Proprioception After Soft Tissue Regenerative Treatment

  • Barış Gülenç
  • Ersin Kuyucu
  • Mehmet Erdil


Proprioception is defined as the perception of joints and extremities provided by the neural inputs through receptors found in joints and surrounding tissues. In general, proprioception is achieved by afferent stimuli coming from receptors found in joint capsule, muscles, tendons, ligaments, other intra-articular structures, and skin. The important role of the soft tissue is discussed in details in this chapter.


Kinesthesia Joint position sense Surgery 


  1. 1.
    Sharma L. Proprioceptive impariment in knee osteoarthtitis. Rheum Dis Clin North. 1999;25:299–314.CrossRefGoogle Scholar
  2. 2.
    Sherrington CS. The integrative action of the nervous system. New Haven, CT: Yale University Press; 1906.Google Scholar
  3. 3.
    Akseki D, Erduran M, Kaya D. Sports injuries and proprioception: current trends and new horizons. In: Sports injuries. Berlin Heidelberg: Springer; 2012. p. 67–71.Google Scholar
  4. 4.
    Zimmy ML. Mechanoreseptors in articular tissues. Am J Anat. 1988;182:16–32.CrossRefGoogle Scholar
  5. 5.
    Kaminski TW, Buckley BD, Powers ME, Hubbard TJ, Ortiz C. Effect of strength and proprioception training on eversion to inversion strength ratios in subjects with unilateral functional ankle instability. Br J Sports Med. 2003;37:410–5.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Verhagen E, Beek A, Twisk J, Bouter L, Bahr R, Mechelen W. The effect of a proprioceptive balance board training program for the prevention of ankle sprains: a prospective controlled trial. Am J Sports Med. 2004;32:1385–93.CrossRefPubMedGoogle Scholar
  7. 7.
    Xu D, Hong Y, Li J, Chan K. Effect of tai chi exercise on proprioception of ankle and knee joints in old people. Br J Sports Med. 2004;38:50–4.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Robbins S, Waked E, Rappel R. Ankle taping improves proprioception before and after exercise in young men. Br J Sports Med. 1995;29:242–7.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Lephart SM, Henry TJ. The physiological basis for open and closed kinetic chain rehabilitation for the upper extremity. J Sport Rehabil. 1996;5:71–87.CrossRefGoogle Scholar
  10. 10.
    Lee HM, Cheng CK, Liau JJ. Correlation between proprioception, muscle strength, knee laxity, and dynamic standing balance in patients with chronic anterior cruciate ligament deficiency. Knee. 2009;16:387–91.CrossRefPubMedGoogle Scholar
  11. 11.
    Corrigan JP, Cashman WF, Brady MP. Proprioception in the cruciate deficient knee. J Bone Joint Surg. 1992;74(2):247–50.CrossRefGoogle Scholar
  12. 12.
    O’Connor BL, Brant KD. Neurogenic factors in the etiopathogenesis of osteoarthritis. Rheum Dis Clin N Am. 1993;19:581–605.Google Scholar
  13. 13.
    Pai YC, Rymer WZ, Chang RW, Sharma L. Effect of age and osteoarthritis on knee proprioception. Arthritis Rheum. 1997;40:2260–5.CrossRefPubMedGoogle Scholar
  14. 14.
    Barrack RL, Skinner HB, Buckley SL. Proprioception in the anterior cruciate deficient knee. Am J Sports Med. 1989;17(1):1–6.CrossRefPubMedGoogle Scholar
  15. 15.
    Kim HJ, Lee JH, Lee DH. Proprioception in patients with anterior cruciate ligament tears. Am J Sports Med. 2017;45:2916–22. Scholar
  16. 16.
    Fischer-Rasmussen T, Jensen PE. Proprioceptive sensitivity and performance in anterior cruciate ligament-deficient knee joints. Scand J Med Sci Sports. 2000;10:85–9.CrossRefPubMedGoogle Scholar
  17. 17.
    Fremerey RW, Lobenhoffer P, Zeichen J, et al. Proprioception after rehabilitation and reconstruction in knees with deficiency of the anterior cruciate ligament: a prospective, longitudinal study. J Bone Joint Surg Br. 2000;82:801–6.CrossRefPubMedGoogle Scholar
  18. 18.
    Ozenci AM, Inanmaz E, Ozcanli H, et al. Proprioceptive comparison of allograft and autograft anterior cruciate ligament reconstructions. Knee Surg Sports Traumatol Arthrosc. 2007;15:1432–7.CrossRefPubMedGoogle Scholar
  19. 19.
    Mir SM, Hadian MR, Talebian S, et al. Functional assessment of knee joint position sense following anterior cruciate ligament reconstruction. Br J Sports Med. 2008;42:300–3.CrossRefPubMedGoogle Scholar
  20. 20.
    Anguoles AG, Mavrogenis AF, Dimitriou R, Karzis K, Drakoulakis E, Michos J, et al. Knee proprioception following ACL reconstruction; a prospective trial comparing hamstring with bone-patellar tendon-bone autograft. Knee. 2011;18:76–82.CrossRefGoogle Scholar
  21. 21.
    Relph N, Herrington L, Tyson S. The effects of ACL injury on knee proprioception: a meta-analysis. Physiotherapy. 2014;100:187–95.CrossRefPubMedGoogle Scholar
  22. 22.
    Barrack RL, Munn BG. Effects of knee ligament injury and reconstruction on proprioception. In: Lephart SM, Fu FH, editors. Proprioception and neuromuscular control in joint stability. Champaign: Human Kinetics; 2000.Google Scholar
  23. 23.
    Pinczewski LA, Lyman J, Salmon LJ, Russell VJ, Roe J, Linklater J. A 10-year comparison of anterior cruciate ligament reconstructions with hamstring tendon and patellar tendon autograft: a controlled, prospective trial. Am J Sports Med. 2007;35:564–74.CrossRefPubMedGoogle Scholar
  24. 24.
    Reider B, Arcand M, Diehl HL, Mroczek K, Abulencia A, Stroud CC, Palm M, Gilbertson J, Staszak P. Proprioception of the knee before and after anterior cruciate ligament reconstruction. Arthroscopy. 2003;19:2–12.CrossRefPubMedGoogle Scholar
  25. 25.
    Ma Y, Deie M, Iwaki D, Asaeda M, Fujita N, Adachi N, Ochi M. Balance ability and proprioception after single-bundle, single-bundle augmentation, and double-bundle ACL reconstruction. Sci World J. 2014;2014:342012.Google Scholar
  26. 26.
    Hewett TE, Paterno MV, Myer GD. Strategies for enhancing proprioception and neuromuscular control of the knee. Clin Orthop Relat Res. 2002;402:76–94.CrossRefGoogle Scholar
  27. 27.
    Lephart SM, Pincivero DM, Rozzi SL. Proprioception of the ankle and knee. Sports Med. 1998;25:149–55.CrossRefPubMedGoogle Scholar
  28. 28.
    Al-Dadah O, Shepstone L, Donell ST. Proprioception following partial meniscectomy in stable knees. Knee Surg Sports Traumatol Arthrosc. 2011;19:207–13.CrossRefPubMedGoogle Scholar
  29. 29.
    Palm HG, Laufer C, von Lubken F, Achatz G, Friemert B. Do meniscus injuries affect postural stability? Orthopade. 2010;39:486–94.CrossRefPubMedGoogle Scholar
  30. 30.
    Jerosch J, Prymka M, Castro WH. Proprioception of knee joints with a lesion of the medial meniscus. Acta Orthop Belg. 1996;62:41–5.PubMedGoogle Scholar
  31. 31.
    Thijs Y, Witvrouw E, Evens B, et al. A prospective study on knee proprioception after meniscal allograft transplantation. Scand J Med Sci Sports. 2007;17:223–9.PubMedGoogle Scholar
  32. 32.
    Glatthorn JF, Berendts AM, Bizzini M, Munzinger U, Maffiuletti NA. Neuromuscular function after arthroscopic partial meniscectomy. Clin Orthop Relat Res. 2010;468:1336–43.CrossRefPubMedGoogle Scholar
  33. 33.
    Bray RC, Leonard CA, Salo PT. Vascular physiology and long-term healing of partial ligament tears. J Orthop Res. 2002;20:984–9.CrossRefPubMedGoogle Scholar
  34. 34.
    Petersen W, Tillmann B. Blood and lymph supply of the posterior cruciate ligament: a cadaver study. Knee Surg Sports Traumatol Arthrosc. 1999;7:42–50.CrossRefPubMedGoogle Scholar
  35. 35.
    Clark P, MacDonald PB, Sutherland K. Analysis of proprioception in the posterior cruciate ligament-deficient knee. Knee Surg Sports Traumatol Arthrosc. 1996;4:225–7.CrossRefPubMedGoogle Scholar
  36. 36.
    Safran MR, Allen AA, Lephart SM, Borsa PA, Fu FH, Harner CD. Proprioception in the posterior cruciate ligament deficient knee. Knee Surg Sports Traumatol Arthrosc. 1999;7:310–7.CrossRefPubMedGoogle Scholar
  37. 37.
    Adachi N, Ochi M, Uchio Y, Iwasa J, Ishikawa M, Shinomiya R. Temporal change of joint position sense after posterior cruciate ligament reconstruction using multi-stranded hamstring tendons. Knee Surg Sports Traumatol Arthrosc. 2007;15:2–8.CrossRefPubMedGoogle Scholar
  38. 38.
    Lee CD, Shon JO, Kwack HB, Lee JS. Proprioception and clinical results of anterolateral single-bundle posterior cruciate ligament reconstruction with remnant preservation. Knee Surg Relat Res. 2013;25:126–32.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Li J, Kong F, Gao X, Shen Y, Gao S. Prospective randomized comparison of knee stability and proprioception for posterior cruciate ligament reconstruction with autograft, hybrid graft, and γ-irradiated allograft. Arthroscopy. 2016;32:2548–55.CrossRefPubMedGoogle Scholar
  40. 40.
    Freeman MAR, Wyke B. The innervation of the knee joint. An anatomical and histological study in the cat. J Anat. 1964;101:505–32.Google Scholar
  41. 41.
    Garn SN, Newton RA. Kinesthetic awareness in subjects with multiple ankle sprains. Phys Ther. 1988;68:1667–71.CrossRefPubMedGoogle Scholar
  42. 42.
    Glencross D, Thorton E. Position sense following joint injury. J Sports Med Phys Fitness. 1982;21:23–7.Google Scholar
  43. 43.
    Konradson L, Ravn JB. Ankle instability caused by prolonged peroneal reaction time. Acta Orthop Scand. 1990;61:388–90.CrossRefGoogle Scholar
  44. 44.
    Li HY, Zheng JJ, Zhang J, Cai YH, Hua YH, Chen SY. The improvement of postural control in patients with mechanical ankle instability after lateral ankle ligaments reconstruction. Knee Surg Sports Traumatol Arthrosc. 2016;24:1081–5.CrossRefPubMedGoogle Scholar
  45. 45.
    McKeon PO, Hertel J. Systematic review of postural control and lateral ankle instability, part I: can deficits be detected with instrumented testing? J Athl Train. 2008;43:293–304.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Bressel E, Larsen BT, McNair PJ, Cronin J. Ankle joint proprioception and passive mechanical properties of calf muscles after an Achilles tendon rupture: a comparison with matched controls. Clin Biomech. 2004;19:284–91.CrossRefGoogle Scholar
  47. 47.
    Kaya D, Doral MN, Nyland J, Toprak U, Turhan E, Donmez G, Citaker S, Atay OA, Callaghan MJ. Proprioception level after endoscopically guided percutaneous Achilles tendon. Knee Surg Sports Traumatol Arthrosc. 2013;21:1238–44.CrossRefPubMedGoogle Scholar
  48. 48.
    Hawkins RB. Arthroscopic stapling repair for shoulder instability: a retrospective study of 50 cases. Arthroscopy. 1989;5:122–8.CrossRefPubMedGoogle Scholar
  49. 49.
    Matthews LS, Vetter WL, Oweida SJ, Spearman J, Helfet D. Arthroscopic staple capsulorrhaphy for recurrent anterior shoulder instability. Arthroscopy. 1988;4:106–11.CrossRefPubMedGoogle Scholar
  50. 50.
    Morgan CD, Bodenstab AB. Arthroscopic Bankart suture repair: technique and early results. Arthroscopy. 1987;3:111–22.CrossRefPubMedGoogle Scholar
  51. 51.
    Vangsness CT Jr, Ennis M, Taylor JG, Atkinson B. Neural anatomy of the glenohumeral ligaments, labrum, and subacromial bursa. Arthroscopy. 1995;11:180–4.CrossRefPubMedGoogle Scholar
  52. 52.
    Jerosch J, Steinbeck J, Schroder M, Westhues M. Intraoperative EMG recording in stimulation of the glenohumeral joint capsule. Unfallchirurg. 1995;98:580–5.PubMedGoogle Scholar
  53. 53.
    Myers JB, Lephart SM. The role of the sensorimotor system in the athletic shoulder. J Athl Train. 2000;35:351–63.PubMedPubMedCentralGoogle Scholar
  54. 54.
    Janwantanakul P, Magarey ME, Jones MA, Dansie BR. Variation in shoulder position sense at mid and extreme range of motion. Arch Phys Med Rehabil. 2001;82:840–4.CrossRefPubMedGoogle Scholar
  55. 55.
    Lephart SM, Warner JJ, Borsa PA, Fu FH. Proprioception of the shoulder joint in healthy, unstable, and surgicallyrepairedshoulders. J Shoulder Elb Surg. 1994;3:371–80.CrossRefGoogle Scholar
  56. 56.
    Fremerey R, Bosch U, Freitag N, Lobenhoffer P, Wippermann B. Proprioception and EMG pattern after capsulolabral reconstruction in shoulder instability: a clinical and experimental study. Knee Surg Sports Traumatol Arthrosc. 2006;14:1315–20.CrossRefPubMedGoogle Scholar
  57. 57.
    Uri O, Pritsch M, Oran A, Liebermann DG. Upperlimb kinematics after arthroscopic and open shoulder stabilization. J Shoulder Elb Surg. 2015;24:399–406.CrossRefGoogle Scholar
  58. 58.
    Sullivan JA, Hoffman MA, Harter RA. Shoulder joint position sense after thermal, open, and arthroscopic capsulorrhaphy for recurrent anterior instability. J Shoulder Elb Surg. 2008;17:389–94.CrossRefGoogle Scholar
  59. 59.
    An YH, Friedman RJ. Multidirectional instability of the glenohumeral joint. Orthop Clin North Am. 2000;31:275–85.CrossRefPubMedGoogle Scholar
  60. 60.
    Anderson VB, Wee E. Impaired joint proprioception at higher shoulder elevations in chronic rotator cuff pathology. Arch Phys Med Rehabil. 2011;92:1146–51.CrossRefPubMedGoogle Scholar
  61. 61.
    Hagert E, Garcia-Elias M, Forsgren S, Ljung BO. Immunohistochemical analysis of wrist ligament innervation in relation to their structural composition. J Hand Surg Am. 2007;32:30–6.CrossRefPubMedGoogle Scholar
  62. 62.
    Mataliotakis G, Doukas M, Kostas I, Lykissas M, Batistatou A, Beris A. Sensory innervation of the subregions of the scapholunate interosseous ligament in relation to their structural composition. J Hand Surg Am. 2009;34:1413–21.CrossRefPubMedGoogle Scholar
  63. 63.
    Hagert E, Persson JK. Desensitizing the posterior interosseous nerve alters wrist proprioceptive reflexes. J Hand Surg Am. 2010;35:1059–66.CrossRefPubMedGoogle Scholar
  64. 64.
    Lluch Bergada A, Leon Lopez MM, Llusa Perez M, Garcia-Elias M. Neuromuscular control of the carpus in simulated palmar midcarpal instability. Thesis in progress, Institut Kaplan, Barcelona University, Spain; 2015.Google Scholar
  65. 65.
    Smith TO, Bacon H, Jerman E, et al. Physiotherapy and occupational therapy interventions for people with benign joint hypermobility syndrome: a systematic review of clinical trials. Disabil Rehabil. 2014;36:797–803.CrossRefPubMedGoogle Scholar
  66. 66.
    Hargreaves DG. Arthroscopic thermal capsular shrinkage for palmar midcarpal instability. J Wrist. 2014;3:162–5.CrossRefGoogle Scholar
  67. 67.
    Hagert E, Lluch A, Rein S. The role of proprioception and neuromuscularstability in carpalinstabilities. J Hand Surg Eur Vol. 2016;4:94–101.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Orthopedics and Traumatology, Faculty of MedicineIstanbul Medipol UniversityIstanbulTurkey

Personalised recommendations