Literature Review on Knee Proprioception

This literature review explores the concept of knee proprioception and its impact on sports injuries. It discusses the role of proprioception in joint stability, balance, and injury prevention. The review also examines the relationship between proprioception and knee injuries, specifically ACL injuries. Various studies and findings related to knee proprioception are discussed in detail.

Running head: LITERATURE REVIEW
Literature review on Knee proprioception between injured knees and non-injured knees

LITERATURE REVIEW 2
Table of Contents
Literature review........................................................................................................................3
Knee proprioception between injured knees and non-injured knees: In context of Sports....3
References................................................................................................................................12

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Literature review
Knee proprioception between injured knees and non-injured knees: In the context of
Sports
According to Negrin Uribe-Echevarria and Reyes (2017), proprioception is defined as the
senses of people that they use in case of injury and non-injury of body part. Proprioceptor is
determined as sensors that deliver information about the angle of joint, muscle tension, and
length. It also gives the information to brain about the position of limb in minimum time. It is
stated that proprioception is used at the time of joints injury like ligament sprains. It is
examined that if an individual loses proprioception about joint after the sprain, then they may
have experience of an unstable sensation about knee injury. In addition, it is evaluated that an
individual injury can decline the ability to make sense in context of inures and non-injured
body.
In support of this, Groot et al. (2016) stated that the most common symptom of declined
proprioception is lack of balance in body parts of an individual. Every injury can decline
individual proprioception and creates imbalance in body parts. It is stated that proprioception
and balance are imperative in performing sports activities. It is used during spins and jumps
because; it is common for sportsman to slip and fall such as injury during sports activities.
Therefore, modern strategy of training should be used by sportsperson to comprehend the
proprioceptive training culture i.e. called sensory-motor training.
On the other hand, Labouteer haeghe Ucay and Minden (2019) illustrated that proprioception
is known as sixth sense and it is the feeling of dynamic alignment. It entails the artistic
experience. Eyes of an individual can balance organs of inner ear, and impulses of muscles in
order to support the balance and steadiness. In addition to this, proprioceptive training is used
to create the sense about joints, ligaments, and muscles injury. It is stated that individual can
obtain data about body by sensing the unforeseen modification in their movements and body

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parts. Due to lack of inner sense of accuracy, the injury rate can be higher and non-injury
movement can be related to cognitive energy.
Apart from this, An et al. (2019) examined that knee joint proprioception is the combination
of input sensory and it is related to afferent receptors variety. It involves the sensation of
motion as well as joint position. It is stated that poor proprioception is considered in risk
components related to muscle injury. It is a common tool of noncontact crucial ligament
injury in vigorous knee valgus. There is no investigation that measures the JPS in mechanism
injury. Hence, this author has noted that knee joint injury can be created in noncontact
anterior position and normal situation.
In support of this, Relph and Herrington (2016) explained that joint position sense is an active
reproduction that creates in injury risk position and normal situation. It is examined that
dominant knees can lead to get reliable data towards an organizational task. Knee joint
proprioception entails certain sensory inputs with respect to receptors variety. Proprioception
entails joint position sense and motion detection and it aids to deal with the knee injury.
Moreover, mechanoreceptors consider different elements like Pacinian corpuscles, Ruffini
endings, and Golgi tendon organ.
On the other side, Zhang et al. (2018) illustrated that ACL injury is imperative in solving
sport associated with knee injuries. ACL injuries could occur with the noncontact tool. ACL
injury ranges are lies between 70 to 84%. ACL injury can occur in both male as well as
female athletes. Moreover, Noncontact ACL injuries could occur during weight-bearing
stage. In the current era, certain elements are considered in the proprioceptive act that helps
to make sense regarding injury and non-injury. Furthermore, it is evaluated that knee
proprioception can be created in non-weight-bearing and sagittal plane position.
Kalimuthu and Mokhtar (2017) stated that the primary aim is to evaluate the knee JPS of
noncontact ACL injury issue and normal WB situation related to healthy areas. It is examined

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that Female athletes are more susceptibility towards the knee injury as compared to the male
supports person. It is examined that Knee injury is determined as the patellofe moral injury,
meniscal, and ligament diagnosed by college sports medicine physician. In addition, it is
examined that contusions and fractures were created due to knee injured group. Athletes were
normally injured during the test.
In contrast to this, Cronström (2017) stated that football is an activity-based game that
physically moves the body of an individual. It is sports running game, which entails physical
activity, scattered with high-intensity act, considering explosive, agile movements, and
unexpected physical relations. Moreover, feature of game can added to higher possibility for
damage. It is evaluated that the potential relation of proprioception is considered in different
acts such as activity level, subjective function, laxity, age, and knee injury.
In the view of Neuman et al. (2017), proprioceptive weakness regarding knee injury is
demonstrated in football team’s member along with stays with meniscal injuries as compared
to anterior cruciate ligament. Moreover, proprioceptive training declines lower injuries from
players. Lower limb injury prevention training culture considered the neuromuscular and
proprioceptive training culture on knee and ankle prevention. It is addressed by the effects of
sprain. It is examined that knee was second most injury part of an individual. From the
application of the tool, it is found that injuries of knees were affected by ACL (anterior
cruciate ligament) as compared to the meditation group.
In opposed to this, An (2018) addressed that the lower proprioception error can decline
possibilities of knee injuries from the sportsman. It could also be imperative to being a
happier and healthy life of people. It is found that proprioception errors are lower in the
uninjured knee as compared to the injured knee among the male professionals. It is also stated
that most of the studies proved that proprioception error could be related to injury of joint and
knee. The organization has selected the professions for preventing knee injuries.

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As per the view of MohtashamShahrbanian and Khoshroo (2018), Knee proprioception
integrates several sensory resources through wider range of receptor. Proprioception entails
JPS (joint position sense) as well as the discovery of motion. JPS is illustrating as the
awareness regarding joint position and is mediated by several receptors. It is known as
mechanoreceptors. It entails the Golgi tendon organ, Pacinian corpuscles, and Ruffini endings
and receptors in human ACL (anterior cruciate ligament). These mechanoreceptors transfer
the loads of pragmatic approach into afferent urges to standardizee the strength of knee joint
as well as avoid muscle injury.
On the other side, Lehmann Paschen and Baumeister (2017) evaluated that in current times;
much attention is put towards the role of proprioception as an integrated element for
functional constancy related to knee joint. An anterior cruciate ligament injury is common
severe sport associated injuries. The high amount of ACL injuries occur due to the non-
contact system. The proportions for noncontact ACL injuries are 70 to 84% that was created
due to ACL tears among both male and female athletes. In contrast to this, non-contact ACL
injuries are regularly created in the weight-bearing stage.
According to Steinberg et al. (2015), set of anterior cruciate ligament can create different
planes because knee valgus, anterior tibial translation, as well as lower edge of rotational
gestures all increases volume of anterior cruciate ligament. In addition, comparative
orientation regarding thigh to shank is a factor contributing to anterior cruciate ligament
rupture. Along with this, Knee joint injury can be executed as a harmful situation for anterior
cruciate ligament. It is currently linked to ACL injury risk. Existing investigation suggests
that an integrated loading pattern is a detrimental effect in the context of ACL injury.
On the other hand, Zebis and Bencke (2018) stated that movement structure, which appears to
gain anterior cruciate ligament injury risk, involves extension moments as well as valgus,

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particularly at the time of small knee flexion. In current times, prevention assessment as well
as conduct associated with proprioceptive shortages can be gained.
As per the view of Steinberg et al. (2015), future assessment is required to characterize the
different proprioceptive acuity in forced planes related to movement of frontal as well as
transverse planes in context of primary plan. It is related to movement at knee as well as test
of proprioception is required in injury. Along with this, several investigations have tested on
knee proprioception in sagittal plane as well as NWB (non-weight-bearing) situation. It can
be illustrated that anterior cruciate ligament is a key limitation of posteroanterior gesture
regarding tibia on femur. It also induces as well as control the muscles movement during WB
activities. Furthermore, limb alignment at the time of high-risk WB practices could be
appropriate in the evaluation of proprioception.
In opposed to this, Zebis and Bencke (2018) evaluated that proprioception is contributed to
development in controlling the motor as well as, plays significant role in impulse safety about
joints in against of harmful forces. It can be significant to avoid the injuries. Along with this,
proprioception is key factor that contributes to knee injury specifically, injury of ACL. In
addition, different risk factors are related to non-contact ACL injuries and poor
proprioception. Hence, proprioception appears not only significant to recover the function
after anterior cruciate ligament and also, hindrances anterior cruciate ligament injuries.
As per the view of Zult et al. (2016), it is suggested that knee proprioception in high-risk
positions can be assessed. Therefore, the outcome of studies using normal WB position
cannot agree with high-risk situation. Evaluation regarding joint position sense (JPS) in
weight-bearing (WB) risk position specifically, offers clinicians to more data about position
of the knee. Thus, it should offer added specific image related to broadcast technique as well
as prevention approaches. Under existing study, joint position sense of knee is demonstrated
by making comparison amid noncontact anterior cruciate ligament injury risk condition and
normal weight-bearing condition in healthy concerns. There is less precise knee joint position
sense (JPS) in noncontact ACL injury risk condition as compared to normal weight-bearing
situation.

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On the other hand, Oliver et al. (2018) evaluated that proprioception is illustrated as the body
sense of position and motion of joint. It is one of an essential factor in graceful movement,
injury prevention, and balance. It permits an automatic reaction to stabilize and protect the
person by keeping posture and balance as they move. It is particularly essential for joint such
as knee and it is often injured through loss of balance. It could be complex to measure as
compared to strength or speed; however, the investigation indicates that people can enhance
proprioception with special exercise.
According to Choe et al. (2016), football is renowned sports at global level. Moreover, nature
and location related to injuries is collective in knee as well as ankle joint according to
documented sports injuries. Proprioception deficit indicates the knee injury regarding 90% of
sensitivity as well as, 56% of specificity in female athletes while no comparable relationship
was seen in male athletes. In addition, the potential association of proprioception can be
considered with laxity, activity level, and knee injury, the age of individual and subjective
function.
On the other side, Muneta et al. (2016) evaluated that lack of proprioceptive feedback cannot
keep arm in stable attitude and implements organized movements rather than viewing their
extremities. Different injury patterns can affect the patient in several manners in the context
of proprioception that may change the result of injuries. A transformation in the structure of
movement and muscular weaken after injury may contribute to proprioceptive defects and
decline the activity level.
Jandacka et al. (2018) illustrated that several injury patterns may influence the patients in
several manners in the context of proprioception. It may change the result of an injury. Along
with this, a transformation in the structure of the movement and muscular atrophy after injury
can contribute to proprioceptive weaknesses and declines the activity level. An age-

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associated decline in proprioception can affect the proprioceptive status during injury as well
as competency to compensate for proprioceptive harm at the time of rehabilitation.
On the other hand, Stone et al. (2017) described that balance training is a significant method
to enhance knee proprioception in the context of reconciling from injury and avoid one.
Along with this, standing and performing light exercise on an unstable surface like instability
dome can create challenge the stabilizer muscles in the knee, wobble board, and ankles. For
instance, an individual can stand on an instability dome with one leg and stand with both legs
as well as do knee circle with mini-squats. Any change that makes an individual to work to
keep stability will enhance proprioception, and overtime it could have maximum
advantageous such as injury prevention.
As per the view of Zult et al. (2016), an individual should ditch the equipment during injury
and non-injury. For the best outcome, an individual should provide little stability training
within each day, particularly to restore the balance as well as mobility after knee injuries.
When an individual does not own instability equipment, does not want to go to the gym every
day, then exercise can be performed anywhere and without equipment.
In contrast to this, Jandacka et al. (2018) described that an individual could increase their
proprioception by considering certain activities like exercise at the time of closing eyes,
strengthening exercises, and crossover walk as it could lead to get reliable outcome. An
individual can sustain their position for a longer period and repeat the same with another leg.
In order to make it more complex, an individual can close the eyes. In the supports, knee is
one of the imperative parts as it moves more than the other body parts.
As per the view of Oliver et al. (2018), knee injuries require surgery and a longer period of
rehabilitation, possible long-term consequences, translating towards high healthcare
expenses, and irregular damage. This fuel can create the interest of knee injury prevention
investigation to assess the extrinsic as well as intrinsic risk factors. It also demonstrates that

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prevention initiatives as well as external aid like knee braces. Along with this, knee braces
are implemented for a longer period to support ACL deficient and reconstructed knees.
In opposed to this, Zebis and Bencke (2018) stated that knee braces can be categorized into
different elements such as prophylactic, rehabilitation, as well as braces of functional knee.
In addition, braces of rehabilitation intended for permitting the secure or decline harshness of
knee injuries.The main purpose of this study is to control the unnecessary program, which
could be damaging, complementing, and strengthening the current muscles.
According to Stone et al. (2017), functional knee braces are braces that are intended to offer
constancy regarding unbalanced knees of patients that are already injured. It is common
practise method to fit all patients at an individual level and is intended to replace or support
the role of torn muscles. In addition, it is examined that individual could improve their knee
injury by having precautions at the time of involving in sports activity.
On the other hand, Zebis and Bencke (2018) stated that braces application in winter sports
particularly defines clinical efficiency of prophylactic as well as biomechanical useful knee
braces. It eliminates the knee injuries and its effect on athletic injured performance as well as
a non-injured person. Knee bracing has significant effects on the performance through several
mechanisms such as alteration in neuromuscular control and proprioception. There are
existing data related to a contradiction because of part of differences in brace design as well
as construction.
As per the view of Jandacka et al. (2018), the negative impact is reported such as increased
oxygen consumption, respiratory rate, increased heart rate and declined speed as well as
quickness in the example of stay slippage. Straps could gain pressure of compartmental,
declining perfusion of muscle as well as gaining the weakness. In the context of strength,
there are several conflicting consequences that indicate both increases and decreasing in
strengthening in the study as well as with diverse outcomes in diverse braces.

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In contrast to this, Stone et al. (2017) evaluated that athlete adjustment towards brace seems
to be possible with respect to fatigue, reaction, as well as performance. It is suggested that
there is need for adaption phase before involving in full sport practices. According to
Jandacka et al. (2018), slalom course demonstrated three skiers could be complete different
level of runs with or without knee brance of an individual. In addition, running time should
be included in the data. Skiers should consider total runs. The initial 3 completed when tiring
a brace as well as demonstrated a declining in contesting time, possibly because of wisdom
impact on repeat scores.
As per the above interpretation, it can be concluded that an individual can run 4-6 times
without brace as well as demonstrated levelling in the context of racing periods. Along with
this, runs 7 to 8 times could be accomplished due to joint. It depicts the insignificant gain in
racing periods. Along with this, run 9 times can be done without support and through which,
no transformation will be existed. Moreover, skiers reported the subjective unfavourable
impact regarding agility, speed of movement as well as painful density regarding hard
material of brace can create subjective feeling and prevent from injury.

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References
An, Y.W., 2018.Evidence of Neuroplasticity and Neuroimaging Techniques following
Anterior Cruciate Ligament Injury. Exercise Science, 27(3), pp.169-176.
An, Y.W., DiTraniLobacz, A., Lehmann, T., Baumeister, J., Rose, W.C., Higginson, J.S.,
Rosen, J. and Swanik, C.B., 2019. Neuroplastic changes in anterior cruciate ligament
reconstruction patients from neuromechanical decoupling. Scandinavian journal of medicine
& science in sports, 29(2), pp.251-258.
Choe, J.A., Stiffler, M.R. and Heiderscheit, B.C., 2016. Kinetic Asymmetries During A
Vertical Jump Persist During Initial Year Post Acl Reconstruction: 1106 Board# 4 June 1,
315 PM-515 PM. Medicine & Science in Sports & Exercise, 48(5S), p.300.
Cronström, A., 2017. Kissing knees-factors behind the attraction.Knee abduction in
individuals with an anterior cruciate ligament injury.Lund University.
Groot, H.E., van der Worp, H., Nijenbanning, L., Diercks, R.L., Zwerver, J. and van den
Akker-Scheek, I., 2016. Is proprioception diminished in patients with patellar
tendinopathy?. Gait & posture, 45, pp.224-228.
Jandacka, D., Plesek, J., Skypala, J., Uchytil, J., Silvernail, J.F. and Hamill, J., 2018. Knee
Joint Kinematics and Kinetics During Walking and Running After Surgical Achilles Tendon
Repair. Orthopedic journal of sports medicine, 6(6), p.2325967118779862.
Kalimuthu, M. and Mokhtar, A.H., 2017. Muscle bulk, strength,and proprioceptive difference
between anterior cruciate ligament deficient and normal knee. Journal of Health and
Translational Medicine, 20(1), pp.1-5.
Laboute, E., Verhaeghe, E., Ucay, O. and Minden, A., 2019. Evaluation kinaesthetic
proprioceptive deficit after knee anterior cruciate ligament (ACL) reconstruction in
athletes. Journal of experimental orthopedics, 6(1), p.6.

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Lehmann, T., Paschen, L. and Baumeister, J., 2017. Single-leg assessment of postural
stability after anterior cruciate ligament injury: a systematic review and meta-analysis. Sports
medicine-open, 3(1), p.32.
Mohtasham, H.M., Shahrbanian, S. and Khoshroo, F., 2018. Epidemiology and history of
knee injury and its impact on activity limitation among football premier league professional
referees. Journal of Injury and Violence Research, 10(1), p.45.
Muneta, T., Koga, H., Nakamura, T., Horie, M., Watanabe, T. and Sekiya, I., 2016. Behind-
remnant arthroscopic observation and scoring of femoral attachment of injured anterior
cruciate ligament. Knee Surgery, Sports Traumatology, Arthroscopy, 24(9), pp.2906-2914.
Negrin, R., Uribe-Echevarria, B.,and Reyes, N., 2017. Do knee braces prevent ski knee
injuries?. Asian journal of sports medicine, 8(4) pp.18-27.
Neuman, P., Dahlberg, L.E., Englund, M. and Struglics, A., 2017.Concentrations of synovial
fluid biomarkers and the prediction of knee osteoarthritis 16 years after anterior cruciate
ligament injury. Osteoarthritis and cartilage, 25(4), pp.492-498.
Oliver, G., Portabella, F. and Hernandez, J.A., 2018.A comparative study of the
neuromuscular response during a dynamic activity after anterior cruciate ligament
reconstruction. European Journal of Orthopaedic Surgery & Traumatology, pp.1-6.
Relph, N. and Herrington, L., 2016. Knee joint position sense ability in elite athletes who
have returned to international level play following ACL reconstruction: A cross-sectional
study. The Knee, 23(6), pp.1029-1034.
Steinberg, N., Tirosh, O., Adams, R., Karin, J. and Waddington, G., 2015. Does wearing
textured insoles during non-class time improve proprioception in professional
dancers?. International journal of sports medicine, 36(13), pp.1093-1099.

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Steinberg, N., Tirosh, O., Adams, R., Karin, J. and Waddington, G., 2015. Does wearing
textured insoles during non-class time improve proprioception in professional
dancers?. International journal of sports medicine, 36(13), pp.1093-1099.
Stone, W.J., Arnett, S.W. and Hoover, D.L., 2017. Lower extremity kinematics of ACL-
repaired and non-injured females when using knee Savers®. International journal of sports
physical therapy, 12(5), p.737.
Zebis, M.K.,andBencke, J., 2018. Biomechanical Aspects in Handball: Lower Limb.
In Handball Sports Medicine (pp. 61-68).USA: Springer, Berlin, Heidelberg.
Zebis, M.K.,andBencke, J., 2018. Biomechanical Aspects in Handball: Lower Limb.
In Handball Sports Medicine (pp. 61-68).USA: Springer, Berlin, Heidelberg.
Zhang, L., Qi, J., Zeng, Y., Zhang, S., Fu, S., Zhou, X., Ping, R. and Li, Y., 2018.
Proprioceptive Changes in Bilateral Knee Joints Following Unilateral Anterior Cruciate
Ligament Injury in Cynomolgus Monkeys. Medical science monitor: international medical
journal of experimental and clinical research, 24, p.105.
Zult, T., Gokeler, A., van Raay, J.J., Brouwer, R.W. and Hortobágyi, T., 2016. Unilateral
ACL Injury Does Not Affect Neuromuscular Function In The Non-injured Leg: 1105 Board#
3 June 1, 315 PM-515 PM. Medicine & Science in Sports & Exercise, 48(5S), p.300.