Joint position sense in total knee arthroplasty

Skinner, Harry B.; Barrack, Robert L.; Cook, Stephen D.; Haddad, Ray J.

doi:10.1002/jor.1100010307

Cited by 140 publications

(66 citation statements)

References 18 publications

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“…A relationship between proprioceptive inaccuracy assessed at study baseline and physical function over the ensuing years has not previously been reported. Proprioceptive accuracy declines with age (13), was worse in persons with OA even in their nonarthritic knee than in healthy elderly subjects (10), and was correlated with physical function in cross-sectional studies of knee OA (13,(39)(40)(41). The results of the current study are noteworthy, especially since this was a passive test; dynamic jointposition sense inaccuracy may play a greater role in physical tasks and activities and more strongly predict physical function outcome.…”

mentioning

confidence: 65%

Physical functioning over three years in knee osteoarthritis: Role of psychosocial, local mechanical, and neuromuscular factors

Sharma

Cahue

Song

et al. 2003

Arthritis & Rheumatism

412

351

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Objective. To identify factors that predict a poor physical function outcome over 3 years in individuals with knee osteoarthritis (OA), in an effort to aid in the development of strategies to prevent such functional limitations and consequential disability.Methods. Community-recruited individuals with knee OA underwent baseline, 18-month, and 3-year assessments of candidate risk factors and physical function. Risk factors were age, body mass index (BMI), knee pain intensity (on a visual analog scale [VAS]), local mechanical and neuromuscular factors (varusvalgus laxity, malalignment, proprioceptive inaccuracy, quadriceps strength, hamstring strength), activity level (Physical Activity Scale for the Elderly, amount of aerobic exercise), and psychosocial factors (Short-Form 36 [SF-36] mental health and role-functioning emotional subscales, self-efficacy using the Arthritis SelfEfficacy Scale physical function subscale, and social support using the Medical Outcomes Study Social Support Survey). Outcome was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) physical function scale and rate of chair-stand performance. Participants were grouped by quintile of baseline WOMAC score. The baseline to 3-year outcome was considered "good" when function improved by 1 or more quintiles or remained within the 2 highest function groups, and was considered "poor" when function declined by 1 or more quintiles or remained within the 3 lowest function groups. The same approach was taken for chair-stand outcome. Logistic regression was used to evaluate both the baseline level and the baseline to 18-month change in each factor as a predictor of physical function outcome over 3 years, adjusting for age, BMI, knee pain intensity, disease severity, and additional potential confounders. Results. Factors that significantly increased the likelihood of a poor WOMAC outcome were baseline laxity (crude odds ratio

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mentioning

confidence: 65%

Physical functioning over three years in knee osteoarthritis: Role of psychosocial, local mechanical, and neuromuscular factors

Sharma

Cahue

Song

et al. 2003

Arthritis & Rheumatism

412

351

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“…Proprioception measurement Proprioception of the knee was evaluated by examining the joint position sense according to the methods of Skinner et al [18] and Ochi et al [15]. In brief, the measurement method was first explained to the subjects until they understood it.…”

Section: Methodsmentioning

confidence: 99%

Proprioception and performance after anterior cruciate ligament rupture

Katayama

Handa

Kimura

et al. 2004

International Orthopaedics (SICOT)

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The aim of this study was to investigate the characteristics of proprioception in patients with an anaterior-cruciate-ligament (ACL)-injured knee and to determine whether there is a correlation between proprioception and performance. We studied 32 patients with unilateral isolated ACL ruptures. Proprioception of the knee was evaluated by examining the joint position sense. Functional performance was evaluated with the one-leg hop (OLH) and one-leg vertical jump (OLV) tests. The mean error angle of the joint position sense was 3.6±1.5°o n the intact side and 5.2±1.9°on the injured side. The joint position sense was thus clearly reduced on the injured side (p<0.05). The distance of jumping in the OLH test and the height of jumping in the OLV test was also clearly reduced on the injured side compared with that on the intact side (p<0.01) both with and without visual control. Moreover, we found a significant correlation between proprioception and performance in the ACL-injured knees, and this correlation was more distinct with visual deprivation. In conclusion, decreased proprioception in patients with ACL deficiency reduced their functional ability.Résumé Le but de cette étude était d'étudier les caractéristiques de proprioception chez les malades avec une lésion du LCA, et déterminer s'il y avait une corrélation entre proprioception et performance. Nous avons étudié 32 malades avec une rupture isolée unilatérale du LCA. La proprioception du genou a été évalué en examinant le sens des positions de l'articulation. La fonction a été évaluée avec le saut à cloche-pied (OLH) et saut vertical unipodal (OLV). L'angle moyen d'erreur de position était 3,6±1,5°sur le côté intact et 5,2±1,9°sur le côté blessé. Le sens de position était donc notablement réduit du côté blessé (p<0.05). La distance de saut dans l'épreuve OLH et la hauteur du saut dans l'épreuve OLV ont aussi été réduite du côté blessé comparé avec le côté intact (p<0.01) les deux avec et sans contrôle visuel. De plus, nous avons trouvé une corrélation certaine entre proprioception et performance dans les genoux avec lésion du LCA, et cette corrélation était encore plus nette avec privation visuelle. En conclusion, la diminution de la proprioception chez les malades avec une insuffisance du LCA à réduit leur capacité fonctionnelle.

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“…Using the procedure as modified by Skinner et al, 9 the position sense of the joint was defined as the ability to reproduce an angle at which the joint had been placed moments before. The examiner extended one of the legs at a slow, steady rate of approximately 10°/s from a starting angle of 90°.…”

Section: Methodsmentioning

confidence: 99%

Induction of somatosensory evoked potentials by mechanical stimulation in reconstructed anterior cruciate ligaments

Ochi

Iwasa

Uchio

et al. 2002

The Journal of Bone and Joint Surgery. British volume

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W e have determined whether somatosensory evoked potentials (SEPs) were detectable after direct mechanical stimulation of normal, injured and reconstructed anterior cruciate ligaments (ACLs) during arthroscopy. We investigated the position sense of the knee before and after reconstruction, and correlated the SEP with instability.Reproducible SEPs were detected in all 19 normal ACLs and in 36 of 38 ACLs reconstructed during a period of 13 months. Of the 45 injured ACLs, reproducible SEPs were detected in 26. The mean difference in anterior displacement in the SEP-positive group of the injured ACL group was significantly lower than that in the SEP-negative group. In the reconstructed group, the postoperative position sense was significantly better than the preoperative position sense. Our results indicate not only that sensory reinnervation occurs in the reconstructed ACL, but also that the response to mechanical loads can be restored, and is strongly related to improvement in position sense. Very little information is available regarding the sensory role of the anterior cruciate ligament (ACL). Although the mechanical contribution of the ligament is well documented, recent information suggests that it may have an important sensory role in initiating protective reflexes to control surrounding muscle tone through the 1a-musclespindle to the afferent-nerve system. [1][2][3][4] Many studies have shown the existence of several types of mechanoreceptor in human and animal ACLs.5-8 Whether these mechanoreceptors and their associated functions are restored after reconstruction of the ACL is uncertain. 1,5 Our aim therefore was to determine whether regenerated nerve fibres and mechanoreceptors in the reconstructed ACL could respond to mechanical loads applied to the ligament and to test for afferent impulses and somatosensory evoked potentials (SEPs), which would indicate functional restoration of axons and mechanoreceptors. Patients and MethodsWe enrolled 110 patients (110 knees) with intact posterior cruciate ligaments (PCL), but with knee injuries, into the study. Their mean age was 31 years (9 to 66). All gave consent and the protocol was approved by the Ethical Board of our institution. In four knees, mechanical stimulation of the intact PCL produced no cortical SE, because of technical defects and these individuals were excluded leaving 106 knees (106 patients, 49 men and 57 women) for analysis.The patients were placed into one of three groups. Group I comprised 21 men and 24 women of mean age 29.8 years with an injury to their ACL, who had been diagnosed with anterior instability before arthroscopy. They underwent an arthroscopically-assisted reconstruction of the ligament. In this group the ACL had been ruptured, but remnants were observed bridging the femur and tibia. These attachment sites were not anatomical and the bridging tissue was flimsy. Knees in which the remnant of the ACL was attached to the PCL were excluded from group I, since the mechanical stimulation of the remnant through its attachment could ind...

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Joint position sense in total knee arthroplasty

Cited by 140 publications

References 18 publications

Physical functioning over three years in knee osteoarthritis: Role of psychosocial, local mechanical, and neuromuscular factors

Physical functioning over three years in knee osteoarthritis: Role of psychosocial, local mechanical, and neuromuscular factors

Proprioception and performance after anterior cruciate ligament rupture

Induction of somatosensory evoked potentials by mechanical stimulation in reconstructed anterior cruciate ligaments

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