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Proprioceptive deficits after ACL injury: are they clinically relevant?
  1. Alli Gokeler1,
  2. Anne Benjaminse2,3,
  3. Timothy E Hewett4,
  4. Scott M Lephart5,
  5. Lars Engebretsen6,
  6. Eva Ageberg7,
  7. Martin Engelhardt8,
  8. Markus P Arnold9,
  9. Klaas Postema10,
  10. Egbert Otten11,
  11. Pieter U Dijkstra12
  1. 1Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
  2. 2Center for Human Movement Science, University Medical Center Groningen, University of Groningen, The Netherlands
  3. 3SportsFieldLab Groningen, School of Sports Studies, Hanze University Groningen, University of Applied Sciences, Groningen, The Netherlands
  4. 4Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati Children's Hospital Research Foundation, Cincinnati, Ohio, USA
  5. 5Neuromuscular Research Laboratory, Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  6. 6Department of Orthopaedics, Oslo University Hospital, Oslo, Norway
  7. 7Department of Health Sciences, Lund University, Lund, Sweden
  8. 8Department of Orthopedic and Trauma Surgery, Klinikum Osnabrück, Osnabrück, Germany
  9. 9Orthopedic Surgery & Skeletal Traumatology, Kantonsspital Bruderholz, Basel, Switzerland
  10. 10Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
  11. 11Center for Rehabilitation, Center for Human Movement Science, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
  12. 12Center for Rehabilitation, Department of Oral and Maxillofacial Surgery, School for Health Research, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
  1. Correspondence to Alli Gokeler, Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen 9700 RB, The Netherlands; a.gokeler{at}rev.umcg.nl

Abstract

Objective To establish the clinical relevance of proprioceptive deficits reported after anterior cruciate ligament (ACL) injury.

Material and methods A literature search was done in electronic databases from January 1990 to June 2009. Inclusion criteria for studies were ACL deficient (ACL-D) and ACL reconstruction (ACL-R) articles written in English, Dutch or German and calculation of correlation(s) between proprioception tests and clinical outcome measures. Clinical outcome measures were muscle strength, laxity, hop test, balance, patient-reported outcome, objective knee score rating, patient satisfaction or return to sports. Studies included in the review were assessed on their methodological quality.

Results In total 1161 studies were identified of which 24 met the inclusion criteria. Pooling of all data was not possible due to substantial differences in measurement techniques and data analysis. Most studies failed to perform reliability measurements of the test device used. In general, the correlation between proprioception and laxity, balance, hop tests and patient outcome was low. Four studies reported a moderate correlation between proprioception, strength, balance or hop test.

Conclusion There is limited evidence that proprioceptive deficits as detected by commonly used tests adversely affect function in ACL-D and ACL-R patients. Development of new tests to determine the relevant role of the sensorimotor system is needed. These tests should ideally be used as screening tests for primary and secondary prevention of ACL injury.

https://doi.org/10.1136/bjsm.2010.082578

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    Footnotes

    • Competing interests None.

    • Provenance and peer review Not commissioned; externally peer reviewed.