) , ( target position − trial 3 ) Figure 1 —Knee-joint position sense test in an open kinetic chain. Statistical Analysis All data for the proprioceptive errors are presented as the mean (SD). To analyze the concurrent validity of the digital inclinometer against the isokinetic dynamometer, we used Pearson
Natalia Romero-Franco, Juan Antonio Montaño-Munuera, Juan Carlos Fernández-Domínguez and Pedro Jiménez-Reyes
Authors have investigated knee joint-position sense (JPS) in non-weight-bearing open kinetic chain (OKC) manner, but few have investigated JPS during closed kinetic chain (CKC) weight-bearing activities or the relationship between these two.
To investigate the relationship between knee JPS during OKC and CKC maneuvers.
2-group (men and women) repeated-measures.
80 asymptomatic subjects.
Main Outcome Measure:
Absolute error score of knee JPS during 2 conditions, a CKC squat or OKC knee-flexion maneuver.
Statistical analysis by 2-way ANOVA showed sex not to have a significant effect on error score (P = .475), but statistically significant differences between error scores occurred during the 2 tests (P = .0001), the CKC test producing lower error scores (group mean absolute error score OKC [5.6° ± 4.3°] and CKC [2.8° ± 2.4°]), with the absence of a correlation between scores of each test (r = .1).
Testing JPS in a CKC scenario would seem appropriate—the ability is greatest (least errors), and conversely any deficits might be most obvious.
Nicola Relph and Lee Herrington
Context: Clinicians require portable, valid, and cost-effective methods to monitor knee joint-position-sense (JPS) ability. Objective: To examine the criterion-related validity of image-capture JPS measures against an isokinetic-dynamometer (IKD) procedure. Design: Random crossover design providing a comparison of knee JPS measures from image capture and IKD procedures. Participants: 10 healthy participants, 5 female, age 28.0 ± 13.29 y, mass 60.3 ± 9.02 kg, height 1.65 ± 0.07 m, and 5 male, 29.6 ± 10.74 y, mass 73.6 ± 5.86 kg, height 1.75 ± 0.07 m. Main Outcome Measures: The dependent variables were absolute error scores (AES) provided by 2 knee directions (flexion and extension). The independent variables were the method (image capture and IKD). Results: There was no significant difference between clinical and IKD AED into knee-extension data (P = .263, r = 0.55). There was a significant difference between clinical and IKD AES into knee-flexion data (P = .016, r =.70). Conclusions: Analysis of photographic images to assess JPS measurements using knee flexion is valid against IKD techniques. However, photo-analysis measurements provided a lower error score using knee-extension data and thus may provide an optimal environment to produce maximal knee JPS acuity. Therefore, clinicians do not need expensive equipment to collect representative JPS ability.
Nicola Relph and Lee Herrington
Context: Knee joint-position sense (JPS) plays a critical role in controlled and stable joint movement. Poor ability to sense position of the knee can therefore increase risk of injury. There is no agreed consensus on JPS measurement techniques and a lack of reliability statistics on methods. Objective: To identify the most reliable knee JPS measurement technique using image capture. Design: Interexaminer, intraexaminer, and test-retest reliability of knee JPS measurements. Setting: Biomechanics laboratory. Participants: 10 asymptomatic participants. Interventions: None. Main Outcome Measures: Relative and absolute error scores of knee JPS in 3 conditions (sitting, prone, active) through 3 ranges of movement (10-30°, 30-60°, 60-90°), into 2 directions (flexion and extension) using both legs (dominant and nondominant) collected during 15 trials and repeated 7 d after the first data collection. Results: Statistical analysis by intraclass correlations revealed excellent interexaminer reliability between researchers (.98) and intraexaminer reliability within 1 researcher (.96). Test-retest reliability was highest in the sitting condition from a starting angle of 0°, target angle through 60-90° of flexion, using the dominant leg and absolute-error-score variables (ICC = .92). However, it was noted smallest detectable differences were a high percentage of mean values for all measures. Conclusions: The most reliable JPS measurement for asymptomatic participants has been identified. Practitioners should use this protocol when collecting JPS data during prescreening sessions. However, generalizability of findings to a class/group of clients exhibiting knee pathologies should be done with caution.
Natalia Romero-Franco, Juan Antonio Montaño-Munuera and Pedro Jiménez-Reyes
Context: Knee joint-position sense (JPS) is a key parameter for optimum performance in many sports but is frequently negatively affected by injuries and/or fatigue during training sessions. Although evaluation of JPS may provide key information to reduce the risk of injury, it often requires expensive and/or complex tools that make monitoring proprioceptive deterioration difficult. Objective: To analyze the validity and reliability of a digital inclinometer to measure knee JPS in a closed kinetic chain (CKC). Design: The validity and intertester and intratester reliability of a digital inclinometer for measuring knee JPS were assessed. Setting: Biomechanics laboratory. Participants: 10 athletes (5 men and 5 women; 26.2 ± 1.3 y, 71.7 ± 12.4 kg; 1.75 ± 0.09 m; 23.5 ± 3.9 kg/m2). Intervention: Knee JPS was measured in a CKC. Main Outcome Measures: Absolute angular error (AAE) of knee JPS in a CKC. Results: Intraclass correlation coefficient (ICC) and standard error of the mean (SEM) were calculated to determine the validity and reliability of the inclinometer. Data showed that the inclinometer had a high level of validity compared with an isokinetic dynamometer (ICC = 1.0, SEM = 1.39, P < .001), and there was very good intra- and intertester reliability for reading the inclinometer (ICC = 1.0, SEM = 0.85, P < .001). Compared with AutoCAD video analysis, inclinometer validity was very high (ICC = 0.980, SEM = 3.46, P < .001) for measuring AAE during knee JPS in a CKC. In addition, the intertester reliability of the inclinometer for obtaining AAE was very high (ICC = .994, SEM = 1.67, P < .001). Conclusion: The inclinometer provides a valid and reliable method for assessing knee JPS in a CKC. Health and sports professionals could take advantage of this tool to monitor proprioceptive deterioration in athletes.
Takuma Hoshiba, Hiroki Nakata, Yasuaki Saho, Kazuyuki Kanosue and Toru Fukubayashi
sufficient to identify subtle, but functionally important, deficits in knee joint position sense following ACL injury and/or reconstruction surgery. 13 Specifically, the reference position is not available throughout the trial, and therefore, subjects must both “recognize” and “memorize” the reference
Janice K. Loudon
Proprioception of the knee joint.
To determine the difference in knee-joint-angle reproduction in women with and without genu recurvatum (GR).
Twenty-four women divided into 2 groups according to their standing knee-extension angle.
Main Outcome Measures:
Each subject's ability to actively reproduce active positioning of 3 knee angles (10, 30, and 60°) was measured. Pearson correlation coefficients were calculated to determine correlation values for standing GR angle and absolute angular error (AAE). A1 -way repeated-measures MANOVA was computed to evaluate differences in group, angle, limb, and trial.
Standing GR angle correlated significantly to the AAE angle at 10° (r = .48). The high-recurvatum group consistently scored worse, with the highest error rate occurring at 10°.
Individuals with GR might have diminished proprioceptive sense at end-range extension that could potentially lead to knee injury.
Rod A. Harter, Louis R. Osternig and Kenneth M. Singer
This study evaluated knee joint position sense in the ACL-reconstructed and contralateral normal knees of 48 male and female subjects (M age 27.6 ± 6.9 yrs). Subjects were blindfolded and tested on their ability to actively reproduce five passively placed knee positions at 5° intervals between 35 and 15° of knee flexion. Mean algebraic target angle error and mean absolute error values were measured in degrees. The grand mean absolute error for the postsurgical knees at all positions was 5.4 ± 3.2°, compared with 5.2 ± 2.7° for the normal contralateral knees. There were no significant differences in knee joint position sense between the postsurgical and normal contralateral limbs at any of the five positions tested. Pivot shift, anterolateral rotatory instability, and Lachman test results were poorly correlated with knee joint position sense. The results suggest that if knee joint position sense was indeed disrupted by ACL injury and reconstructive surgery, related sensory mechanisms compensated for any proprioceptive loss prior to the minimum 2-yr postsurgical follow-up period employed in our study.
Dai Sugimoto, Jessica C. LeBlanc, Sarah E. Wooley, Lyle J. Micheli and Dennis E. Kramer
It is estimated that approximately 350,000 individuals undergo anterior cruciate ligament (ACL) reconstruction surgery in each year in the US. Although ACL-reconstruction surgery and postoperative rehabilitation are successfully completed, deficits in postural control remain prevalent in ACL-reconstructed individuals. In order to assist the lack of balance ability and reduce the risk of retear of the reconstructed ACL, physicians often provide a functional knee brace on the patients’ return to physical activity. However, it is not known whether use of the functional knee brace enhances knee-joint position sense in individuals with ACL reconstruction. Thus, the effect of a functional knee brace on knee-joint position sense in an ACL-reconstructed population needs be critically appraised. After systematically review of previously published literature, 3 studies that investigated the effect of a functional knee brace in ACL-reconstructed individuals using joint-position-sense measures were found. They were rated as level 2b evidence in the Centre of Evidence Based Medicine Level of Evidence chart. Synthesis of the reviewed studies indicated inconsistent evidence of a functional knee brace on joint-position improvement after ACL reconstruction. More research is needed to provide sufficient evidence on the effect of a functional knee brace on joint-position sense after ACL reconstruction. Future studies need to measure joint-position sense in closed-kinetic-chain fashion since ACL injury usually occurs under weight-bearing conditions.
Giuliamarta Bottoni, Dieter Heinrich, Philipp Kofler, Michael Hasler and Werner Nachbauer
During sport activity, knee proprioception might worsen. This decrease in proprioceptive acuity negatively influences motor control and therefore may increase injury risk. Hiking is a common activity characterized by a higher-intensity-exercise phase during uphill walking and a lower-intensity-exercise phase during downhill walking. Pain and injuries are reported in hiking, especially during the downhill phase.
To examine the effect of a hiking-fatigue protocol on joint-position sense.
University research laboratory.
24 nonprofessional sportswomen without knee injuries.
Main Outcome Measures:
Joint-position sense was tested at the beginning, after 30 min uphill walking, and after 30 min downhill walking on a treadmill (continuous protocol).
After downhill walking, joint-position sense was significantly worse than in the test at the beginning (P = .035, α = .05). After uphill walking, no differences were observed in comparison with the test at the beginning (P = .172, α = .05) or the test after downhill walking (P = .165, α = .05).
Downhill walking causes impairment in knee-joint-position sense. Considering these results, injury-prevention protocols for hiking should focus on maintaining and improving knee proprioception during the descending phase.