Proprioception analysis of patients with anterior cruciate ligament reconstruction

Year 2023, Volume: 9 Issue: 6 - November 2023, 1420 - 1428, 04.11.2023

Nazım Erkurt , Mustafa Yerli , Ali Yüce , Tahsin Olgun Bayraktar , Sevgi Atar , Kaya Turan , Haluk Çabuk

https://doi.org/10.18621/eurj.1265826

Abstract

Objectives: This study evaluates the effect of tibial stump mechanoreceptor preservation on proprioception, muscle strength, recovery and functional outcomes after arthroscopic anterior cruciate ligament surgery (ACLS).

Methods: Patients undergoing ACLS between January-July 2019 were evaluated by a single surgeon. The HUMAC NORM 2 device measured patients' proprioceptive sensation and muscle strength before and after surgery; KOOS and Oxford scales were used to score patients’ functional results. The patients were divided into two groups: those who underwent stump-preserving surgery (SP group) and those who underwent conventional surgery (C group).

Results: Our study evaluated 27 patients, 11 in the SP and 16 in the C groups. The two groups had no statistical difference in muscle strength, proprioception, and functional scores in the first and third postoperative months. In the sixth-month evaluation, significantly better functional scores were found in the C group. Further, the athletic function was better in patients with good proprioception recovery, regardless of the group comparison.

Conclusions: Preserving the stump and mechanoreceptors on the tibial face was not determined to provide additional benefit to the patients in the first six months after surgery. Returning to sports was faster and functional scores were better in patients with good proprioception recovery.

Keywords

Anterior cruciate ligament tear, arthroscopic anterior cruciate ligament surgery, tibial remnant

References

• 1. Gföller P, Abermann E, Runer A, Hoser C, Pflüglmayer M, Wierer G, et al. Non-operative treatment of ACL injury is associated with opposing subjective and objective outcomes over 20 years of follow-up. Knee Surg Sports Traumatol Arthrosc 2019;27:2665-71.
• 2. Kaya D, Guney-Deniz H, Sayaca C, Calik M, Doral MN. Effects on lower extremity neuromuscular control exercises on knee proprioception, muscle strength, and functional level in patients with ACL reconstruction. Biomed Res Int 2019;2019:1694695.
• 3. Singh I, Singh A. Remnant-preserving anterior cruciate ligament reconstruction: remnant envelope technique. Arthrosc Tech 2020;9:e1805-12.
• 4. Dhillon MS, Bali K, Vasistha RK. Immunohistological evaluation of proprioceptive potential of the residual stump of injured anterior cruciate ligaments (ACL). Int Orthop 2010;34:737-41.
• 5. Takahashi T, Kondo E, Yasuda K, Miyatake S, Kawaguchi Y, Onodera J, et al. Effects of remnant tissue preservation on the tendon graft in anterior cruciate ligament reconstruction: a biomechanical and histological study. Am J Sports Med 2016;44:1708-16.
• 6. Bayramoglu M, Toprak R, Sozay S. Effects of osteoarthritis and fatigue on proprioception of the knee joint. Arch Phys Med Rehabil 2007;88:346-50.
• 7. Roos EM, Lohmander LS. The knee injury and osteoarthritis outcome score (KOOS): from joint injury to osteoarthritis. Health Qual Life Outcomes 2003;1:64.
• 8. Dawson J, Fitzpatrick R, Murray D, Carr A. Questionnaire on the perceptions of patients about total knee replacement. J Bone Joint Surg Br 1998;80:63-9.
• 9. Fremerey RW, Lobenhoffer P, Zeichen J, Skutek M, Bosch U, Tscherne H. Proprioception after rehabilitation and reconstruction in knees with deficiency of the anterior cruciate ligament: a prospective, longitudinal study. J Bone Joint Surg Br 2000;82:801-6.
• 10. Ardern CL, Taylor NF, Feller JA, Whitehead TS, Webster KE. Psychological responses matter in returning to preinjury level of sport after anterior cruciate ligament reconstruction surgery. Am J Sports Med 2013;41:1549-58.
• 11. Patterson B, Culvenor AG, Barton CJ, Guermazi A, Stefanik J, Morris HG, et al. Poor functional performance 1 year after ACL reconstruction increases the risk of early osteoarthritis progression. Br J Sports Med 2020;54:546-53.
• 12. Barrett DS. Proprioception and function after anterior cruciate reconstruction. J Bone Joint Surg Br 1991;73:833-7.
• 13. Georgoulis AD, Pappa L, Moebius U, Malamou-Mitsi V, Pappa S, Papageorgiou CO, et al. The presence of proprioceptive mechanoreceptors in the remnants of the ruptured ACL is a possible source of re-innervation of the ACL autograft. Knee Surg Sports Traumatol Arthrosc 2001;9:364-8.
• 14. Almonroeder TG, Garcia E, Kurt M. The effects of anticipation on the mechanics of the knee during single-leg cutting tasks: a systematic review. Int J Sports Phys Ther 2015;10:918-28.
• 15. Ashton-Miller JA, Wojtys EM, Huston LJ, Fry-Welch D. Can proprioception really be improved by exercises? Knee Surg Sports Traumatol Arthrosc 2001;9:128-36.
• 16. Han J, Anson J, Waddington G, Adams R. Sport attainment and proprioception. Int J Sports Sci Coach 2014;9:159-70.
• 17. Relph N, Herrington L, Tyson S. The effects of ACL injury on knee proprioception: a meta-analysis. Physiotherapy 2014;100:187-95.
• 18. Relph N, Herrington L. Knee joint position sense ability in elite athletes who have returned to international level play following ACL reconstruction: a cross-sectional study. Knee 2016;23:1029-34.
• 19. Iles JF, Stokes M, Young A. Reflex actions of knee joint afferents during contraction of the human quadriceps. Clin Physiol 1990;10:489-500.
• 20. Snow BJ, Wilcox JJ, Burks RT, Greis PE. Evaluation of muscle size and fatty infiltration with MRI nine to eleven years following hamstring harvest for ACL reconstruction. J Bone Joint Surg Am 2012;94:1274-82.
• 21. Corry IS, Webb JM, Clingeleffer AJ, Pinczewski LA. Arthroscopic reconstruction of the anterior cruciate ligament. A comparison of patellar tendon autograft and four-strand hamstring tendon autograft. Am J Sports Med 1999;27:444-54.
• 22. Ageberg E, Roos HP, Silbernagel KG, Thomeé R, Roos EM. Knee extension and flexion muscle power after anterior cruciate ligament reconstruction with patellar tendon graft or hamstring tendons graft: a cross-sectional comparison 3 years post-surgery. Knee Surg Sports Traumatol Arthrosc 2009;17:162-9.
• 23. Roberts D, Andersson G, Fridén T. Knee joint proprioception in ACL-deficient knees is related to cartilage injury, laxity and age: a retrospective study of 54 patients. Acta Orthop Scand 2004;75:78-83.
• 24. Choi S, Kim MK, Kwon YS, Kang H. Clinical and arthroscopic outcome of single-bundle anterior cruciate ligament reconstruction: comparison of remnant preservation versus conventional technique. Knee 2017;24:1025-32.
• 25. Pujol N, Colombet P, Potel JF, Cucurulo T, Graveleau N, Hulet C, et al. Anterior cruciate ligament reconstruction in partial tear: selective anteromedial bundle reconstruction conserving the posterolateral remnant versus single-bundle anatomic ACL reconstruction: preliminary 1-year results of a prospective randomised study. Orthop Traumatol Surg Res 2012;98(8 Suppl):S171-7.
• 26. Kim SJ, Choi CH, Chun YM, Kim SH, Lee SK, Jung WS, et al. Anterior cruciate ligament reconstruction using bone-patellar tendon-bone autograft with remnant preservation: comparison of outcomes according to the amount of remnant tissue. J Knee Surg 2019;32:847-59.
• 27. Naylor AJ, Mohtadi NGH, Chan DS, Humphrey RS, Donald M. Anterior cruciate ligament preservation during reconstructive surgery: Does the extra surgical effort improve patient outcomes at one year? Sport Orthop Sport Traumatol 2013;29:29-39.
• 28. Kocher MS, Steadman JR, Briggs K, Zurakowski D, Sterett WI, Hawkins RJ. Determinants of patient satisfaction with outcome after anterior cruciate ligament reconstruction. J Bone Joint Surg Am 2002;84:1560-72.
• 29. Carr AJ, Higginson IJ. Are the quality of life measures patient centered? BMJ 2001;322:1357-60.
• 30. Higginson IJ, Carr AJ. Measuring quality of life: Using quality of life measures in the clinical setting. BMJ 2001;322:1297-300.