Effect of an Anterior Cruciate Ligament Rupture on Knee Proprioception Within 2 Years After Conservative and Operative Treatment: A Systematic Review with Meta-Analysis

Abstract

Background: The anterior cruciate ligament (ACL) plays a major role in knee proprioception and is thus responsible for maintaining knee joint stability and functionality. The available evidence suggests that ACL reconstruction diminishes somatosensory feedback and proprioceptive functioning, which are vital for adequate joint positioning and movement control.

Objective: The aim of this systematic review and meta-analysis was to investigate the effect of an ACL rupture on knee proprioception after arthroscopic ACL repair surgery or conservative treatment.

Methods: A systematic review with meta-analysis was conducted according to the Preferred Reporting Guidelines for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The literature search was performed in the following databases from inception to 10th October 2020: PubMed, Web of Science, SPORTDiscus, Cochrane Library and Scopus. Randomized and non-randomized studies that evaluated proprioception using the joint position sense (JPS) and threshold to detection of passive motion (TTDPM) techniques at 15°-30° knee flexion with an external healthy control group in a time period between 6 and 24 months post injury or operation were included in the analysis.

Results: In total, 4857 studies were identified, from which 11 were included in the final quantitative analysis. The results demonstrated that proprioception after arthroscopic ACL repair surgery was significantly lower than in the healthy control group (JPS: standardized mean difference [SMD] 0.57, 95% confidence interval [CI] 0.27-0.87, p < 0.01, n = 6 studies; TTDPM: SMD 0.77, 95% CI 0.20-1.34, p < 0.01, n = 4 studies). There were no significant differences in proprioception between the conservative treatment group and the healthy control group (JPS: SMD 0.57, 95% CI - 0.69 to 1.84, p = 0.37, n = 4 studies; TTDPM: SMD 0.82, 95% CI - 0.02 to 1.65, p = 0.05, n = 2 studies), although measures for TTDPM were close to statistical significance.

Conclusion: The findings of the present systematic review and meta-analysis revealed that knee proprioception is persistently compromised 6-24 months following surgical treatment of ACL tears compared with healthy controls. The reduced kinesthetic awareness after ACL surgery is of high relevance for optimizing individual treatment plans in these patients. As the current literature is still scarce about the exact underlying mechanisms, further research is needed.

Trial registration: The present systematic review was registered in PROSPERO (CRD42021198617).

Fig. 1

Study selection process

Fig. 2

Forest plot of the ACLR group demonstrating the JPS between the operated group and the healthy control group. ACLR anterior cruciate ligament reconstructed, JPS joint position sense, Std. standardized, IV inverse variance, CI confidence interval, df degrees of freedom

Fig. 3

Forest plot of the ACLR group demonstrating the TTDPM between the operated group and the healthy control group. ACLR anterior cruciate ligament reconstructed, TTDPM threshold to detection of passive motion, Std. standardized, IV inverse variance, CI confidence interval, df degrees of freedom

Fig. 4

Forest plot of the ACLD group demonstrating the JPS between the conservatively treated group and the healthy control group. ACLD anterior cruciate ligament deficient, JPS joint position sense, Std. standardized, IV inverse variance, CI confidence interval, df degrees of freedom

Fig. 5

Forest plot of the ACLD group demonstrating the TTDPM between the conservatively treated group and the healthy control group. ACLD anterior cruciate ligament deficient, TTDPM threshold to detection of passive motion, Std. standardized, IV inverse variance, CI confidence interval, df degrees of freedom