title: Proprioceptive deficits after ACL injury: are they clinically relevant?
abstract: OBJECTIVE
  To establish the clinical relevance of proprioceptive deficits reported after anterior cruciate ligament (ACL) injury.
  
  
  METHODS
  A literature search was done in electronic databases from January 1990 to June 2009. Inclusion criteria for studies were ACL deficient (ACL-D) and ACL reconstruction (ACL-R) articles written in English, Dutch or German and calculation of correlation(s) between proprioception tests and clinical outcome measures. Clinical outcome measures were muscle strength, laxity, hop test, balance, patient-reported outcome, objective knee score rating, patient satisfaction or return to sports. Studies included in the review were assessed on their methodological quality.
  
  
  RESULTS
  In total 1161 studies were identified of which 24 met the inclusion criteria. Pooling of all data was not possible due to substantial differences in measurement techniques and data analysis. Most studies failed to perform reliability measurements of the test device used. In general, the correlation between proprioception and laxity, balance, hop tests and patient outcome was low. Four studies reported a moderate correlation between proprioception, strength, balance or hop test.
  
  
  CONCLUSIONS
  There is limited evidence that proprioceptive deficits as detected by commonly used tests adversely affect function in ACL-D and ACL-R patients. Development of new tests to determine the relevant role of the sensorimotor system is needed. These tests should ideally be used as screening tests for primary and secondary prevention of ACL injury.
authors.affiliation: Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. a.gokeler@rev.umcg.nl
authors.forename: Alli
authors.initials: A
authors.lastname: Gokeler
authors.forename: Anne
authors.initials: A
authors.lastname: Benjaminse
authors.forename: Timothy E
authors.initials: TE
authors.lastname: Hewett
authors.forename: Scott M
authors.initials: SM
authors.lastname: Lephart
authors.forename: Lars
authors.initials: L
authors.lastname: Engebretsen
authors.forename: Eva
authors.initials: E
authors.lastname: Ageberg
authors.forename: Martin
authors.initials: M
authors.lastname: Engelhardt
authors.forename: Markus P
authors.initials: MP
authors.lastname: Arnold
authors.forename: Klaas
authors.initials: K
authors.lastname: Postema
authors.forename: Egbert
authors.initials: E
authors.lastname: Otten
authors.forename: Pieter U
authors.initials: PU
authors.lastname: Dijkstra
mesh_terms: D000293:Adolescent; D000328:Adult; D000070598:Anterior Cruciate Ligament Injuries; D001265:Athletic Injuries / Q000503:physiopathology*; D005080:Exercise Test / Q000379:methods; D005684:Gait / Q000502:physiology; D006801:Humans; D007593:Joint Instability / Q000209:etiology / Q000503:physiopathology; D053580:Muscle Strength / Q000502:physiology; D004856:Postural Balance / Q000502:physiology; D011434:Proprioception / Q000502:physiology*; D052097:Quadriceps Muscle / Q000503:physiopathology; D016896:Treatment Outcome; D055815:Young Adult