Review of knee proprioception and the relation to extremity function after an anterior cruciate ligament rupture

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.