scholarly journals Properties of Knee Joint Position Sense Tests for Anterior Cruciate Ligament Injury: A Systematic Review and Meta-analysis

2021 ◽  
Vol 9 (6) ◽  
pp. 232596712110078
Author(s):  
Andrew Strong ◽  
Ashokan Arumugam ◽  
Eva Tengman ◽  
Ulrik Röijezon ◽  
Charlotte K. Häger
Keyword(s):  
Systematic Review ◽  
Cruciate Ligament ◽  
Meta Analysis ◽  
Acl Injury ◽  
Position Sense ◽  
Joint Position Sense ◽  
Joint Position ◽  
Level Of Evidence ◽  
Anterior Cruciate ◽  
Meta Analyses

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 ( I 2 > 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.

A Majority of Anterior Cruciate Ligament Injuries Can Be Prevented by Injury Prevention Programs: A Systematic Review of Randomized Controlled Trials and Cluster–Randomized Controlled Trials With Meta-analysis

2019 ◽  
Vol 48 (6) ◽  
pp. 1505-1515 ◽  
Author(s):  
Yu-Lun Huang ◽  
Jaehun Jung ◽  
Colin M.S. Mulligan ◽  
Jaekeun Oh ◽  
Marc F. Norcross
Keyword(s):  
Systematic Review ◽  
Protective Effect ◽  
Best Practice ◽  
Cruciate Ligament ◽  
Meta Analysis ◽  
Acl Injury ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Anterior Cruciate ◽  
Meta Analyses

Background: Anterior cruciate ligament (ACL) injury prevention programs (IPPs) are generally accepted as being valuable for reducing injury risk. However, significant methodological limitations of previous meta-analyses raise questions about the efficacy of these programs and the extent to which meeting current best-practice ACL IPP recommendations influences the protective effect of these programs. Purpose: To (1) estimate the protective effect of ACL IPPs while controlling for common methodological limitations of previous meta-analyses and (2) systematically categorize IPP components and factors related to IPP delivery to assess the validity of current best-practice IPP recommendations. Study Design: Systematic review with meta-analysis. Methods: A systematic search of 5 electronic scientific databases was conducted to identify studies testing the efficacy of ACL IPPs. Studies were included if (1) the intervention aimed to prevent ACL injury, (2) the incidence rate (IR) or other outcome data that made it possible to calculate the IR for both the intervention and control groups were reported, and (3) the study design was a prospective randomized controlled trial (RCT) or cluster-RCT. Results: Of the 2219 studies screened, 8 studies were included in the quantitative synthesis, and their analysis revealed a significant reduction in ACL IR when athletes received IPPs (IR ratio = 0.47; 95% CI, 0.30-0.73; P < .001). The majority of included IPPs tended to meet minimum best-practice recommendations and incorporated plyometric, strengthening, and agility exercises along with feedback on proper landing technique. However, the specific exercises included in each IPP and key factors related to IPP delivery were highly variable. Conclusion: Despite limiting the analysis to only high-quality studies and controlling for time at risk and potential clustering effects, the study showed that ACL IPPs had a significant protective effect and reduced injury rates by 53%. However, significant variability in the specific exercises and the manner of program delivery suggests that ACL IPPs may be able to be designed within an overarching best-practice framework. This may allow practitioners the flexibility to develop IPPs that meet the specific characteristics of the target population and potentially increase the likelihood that these programs will be widely adopted and implemented.

scholarly journals Risk of Secondary Injury in Younger Athletes After Anterior Cruciate Ligament Reconstruction

2016 ◽  
Vol 44 (7) ◽  
pp. 1861-1876 ◽  
Author(s):  
Amelia J. Wiggins ◽  
Ravi K. Grandhi ◽  
Daniel K. Schneider ◽  
Denver Stanfield ◽  
Kate E. Webster ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cruciate Ligament ◽  
Meta Analysis ◽  
Return To Sport ◽  
Injury Rate ◽  
Acl Injury ◽  
Return To Play ◽  
Review Of The Literature ◽  
Anterior Cruciate ◽  
Meta Analyses

Background: Injury to the ipsilateral graft used for reconstruction of the anterior cruciate ligament (ACL) or a new injury to the contralateral ACL are disastrous outcomes after successful ACL reconstruction (ACLR), rehabilitation, and return to activity. Studies reporting ACL reinjury rates in younger active populations are emerging in the literature, but these data have not yet been comprehensively synthesized. Purpose: To provide a current review of the literature to evaluate age and activity level as the primary risk factors in reinjury after ACLR. Study Design: Systematic review and meta-analysis. Methods: A systematic review of the literature was conducted via searches in PubMed (1966 to July 2015) and EBSCO host (CINAHL, Medline, SPORTDiscus [1987 to July 2015]). After the search and consultation with experts and rating of study quality, 19 articles met inclusion for review and aggregation. Population demographic data and total reinjury (ipsilateral and contralateral) rate data were recorded from each individual study and combined using random-effects meta-analyses. Separate meta-analyses were conducted for the total population data as well as the following subsets: young age, return to sport, and young age + return to sport. Results: Overall, the total second ACL reinjury rate was 15%, with an ipsilateral reinjury rate of 7% and contralateral injury rate of 8%. The secondary ACL injury rate (ipsilateral + contralateral) for patients younger than 25 years was 21%. The secondary ACL injury rate for athletes who return to a sport was also 20%. Combining these risk factors, athletes younger than 25 years who return to sport have a secondary ACL injury rate of 23%. Conclusion: This systematic review and meta-analysis demonstrates that younger age and a return to high level of activity are salient factors associated with secondary ACL injury. These combined data indicate that nearly 1 in 4 young athletic patients who sustain an ACL injury and return to high-risk sport will go on to sustain another ACL injury at some point in their career, and they will likely sustain it early in the return-to-play period. The high rate of secondary injury in young athletes who return to sport after ACLR equates to a 30 to 40 times greater risk of an ACL injury compared with uninjured adolescents. These data indicate that activity modification, improved rehabilitation and return-to-play guidelines, and the use of integrative neuromuscular training may help athletes more safely reintegrate into sport and reduce second injury in this at-risk population.

The Analysis of Proprioception Alteration during First Five Months after Anterior Cruciate Ligament Reconstruction

2018 ◽  
Vol 1 (84) ◽  
Author(s):  
Vilma Jurevičienė ◽  
Albertas Skurvydas ◽  
Juozas Belickas ◽  
Giedra Bušmanienė ◽  
Dovilė Kielė ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Angular Velocity ◽  
Knee Joint ◽  
Cruciate Ligament ◽  
Position Sense ◽  
Joint Position Sense ◽  
Joint Position ◽  
Starting Position ◽  
Angular Velocities ◽  
Anterior Cruciate

Research  background  and  hypothesis.  Proprioception  is  important  in  the  prevention  of  injuries  as  reduced proprioception  is  one  of  the  factors  contributing  to  injury  in  the  knee  joint,  particularly  the  ACL.  Therefore, proprioception appears not only important for the prevention of ACL injuries, but also for regaining full function after ACL reconstruction.Research aim. The aim of this study was to understand how proprioception is recovered four and five months after anterior cruciate ligament (ACL) reconstruction.Research methods. The study included 15 male subjects (age – 33.7 ± 2.49 years) who had undergone unilateral ACL reconstruction with a semitendinosus/gracilis (STG) graft in Kaunas Clinical Hospital. For proprioceptive assessment, joint position sense (JPS) was measured on both legs using an isokinetic dynamometer (Biodex), at knee flexion of 60° and 70°, and at different knee angular velocities of 2°/s and 10°/s. The patients were assessed preoperatively and after 4 and 5 months, postoperatively.Research results. Our study has shown that the JPS’s (joint position sense) error scores  to a controlled active movement is significantly higher in injured ACL-deficient knee than in the contralateral knee (normal knee) before surgery and after four and five months of rehabilitation.  After 4 and 5 months of rehabilitation we found significantly lower values in injured knees compared to the preoperative data. Our study has shown that in injured knee active angle reproduction errors after 4 and 5 months of rehabilitation were higher compared with the ones of the uninjured knee. Proprioceptive ability on the both legs was  independent of all differences angles for target and starting position for movement. The knee joint position sense on both legs depends upon the rate of two different angular velocities and the mean active angle reproduction errors at the test of angular velocity slow speed was the highest compared with the fast angular velocity. Discussion and conclusions. In conclusion, our study shows that there was improvement in mean JPS 4 and 5 months after ACL reconstruction, but it did not return to normal indices.Keywords: knee joint, joint position sense, angular velocity, starting position for movement.

Joint position sense is not changed after acute disruption of the anterior cruciate ligament

1999 ◽  
Vol 70 (2) ◽  
pp. 194-198 ◽  
Author(s):  
Lars Good ◽  
Harald Roos ◽  
Daniel J Gottlieb ◽  
Per A Renström ◽  
Bruce D Beynnon
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Position Sense ◽  
Joint Position Sense ◽  
Joint Position ◽  
Anterior Cruciate

scholarly journals Arthroscopic primary repair of proximal anterior cruciate ligament tears seems safe but higher level of evidence is needed: a systematic review and meta-analysis of recent literature

2019 ◽  
Vol 28 (6) ◽  
pp. 1946-1957 ◽  
Author(s):  
Jelle P. van der List ◽  
Harmen D. Vermeijden ◽  
Inger N. Sierevelt ◽  
Gregory S. DiFelice ◽  
Arthur van Noort ◽  
...  
Keyword(s):  
Systematic Review ◽  
Anterior Cruciate Ligament ◽  
Recent Literature ◽  
Primary Repair ◽  
Cruciate Ligament ◽  
Meta Analysis ◽  
Level Of Evidence ◽  
Outcome Scores ◽  
Anterior Cruciate

Abstract Purpose To assess the outcomes of the various techniques of primary repair of proximal anterior cruciate ligament (ACL) tears in the recent literature using a systematic review with meta-analysis. Methods PRISMA guidelines were followed. All studies reporting outcomes of arthroscopic primary repair of proximal ACL tears using primary repair, repair with static (suture) augmentation and dynamic augmentation between January 2014 and July 2019 in PubMed, Embase and Cochrane were identified and included. Primary outcomes were failure rates and reoperation rates, and secondary outcomes were patient-reported outcome scores. Results A total of 13 studies and 1,101 patients (mean age 31 years, mean follow-up 2.1 years, 60% male) were included. Nearly all studies were retrospective studies without a control group and only one randomized study was identified. Grade of recommendation for primary repair was weak. There were 9 out of 74 failures following primary repair (10%), 6 out of 69 following repair with static augmentation (7%) and 106 out of 958 following dynamic augmentation (11%). Repair with dynamic augmentation had more reoperations (99; 10%), and more hardware removal (255; 29%) compared to the other procedures. All functional outcome scores were > 85% of maximum scores. Conclusions This systematic review with meta-analysis found that the different techniques of primary repair are safe with failure rates of 7–11%, no complications and functional outcome scores of > 85% of maximum scores. There was a high risk of bias and follow-up was short with 2.1 years. Prospective studies comparing the outcomes to ACL reconstruction with sufficient follow-up are needed prior to widespread implementation. Level of evidence IV.

Proprioception in Patients With Anterior Cruciate Ligament Tears: A Meta-analysis Comparing Injured and Uninjured Limbs

2017 ◽  
Vol 45 (12) ◽  
pp. 2916-2922 ◽  
Author(s):  
Hyun-Jung Kim ◽  
Jin-Hyuck Lee ◽  
Dae-Hee Lee
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Meta Analysis ◽  
Joint Position Sense ◽  
Joint Position ◽  
Joint Movement ◽  
Mechanical Instability ◽  
Subgroup Analyses ◽  
The Mean ◽  
Anterior Cruciate

Background: Because of a reduction in the number of mechanoreceptors or alterations of their characteristics, anterior cruciate ligament (ACL) tears lead not only to mechanical instability but also to impaired proprioception. Purpose/Hypothesis: This study analyzed whether ACL tears cause a greater decrease in proprioception in injured than in uninjured knees. The hypothesis was that knee proprioception after ACL tears would decrease more in injured than in contralateral uninjured knees, regardless of the method used to measure knee proprioception. Study Design: Meta-analysis. Methods: We identified studies comparing proprioception in ACL-injured and contralateral intact knees using threshold for detection of passive motion (TTDPM) or joint position sense (JPS) tests. JPS was assessed by measuring the reproduction of passive positioning (RPP) or active repositioning (RAP) of the knee. Results: Sixteen studies were included in this meta-analysis. The pooled results of subgroup analyses of TTDPM for both 20° and 40° of knee flexion showed that mean angle of error was 0.23° (95% CI, 0.08°-0.37°) greater in ACL-injured than in contralateral intact knees ( P = .002). Pooled data RAP and RPP subgroup analyses also showed that the mean angle of error was 0.94° higher in ACL-injured than in contralateral intact knees. The mean difference in angle of error between ACL-injured and contralateral intact knees was 0.71° greater (95% CI, 0.68°-0.74°; P < .001) by JPS than by TTDPM. Conclusion: Proprioception of ACL-injured knees was decreased compared with contralateral intact knees, as determined by both joint movement (kinesthesia) and joint position. The magnitude of loss of proprioception was greater in joint position than in joint movement.

Sign in / Sign up

Export Citation Format

Share Document