Reproduction Of Passive Positioning Research Articles

Proprioceptive and Clinical Outcomes after Remnant Preserved Anterior Cruciate Ligament Reconstruction: Assessment with Minimal Confounding Factors.

ObjectiveTo evaluate the proprioceptive and clinical function of the knee joint after anterior cruciate ligament reconstruction (ACLR) with various amounts of remnant preserved with as few confounding factors as possible.MethodsThis retrospective study included 46 patients who underwent ACLR with remnant preservation between March 2013 and February 2019. These patients had less than 6 months injury‐to‐surgery interval and no concomitant injuries. The researchers divided these subjects into two groups based on the length of the remnant preserved after ACLR, with group A defined as having more than 1/3 of the original length preserved and group B defined as less than 1/3 of the original length preserved. Clinical scores were obtained using the Lysholm knee scoring scale and the Tegner activity scale. The Lysholm score was calculated preoperatively, at 3, 6, and 12 months postoperatively, and at the last follow up. The Tegner score was calculated preoperatively, at 12 months postoperatively and at the last follow up. Anterior laxity was measured using the KT2000 arthrometer preoperatively and at 12 months postoperatively. Proprioceptive function was evaluated through reproduction of passive positioning (RPP) and threshold to detection of passive motion (TDPM). Both RPP and TDPM were measured at the angle of 15° at 3, 6, and 12 months postoperatively. Unpaired t‐tests were performed to investigate the difference in each parameters between the two groups.ResultsIn the present study, 20 patients were classified into group A and 26 into group B. All patients were followed up for an average of 34.70 ± 12.79 months. All 46 patients were satisfied with the outcome of the surgery and no complications were reported at the end of the study. No significant differences were found between the two groups in terms of the Lysholm score and anterior laxity by KT2000 at all time points. The Tegner score was significantly higher in group A at 12 months postoperatively and at the final follow‐up. In addition, group A's RPP was significantly better than that of group B's when tested at the angles of 15° and 30° at 3 months postoperatively, and at the angle of 15° at 6 months postoperatively. Group A's TDPM was also significantly better than that of group B's at all three tested angles at 3 months postoperatively, and at the angle of 15° at 6 months postoperatively.ConclusionPatients with ACLR with more than 1/3 of the original length preserved demonstrated a higher activity level 12 months postoperatively and better proprioceptive function at 15° of extension at 3 and 6 months postoperatively.

Proprioception After Multiligament Knee Injury: Does Ligament Repair Lead to Better Proprioceptive Acuity Than Ligament Reconstruction?

IntroductionMultiligament knee injuries are uncommon but serious injuries. There is ongoing debate on the optimal treatment of these injuries. We designed a study to establish the effects of repair or reconstruction on proprioceptive outcomes following multiligament injury to the knee.Materials and MethodsA total of 34 patients were analysed by independent researchers who had no conflict of interest in the cases (23 in the repair group and 11 in the reconstruction group). Proprioception of the knee was measured using a previously validated tool to assess the reproduction of passive positioning. Functional outcome was measured using the Lysholm score. Sub-group analysis was performed. The mean time from injury to review was 83 months (range: 25-193 months).ResultsThere were no significant differences in proprioceptive acuity between the injured (5.9±4.2°; range: 1.0-18.3°) and uninjured contralateral (control) knees (5.2±3.8°; range: 1.0-15.0°; p=0.35). Similarly, there was no significant difference in proprioceptive acuity identified between the injured knees that underwent repair (6.0±4.3°; range: 1.0-18.3°) or reconstruction (5.0±3.6°; range: 1.3-14°; p=0.53).Overall knee outcomes were good; the mean Lysholm score at final follow-up was 75.5±16.8 (range: 36-100). No significant differences were identified in any of the sub-groups.ConclusionsWe were unable to identify any differences in knee proprioceptive acuity between injured knees and controls nor between the types of surgical treatment, demonstrating equivocal recovery for both methods of treatment.

Preservation of the Tibial Remnant in Anterior Cruciate Ligament Reconstruction May Improve Postoperative Proprioceptive Function.

The purpose of this study was to retrospectively compare clinical results, including proprioceptive function, after anterior cruciate ligament (ACL) reconstruction between 2 groups using techniques that preserve and eliminate the tibial remnant. Forty-eight patients who were followed for at least 24 months after ACL reconstruction with 4-strand hamstring tendon autografts were enrolled in this study. They were then divided into 2 groups: the remnant-preserving group (group A, 26 patients), in whom more than 7 mm of the remnant tibial stump (approximately 20% of the mean length of the ACL) was preserved; and the remnant-eliminating group (group B, 22 patients), in whom the tibial remnant was eliminated during ACL reconstruction. The average duration of follow-up was 25.5 months. At last follow-up, patients were evaluated using the International Knee Documentation Committee scale, Hospital for Special Surgery score, Lachman test, arthrometer, reproduction of passive positioning (RPP) test, threshold to detection of passive motion (TTDPM) test, one-leg hop test, and single-limb standing test. The clinical results between the 2 groups were statistically compared. Group A showed significantly better results on the RPP test at 15° (P=.040) and 30° (P=.010), one-leg hop test (P=.017), and single-limb standing test (P=.007) compared with group B. The other results showed no significant differences. The remnant-preserving technique in ACL reconstruction yields better proprioceptive and functional outcomes and may help achieve postoperative patient satisfaction. [Orthopedics. 2020;43(4):e231-e236.].

Comparison of proprioception between osteoarthritic and age-matched unaffected knees: a systematic review and meta-analysis.

Theoretically, proprioceptive acuity could decrease in patients with knee osteoarthritis. However, there have been conflicting results in terms of proprioceptive deficit in osteoarthritic knees. The purpose of this systematic review and meta-analysis was to compare knee proprioception between osteoarthritic and healthy control knees. Studies comparing proprioception in osteoarthritic and healthy knees of age-matched control group using thresholds to detect passive motion (TTDPM) or joint position sense (JPS) tests were identified. JPS was assessed by measuring the reproduction of passive positioning (RPP) or active positioning (RAP) of the knees. Seventeen studies were finally included in this meta-analysis. The pooled results of the analyses of the TTDPM for both 30° and 45° knee flexion showed that the mean angle of error was 0.83° greater (95% confidence interval: 0.44 to 1.23°; p < 0.001) in the osteoarthritic knees than in control knees. The pooled data of the RAP and RPP also showed that the mean angle of error was 1.89° greater in the osteoarthritic knees than in the control group. The mean difference in the angle of error between the osteoarthritic knees and control group was 1.06° greater in the JPS test than in the TTDPM (p < 0.001). The knee proprioceptive acuity of the patients with knee osteoarthritis was poorer than that of the patients with unaffected knees in the age-matched control group both in terms of the TTDPM and JPS; clinical relevance of these deficits needs to be clarified in further studies. Meta-analysis, Level II.

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

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.

Comparison of Clinical Results According to Amount of Preserved Remnant in Arthroscopic Anterior Cruciate Ligament Reconstruction Using Quadrupled Hamstring Graft

The purpose of this study was to analyze the clinical results of anterior cruciate ligament (ACL) reconstruction with the remnant-preserving technique by use of a hamstring graft and looped sutures according to the amount of the tibial remnant of the ACL. Sixteen subjects had undergone ACL reconstruction with the remnant-preserving technique by use of 4 strands of a hamstring tendon and a looped suture technique and were followed up for at least 12 months. The mean follow-up was 35.1 months. At the last follow-up examination, the patients were evaluated with the International Knee Documentation Committee scale and Hospital for Special Surgery score as subjective tests; stress radiographs, Lachman test, and anterior drawer test by use of the KT-2000 arthrometer (MEDmetric, San Diego, CA) as objective tests; and single-legged hop test, reproduction of passive positioning, threshold to detection of passive motion, and single-limb standing test as functional tests. On the basis of the extent of ACL remnant, patients were then divided into 2 groups. Group I comprised patients with more than 20%, and group II comprised those with less than 20%. For each of the 2 groups, a statistical comparison of the final results was made. The mean Hospital for Special Surgery score improved from 65.8 (preoperatively) to 95.2 (at last follow-up). Functional evaluation revealed that the difference was not significant in terms of mechanical stability, but a significant difference was detected in functional outcome and proprioception. Regarding the threshold to detection of passive motion at 30 degrees (P = .030) and reproduction of passive positioning at 15 degrees (P = .032) and 30 degrees (P = .024), group I (> 20%) showed better results than group II (< 20%). We confirmed that the remnant-preserving technique described showed good proprioceptive and functional outcomes with statistical significance. Therefore it may be expected that the more the tibial remnant is kept intact, the better the preservation of proprioceptive function will be. Level IV, prognostic case series.

Joint position sense and rehabilitation in the anterior cruciate ligament deficient knee.

BACKGROUND: Impaired joint position sense (JPS) has been shown in anterior cruciate ligament (ACL) deficient and osteoarthritic knees. The relation between JPS and function is uncertain. The aim of this...