The effect of ACL injury on knee proprioception: a meta-analysis

Background: It is suggested the anterior cruciate ligament (ACL) plays a significant role in knee proprioception, however, the effect of ACL injury on knee proprioception is unclear. Studies utilising the two most common measurement techniques, joint position sense and threshold to detect passive motion, have provided evidence both for and against a proprioceptive deficient following ACL injury. Objective: The objective of the study was to undertake a meta-analysis investigating the effects of ACL injury, treated conservatively or by reconstruction, on proprioception of the knee, measured using joint position sense and/or threshold to detect passive movement techniques. Data sources: Seven databases were searched from their inception to September 2013 using the subject headings ‘anterior cruciate ligament, proprioception, postural sway, joint position sense, balance, equilibrium or posture’ to identify relevant studies. Eligibility criteria: PRISMA guidelines were followed as much as possible. Studies that investigated the effect of ACL injury on either knee joint kinaesthesia or position sense were included in this review. Data extraction and synthesis: Two reviewers independently extracted data using a standardised assessment form. Comparisons were made using a fixed effect model with an inverse variance method using Review Manager Software (V5.1). Results: Patients with ACL injury have poorer proprioception than people without such injuries (SMD = 0.35°; P = 0.001 and SMD = 0.38°; P = 0.03) when measured using joint position sense and threshold to detect passive motion techniques respectively. Patients had poorer proprioception in the injured than uninjured leg (SMD = 0.52°; P < 0.001) and the proprioception of people whose ACL was repaired was better than those whose ligament was left unrepaired (SMD = −0.62°; P < 0.001). Limitations: Heterogeneity of measurement techniques and lack of psychometric details. Conclusion: ACL injuries may cause knee proprioception deficits compared to uninjured knees and control groups. Although differences were statistically significant, the clinical significance of findings can be questioned. Clinical practitioners using joint position sense or threshold to detect passive motion techniques need to consider the reliability and validity of data provided.