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Sinem Suner-Keklik, Gamze Cobanoglu-Seven, Nihan Kafa, Mustafa Ugurlu and Nevin Atalay Guzel

Context: Proprioception is the basic element of the spontaneous control of movement, balance and joint stability. Therefore, it is necessary for the execution of walking and daily and sport activities. Loss of proprioception of the knee, which may cause a new injury, is important to evaluate the position sense of the joint during the rehabilitation period. However, the evaluation methods that are used are very expensive, complicated and nonportable, or the measuring method is difficult to implement. Objective: We demonstrated the validity and reliability of knee proprioception measurements performed in the open kinetic chain position and closed kinetic chain position with a dual inclinometer. Design: We assessed the validity and intratester reliability of a digital inclinometer for measuring the knee joint position sense in different positions. Setting: Clinical laboratory. Participants: We enrolled 22 participants (age = 21.8 ± 0.95 y, height = 172 ± 9.1 cm, weight = 64.9 ± 14 kg) into the study. Intervention: The same investigator used an inclinometer to take knee proprioception measurements in open and closed kinetic chain positions. Main Outcome Measures: The relative angular error was calculated by taking the arithmetic average of the difference between the target angle and reproduced angle and was the main outcome measure. Results: We found that the dynamometer-inclinometer had a moderate ICC value (ICC = 0.594, SEM = 1.60, P = .005), whereas inclinometer t1 vs inclinometer t2 (ICC = 0.778, SEM = 0.62, P < 0.001) and closed kinetic chain position t1 and closed kinetic chain position t2 (ICC = 0.888, SEM = 0.63, P < 0.001) had high ICC values. Conclusion: Knee proprioception measurements performed with a dual inclinometer were reliable in the closed kinetic chain position in healthy, sedentary individuals and were valid and reliable in the open kinetic chain position.

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Marc R. Safran, Christopher D. Harner, Jorge L. Giraldo, Scott M. Lephart, Paul A. Borsa and Freddie H. Fu

Proprioceptive deficits have been demonstrated following anterior cruciate ligament (ACL) disruption, but little research exists evaluating proprioception in the posterior cruciate ligament (PCL)-deficient and/or -reconstructed knee. We have studied proprioception in PCL-deficient and PCL-reconstructed knees. The following summarizes our protocol and results of proprioceptive testing of kinesthesia and joint position sense in participants with isolated PCL injuries and those who underwent PCL reconstruction. We studied 18 participants with isolated raptures of the PCL and 10 participants who underwent PCL reconstruction. Proprioception was evaluated by two tests: the threshold to detect passive motion (TTDPM) and the ability to passively reproduce passive positioning (RPP). These assess kinesthesia and joint position sense, respectively. We have shown that isolated PCL deficiency in the human knee does result in reduced kinesthesia and enhanced joint position sense. Thus, the proprioceptive mechanoreceptors in the PCL do appear to have some function. We further found that PCL reconstruction significantly improved kinesthesia at 45° of knee flexion, while 110° was not significantly different between the involved and uninvolved knee in both studies.

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Barıs Seven, Gamze Cobanoglu, Deran Oskay and Nevin Atalay-Guzel

Proprioception is defined as being aware of body position in space. Impulses that come from muscles, tendons, joint capsules, and skin compose proprioception. The afferent information, which comes from these areas, is important for motor performance to be effective and safe. 1 A good

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Marc R. Safran, George L. Caldwell Jr. and Freddie H. Fu

The role of surgery in proprioception, and the current role of proprioception in surgery, is unclear due to the lack of scientific research and clinical studies. The main components of proprioception in surgery are viewed to be preservation of afferents, promotion of regeneration of mechanoreceptors, and modification of protective reflex arcs in the postoperative patient. Soft tissue tension is hypothesized to be important in the efficiency of proprioceptors. Further, postoperative rehabilitation concentrating on proprioception may improve the results of surgery. With better understanding by clinicians, proprioception may play a bigger role in surgical technique, prosthetic replacement choice, and even indications for surgery. Further, proprioceptive testing may help determine the time course for optimal functional outcome following procedures. Thus, the future for proprioception in surgery and clinical application is expanding rapidly.

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Robert L. Barrack, Peter J. Lund and Harry B. Skinner

Extensive histological studies have now confirmed a definite link between the anterior cruciate ligament (ACL) and the central nervous system. Preliminary histological evidence indicates that this neurological connection may be restored following reconstruction utilizing a free graft. In spite of this apparent graft reinnervation, clinical studies indicate that proprioception in the reconstructed knee probably remains inferior to that of the contralateral normal knee. A number of abnormalities of gait, reflexes, and muscle firing patterns have been discovered following an ACL tear. The degree to which a successful repair or reconstruction corrects these abnormalities remains uncertain, but again it appears that some abnormalities remain even during normal walking. Increased activity of the hamstrings as well as of the vastus lateralis, tibialis anterior, and medial gastrocnemius seems to be an adaptive mechanism to stabilize the knee after ACL injury. These muscle firing patterns seem to be trainable to some degree and should be incorporated into postinjury and postsurgical rehabilitation protocols.

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Peter Grigg

Proprioception is the sense of position and movement of the limbs. The sense arises through activity in sensory neurons located in skin, muscles, and joint tissues. Proprioception appears to be a compound sense, relying on simultaneous activity in a number of types of afferent neurons. Position sense is largely mediated by activity in muscle afferent neurons. Afferent neurons originating in soft tissues of the joints contribute a sense of joint position only when the joint is rotated into a limit of its range of motion. Joint neurons have an important role in protecting the integrity of joints if they are unstable. Afferent neurons in skin appear to contribute little to position sense but may contribute to the sense of movement.

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John Andrew Badagliacco and Andrew Karduna

. 12 In fact, a recent meta-analysis demonstrated a link between proprioception deficits and several shoulder injuries, such as glenohumeral instability and shoulder impingement syndrome. 13 Many studies have investigated proprioception in a variety of overhead athletes. 14 – 23 However, few studies

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Dana M. Otzel, Chris J. Hass, Erik A. Wikstrom, Mark D. Bishop, Paul A. Borsa and Mark D. Tillman

Given the high likelihood of recurrent ankle sprain after the initial sprain and that proprioception plays a critical role in preventing recurrent injury, 16 a goal of rehabilitation should be on reestablishing effective neuromuscular control. Although traditional rehabilitation serves to promote the

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Katya Trousset, David Phillips and Andrew Karduna

Proprioception is the integration of afferent information, from mechanoreceptors in the periphery, within the central nervous system for the conscious perception of limbs to maintain postural status and overall position in space ( Han, Waddington, Adams, Anson, & Liu, 2015 ; Riemann & Lephart

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Nili Steinberg, Roger Adams, Oren Tirosh, Janet Karin and Gordon Waddington

training and experience relative to a task, delayed onset of muscle contraction, and inadequate proprioception at the ankle joints. 5 , 8 There is now increased attention to previous injury history as an intrinsic risk factor for subsequent injury. 9 Once dancers have suffered a sprain, there may be