Clinical measurements of proprioception, muscle strength and laxity in relation to function in the ACL-injured knee

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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References

  1. 1.

    Ageberg E, Roberts D, Holmstrom E, Friden T (2005) Balance in single-limb stance in patients with anterior cruciate ligament injury. Am J Sports Med 33 (10):1527–1535

    PubMed  Article  Google Scholar 

  2. 2.

    Ashton-Miller JA, Wojtys EM, Huston LJ, Fry-Welch D (2001) Can proprioception really be improved by exercises? Knee Surg Sports Traumatol Arthrosc 9:128–136

    PubMed  Article  CAS  Google Scholar 

  3. 3.

    Barrack RL, Skinner HB, Buckley SL (1989) Proprioception in the anterior cruciate deficient knee. Am J Sports Med 17:1–6

    PubMed  Article  CAS  Google Scholar 

  4. 4.

    Barrett DS (1991) Proprioception and function after anterior cruciate reconstruction. J Bone Joint Surg Br 73:833–837

    PubMed  CAS  Google Scholar 

  5. 5.

    Beard DJ, Kyberd PJ, Fergusson CM, Dodd CA (1993) Proprioception after rupture of the anterior cruciate ligament. An objective indication of the need for surgery? J Bone Joint Surg Br 75:311–315

    PubMed  CAS  Google Scholar 

  6. 6.

    Beynnon BD, Ryder SH, Konradsen L, Johnson RJ, Johnson K, Renstrom PA (1999) The effect of anterior cruciate ligament trauma and bracing on knee proprioception. Am J Sports Med 27:150–155

    PubMed  CAS  Google Scholar 

  7. 7.

    Borsa PA, Lephart SM, Irrgang JJ (1998) Comparison of performance-based and patient-reported measures of function in anterior-cruciate-ligament-deficient individuals. J Orthop Sports Phys Ther 28:392–399

    PubMed  CAS  Google Scholar 

  8. 8.

    Borsa PA, Lephart SM, Irrgang JJ, Safran MR, Fu FH (1997) The effects of joint position and direction of joint motion on proprioceptive sensibility in anterior cruciate ligament-deficient athletes. Am J Sports Med 25:336–340

    PubMed  Article  CAS  Google Scholar 

  9. 9.

    Carter ND, Jenkinson TR, Wilson D, Jones DW, Torode AS (1997) Joint position sense and rehabilitation in the anterior cruciate ligament deficient knee. Br J Sports Med 31:209–212

    PubMed  CAS  Article  Google Scholar 

  10. 10.

    Corrigan JP, Cashman WF, Brady MP (1992) Proprioception in the cruciate deficient knee. J Bone Joint Surg Br 74:247–250

    PubMed  CAS  Google Scholar 

  11. 11.

    Eastlack M, Axe MJ, Snyder-Mackler L (1999) Laxity, instability, and functional outcome after ACL injury: copers versus noncopers. Med Sci Sports Exerc 31 (2):210–215

    PubMed  Article  CAS  Google Scholar 

  12. 12.

    Fischer-Rasmussen T, Jensen PE (2000) Proprioceptive sensitivity and performance in anterior cruciate ligament-deficient knee joints. Scand J Med Sci Sports 10:85–89

    PubMed  Article  CAS  Google Scholar 

  13. 13.

    Fitzgerald GK, Lephart SM, Hwang JH, Wainner RS (2001) Hop tests as predictors of dynamic knee stability. J Orthop Sports Phys Ther 31:588–597

    PubMed  CAS  Google Scholar 

  14. 14.

    Flandry F, Hunt JP, Terry GC, Hughston JC (1991) Analysis of subjective knee complaints using visual analog scales. Am J Sports Med 19:112–118

    PubMed  Article  CAS  Google Scholar 

  15. 15.

    Friden T, Roberts D, Movin T, Wredmark T (1998) Function after anterior cruciate ligament injuries. Influence of visual control and proprioception. Acta Orthop Scand 69:590–594

    PubMed  CAS  Article  Google Scholar 

  16. 16.

    Friden T, Roberts D, Zatterstrom R, Lindstrand A, Moritz U (1997) Proprioception after an acute knee ligament injury: a longitudinal study on 16 consecutive patients. J Orthop Res 15:637–44

    PubMed  Article  CAS  Google Scholar 

  17. 17.

    Friden T, Roberts D, Zatterstrom R, Lindstrand A, Moritz U (1996) Proprioception in the nearly extended knee. Measurements of position and movement in healthy individuals and in symptomatic anterior cruciate ligament injured patients. Knee Surg Sports Traumatol Arthrosc 4:217–224

    PubMed  Article  CAS  Google Scholar 

  18. 18.

    Friden T, Roberts D, Zatterstrom R, Lindstrand A, Moritz U (1999) Proprioceptive defects after an anterior cruciate ligament rupture—the relation to associated anatomical lesions and subjective knee function. Knee Surg Sports Traumatol Arthrosc 7:226–231

    PubMed  Article  CAS  Google Scholar 

  19. 19.

    Hewett TE, Paterno MV, Myer GD (2002) Strategies for enhancing proprioception and neuromuscular control of the knee. Clin Orthop Relat Res 402:76–94

    PubMed  Article  Google Scholar 

  20. 20.

    Jerosch J, Prymka M (1996) Knee joint proprioception in normal volunteers and patients with anterior cruciate ligament tears, taking special account of the effect of a knee bandage. Arch Orthop Trauma Surg 115:162–166

    PubMed  Article  CAS  Google Scholar 

  21. 21.

    Johansson H (1991) Role of knee ligaments in proprioception and regulation of muscle stiffnes. J Electromyogr Kinesiol 1:158–179

    Article  Google Scholar 

  22. 22.

    Johansson H, Lorentzon R, Sjölander P, Sojka P (1990) The anterior cruciate ligament. A sensor acting on the gamma muscle spindle systems of muscles around the knee joint. Neuro Orthop 9:1–23

    Google Scholar 

  23. 23.

    Johansson H, Sjolander P, Sojka P (1991) Receptors in the knee joint ligaments and their role in the biomechanics of the joint. Crit Rev Biomed Eng 18:341–368

    PubMed  CAS  Google Scholar 

  24. 24.

    Johansson H, Sjolander P, Sojka P (1991) A sensory role for the cruciate ligaments. Clin Orthop 268:161–178

    PubMed  Google Scholar 

  25. 25.

    MacDonald PB, Hedden D, Pacin O, Sutherland K (1996) Proprioception in anterior cruciate ligament-deficient and reconstructed knees. Am J Sports Med 24:774–778

    PubMed  Article  CAS  Google Scholar 

  26. 26.

    Nawata K, Teshima R, Morio Y, Hagino H, Enokida M, Yamamoto K (1999) Anterior-posterior knee laxity increased by exercise. Quantitative evaluation of physiologic changes. Acta Orthop Scand 70:261–264

    PubMed  CAS  Google Scholar 

  27. 27.

    Pap G, Machner A, Nebelung W, Awiszus F (1999) Detailed analysis of proprioception in normal and ACL-deficient knees. J Bone Joint Surg Br 81:764–768

    PubMed  Article  CAS  Google Scholar 

  28. 28.

    Pollet V, Barrat D, Meirhaeghe E, Vaes P, Handelberg F (2005) The role of the Rolimeter in quantifying knee instability compared to the functional outcome of ACL-reconstructed versus conservatively-treated knees. Knee Surg Sports Traumatol Arthrosc 13:12–18

    PubMed  Article  CAS  Google Scholar 

  29. 29.

    Risberg MA, Beynnon BD, Peura GD, Uh BS (1999) Proprioception after anterior cruciate ligament reconstruction with and without bracing. Knee Surg Sports Traumatol Arthrosc 7:303–309

    PubMed  Article  CAS  Google Scholar 

  30. 30.

    Roberts D, Andersson G, Friden T (2004) Knee joint proprioception in ACL-deficient knees is related to cartilage injury, laxity and age: a retrospective study of 54 patients. Acta Orthop Scand 75:78–83

    PubMed  Article  Google Scholar 

  31. 31.

    Roberts D, Friden T, Stomberg A, Lindstrand A, Moritz U (2000) Bilateral proprioceptive defects in patients with a unilateral anterior cruciate ligament reconstruction: a comparison between patients and healthy individuals. J Orthop Res 18:565–571

    PubMed  Article  CAS  Google Scholar 

  32. 32.

    Roberts D, Friden T, Zatterstrom R, Lindstrand A, Moritz U (1999) Proprioception in people with anterior cruciate ligament-deficient knees: comparison of symptomatic and asymptomatic patients. J Orthop Sports Phys Ther 29:587–594

    PubMed  CAS  Google Scholar 

  33. 33.

    Rozzi SL, Lephart SM, Gear WS, Fu FH (1999) Knee joint laxity and neuromuscular characteristics of male and female soccer and basketball players. Am J Sports Med 27:312–319

    PubMed  CAS  Google Scholar 

  34. 34.

    Sernert N, Kartus J, Kohler K, Stener S, Larsson J, Eriksson BI, Karlsson J (1999) Analysis of subjective, objective and functional examination tests after anterior cruciate ligament reconstruction. A follow-up of 527 patients. Knee Surg Sports Traumatol Arthrosc 7:160–165

    PubMed  Article  CAS  Google Scholar 

  35. 35.

    Skinner H, Wyatt MP, Stone ML, Hodgdon JA, Barrack RL (1986) Exercise-related knee joint laxity. Am J Sports Med 14:30–34

    PubMed  Article  CAS  Google Scholar 

  36. 36.

    Snyder-Mackler L, Fitzgerald GK, Bartolozzi AR 3rd, Ciccotti MG (1997) The relationship between passive joint laxity and functional outcome after anterior cruciate ligament injury. Am J Sports Med 25:191–195

    PubMed  Article  CAS  Google Scholar 

  37. 37.

    Steiner ME, Grana WA, Chillag K, Schelberg-Karnes E (1986) The effect of exercise on anterior-posterior knee laxity. Am J Sports Med 14:24–29

    PubMed  Article  CAS  Google Scholar 

  38. 38.

    Zätterström R (1999) The injured anterior cruciate ligament and neuromuscular rehabilitation. Doctoral Thesis, University of Lund, Sweden

  39. 39.

    Zätterstrom R, Friden T, Lindstrand A, Moritz U (2000) Rehabilitation following acute anterior cruciate ligament injuries–a 12-month follow-up of a randomized clinical trial. Scand J Med Sci Sports 10:156–163

    PubMed  Article  Google Scholar 

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Acknowledgments

The authors would like to thank Mats Christensson, Department of Medical Technology, for his construction of the apparatus used, all the subjects who volunteered to take part in the study, Ass. Prof. Per-Erik Isberg for statistical advice. Financial support from Medicinska forskningsrådet, project no. 09509, Stiftelsen för Bistånd åt Vanföra i Skåne, Syskonen Persson’s Donation fund, Svenska Sällskapet för Medicinsk Forskning, Thyr och Thure Stenemark’s Fund, Centrum för Idrottsforskning, the Swedish Society of Medicine, the National Board of Health and Welfare and the Faculty of Medicine, Lund University is gratefully acknowledged.

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Roberts, D., Ageberg, E., Andersson, G. et al. Clinical measurements of proprioception, muscle strength and laxity in relation to function in the ACL-injured knee. Knee Surg Sports Traumatol Arthr 15, 9–16 (2007). https://doi.org/10.1007/s00167-006-0128-4

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Keywords

  • Knee injuries
  • Anterior cruciate ligament
  • Knee joint
  • Proprioception
  • Laxity