.
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Affiliation(s)
- L A Hiemstra
- Orthopaedic Sport Medicine, University of Western Ontario, London, Ontario, Canada
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Baltaci G. Knee Surgery in Athletes: The Importance of Post-Operative Rehabilitation Guidelines. PHYSICAL THERAPY REVIEWS 2000. [DOI: 10.1179/108331900786166623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Roberts D, Fridén T, Stomberg A, Lindstrand A, Moritz U. Bilateral proprioceptive defects in patients with a unilateral anterior cruciate ligament reconstruction: a comparison between patients and healthy individuals. J Orthop Res 2000; 18:565-71. [PMID: 11052492 DOI: 10.1002/jor.1100180408] [Citation(s) in RCA: 91] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Proprioception of the knee was measured in 20 patients with reconstructed anterior cruciate ligaments and in 19 age-matched controls. The mean time from surgery was 2 years. Three tests of proprioception were used: (a) threshold to detection of passive motion from 20 and 40 degrees toward flexion and extension, (b) active reproduction of a 30 degrees passive angle change, and (c) visual reproduction of a 30 degrees passive angle change. The aim was a complete, bilateral, proprioceptive evaluation of patients who had undergone reconstruction of the anterior cruciate ligament. As compared with those in the control group, the knees with reconstructed anterior cruciate ligaments had a higher threshold to detection of passive motion in the extension trials from 20 and 40 degrees (p = 0.0003 and 0.04, respectively) and in the flexion trials from 20 and 40 degrees (p = 0.004 and 0.0008, respectively). When the uninjured knees of the patients were compared with those in the control group, higher values for threshold to detection of passive motion were found in the flexion trials from 20 degrees (p = 0.002) and 40 degrees (p = 0.02). Thus, decreased proprioceptive ability was present in some measurements of these patients after reconstructive surgery, not only in injured knees but also in uninjured knees, as compared with the reference group. The functional relevance of these findings was not investigated in this study, but the results suggest that bilateral proprioceptive considerations should be made when evaluating prognostic factors, treatment, and risk of contralateral knee injury in patients with reconstructed anterior cruciate ligaments.
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Affiliation(s)
- D Roberts
- Department of Orthopedics, University Hospital Lund, Sweden.
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Abstract
Proprioception, the perception of limb position in space, is derived from afferent signals originating primarily from musculotendinous and joint receptors. Proprioception is critical to the maintenance of joint stability. Studies have demonstrated that proprioception is less accurate in patients with knee osteoarthritis versus elderly control subjects, in healthy older versus younger subjects, and in the setting of other conditions affecting the knee including anterior cruciate ligament deficiency and hypermobility syndrome. Possible pathways between proprioceptive inaccuracy, knee osteoarthritis, and related knee disorders are described.
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Affiliation(s)
- L Sharma
- Division of Rheumatology, Northwestern University Medical School, Chicago, Illinois, USA
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Abstract
OBJECTIVES To examine the effects of a neoprene lumbar brace on the proprioceptive ability of subjects without pathology and to determine whether those with poorer proprioception were more affected by the brace. STUDY DESIGN Randomized 2 x 2 Latin square cross-over design. SETTING Laboratory in an educational institution. SUBJECTS Forty asymptomatic subjects matched by gender, age, weight, and height. METHOD Blindfolded subjects performed a position matching task in which they flexed the trunk in the sagittal plane. Six positions across the range of motion were examined. Angular data were recorded by a lumbar motion monitor secured by straps to the subject's trunk. MAIN OUTCOME MEASURE Absolute, constant, and variable errors in braced and unbraced conditions. RESULTS The mean absolute, constant, and variable errors were 3.6 degrees, .45 degrees, and 4.4 degrees, respectively. Absolute, constant, and variable errors were significantly decreased when wearing a brace. However, the magnitude of the decreases were small (<1.0 degrees) for all errors when wearing a brace. The high error group's absolute error improved significantly (p < .05), from 6.0 degrees when unbraced to 4.0 degrees when braced. In contrast, absolute error measurements for subjects in the low error group were unchanged, with an error of 2.0 degrees when unbraced and 2.3 degrees when braced. CONCLUSIONS The findings suggest that a neoprene lumbar brace improves the somatosensory information received by the central nervous system and results in less error in trunk positioning. Persons with less ability to match trunk position will benefit more from wearing a neoprene brace than will those who are already adept at the task.
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Affiliation(s)
- P J McNair
- Neuromuscular Research Unit, The School of Physiotherapy, Auckland Institute of Technology, New Zealand
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Fridén T, Roberts D, Movin T, Wredmark T. Function after anterior cruciate ligament injuries. Influence of visual control and proprioception. ACTA ORTHOPAEDICA SCANDINAVICA 1998; 69:590-4. [PMID: 9930103 DOI: 10.3109/17453679808999261] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Information about limb positions and movements consists of input from visual, vestibular, cutaneous, muscular, tendinous and joint receptors, but the relative contribution from each type and location of receptors is not known. The aim of this study was: a) to measure the contribution from visual control on extremity function, as measured with a one-leg hop test in healthy persons, in patients with an asymptomatic ACL injury, after non-operative treatment and in patients with a stable knee after an ACL reconstruction, b) to investigate if there was any relation between proprioception from the extremity, as measured with the threshold for detecting passive motion of the knee, and the one-leg hop test with a gradual decrease in visual control. There was a decrease in hop-length when the subjects were deprived of visual control that was significant when the dominant eye or both eyes were blinded, both in the 2 patient groups and the reference population. The magnitude of the length reduction did not differ between the groups or between injured and healthy limbs. In all 4 threshold tests performed as a measure of peripheral proprioception, a stronger relation to hop-length was recorded for the blinded hop than with full visual control in the patients with nonoperated ACL injuries. The coefficients of correlation between hop-length and the proprioceptive recordings in the injured limb were of the same magnitude as on the healthy side.
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Affiliation(s)
- T Fridén
- Department of Orthopedics, University Hospital, Lund, Sweden
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