Relationship between proprioception and anterior cruciate ligament injury based on neuromuscular control theory_West China Medical Journal

Authors：

ZHU Ye ^1,2 , SHU Qing ¹ , YU Dawei ¹ , JIA Shaohui ² ,  TIAN Jun ^1,2

1. Department of Rehabilitation, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, P. R. China;
2. College of Health Sciences of Wuhan Sports University, Wuhan, Hubei 430079, P. R. China;

Corresponding author：

TIAN Jun, Email: tianjun@znhospital.cn

Keywords：

Anterior cruciate ligament; neuromuscular; proprioception

DOI：

10.7507/1002-0179.202203086

Video：

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Anterior cruciate ligament (ACL) injury is one of the most common and typical sports injuries. Neuromuscular proprioceptive training has been widely used in clinical practice in recent years due to its significant therapeutic effects, but the correlation between proprioception and ACL injury is still lacking in-depth exploration. ACL injury can result in the loss of mechanoreceptors, which in turn affects proprioceptive signal afferents, resulting in impaired neuromuscular control. Impaired neuromuscular control, in turn, can cause ligamentous structures to be overburdened beyond their stretch thresholds, leading to proprioceptive impairment, creating a vicious cycle. Based on neuromuscular control theory, this article further discusses the relationship between proprioception and ACL injury, aiming to provide new ideas for rehabilitation after ACL injury.

Citation： ZHU Ye, SHU Qing, YU Dawei, JIA Shaohui, TIAN Jun. Relationship between proprioception and anterior cruciate ligament injury based on neuromuscular control theory. West China Medical Journal, 2022, 37(5): 688-692. doi: 10.7507/1002-0179.202203086 Copy

1.	Spencer L, Burkhart TA, Tran MN, et al. Biomechanical analysis of simulated clinical testing and reconstruction of the anterolateral ligament of the knee. Am J Sports Med, 2015, 43(9): 2189-2197.
2.	Zhang S, Huang Q, Xie J, et al. Factors influencing postoperative length of stay in an enhanced recovery after surgery program for primary total knee arthroplasty. J Orthop Surg Res, 2018, 13(1): 29.
3.	Petersen W, Zantop T. Partial rupture of the anterior cruciate ligament. Arthroscopy, 2006, 22(11): 1143-1145.
4.	刘俊华, 杨凌, 杨冬. 本体感觉与运动控制研究进展. 生理科学进展, 2021, 52(4): 259-264.
5.	Kaya D, Guney-Deniz H, Sayaca C, et al. 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.
6.	Skoglund S. Anatomical and physiological studies of knee joint innervation in the cat. Acta Physiol Scand Suppl, 1956, 36(124): 1-101.
7.	Arumugam A, Björklund M, Mikko S, et al. Effects of neuromuscular training on knee proprioception in individuals with anterior cruciate ligament injury: a systematic review and GRADE evidence synthesis. BMJ Open, 2021, 11(5): e049226.
8.	Bragonzoni L, Rovini E, Barone G, et al. How proprioception changes before and after total knee arthroplasty: a systematic review. Gait Posture, 2019, 72: 1-11.
9.	Wilson WT, Hopper GP, Banger MS, et al. Anterior cruciate ligament repair with internal brace augmentation: a systematic review. Knee, 2022, 35: 192-200.
10.	Kosy JD, Mandalia VI. Anterior cruciate ligament mechanoreceptors and their potential importance in remnant-preserving reconstruction: a review of basic science and clinical findings. J Knee Surg, 2018, 31(8): 736-746.
11.	Strong A, Arumugam A, Tengman E, et al. Properties of knee joint position sense tests for anterior cruciate ligament injury: a systematic review and meta-analysis. Orthop J Sports Med, 2021, 9(6): 23259671211007878.
12.	Alahmari KA, Silvian P, Ahmad I, et al. Effectiveness of low-frequency stimulation in proprioceptive neuromuscular facilitation techniques for post ankle sprain balance and proprioception in adults: a randomized controlled trial. Biomed Res Int, 2020, 2020: 9012930.
13.	Hu X, Li J, Wang L. Sex differences in lower limb proprioception and mechanical function among healthy adults. Motor Control, 2020, 24(4): 571-587.
14.	Tayfur B, Charuphongsa C, Morrissey D, et al. Neuromuscular function of the knee joint following knee injuries: does it ever get back to normal? A systematic review with meta-analyses. Sports Med, 2021, 51(2): 321-338.
15.	Konishi Y, Fukubayashi T, Takeshita D. Mechanism of quadriceps femoris muscle weakness in patients with anterior cruciate ligament reconstruction. Scand J Med Sci Sports, 2002, 12(6): 371-375.
16.	Meier ML, Vrana A, Schweinhardt P. Low back pain: the potential contribution of supraspinal motor control and proprioception. Neuroscientist, 2019, 25(6): 583-596.
17.	Kao TC, Sadabadi MS, Hennequin G. Optimal anticipatory control as a theory of motor preparation: a thalamo-cortical circuit model. Neuron, 2021, 109(9): 1567-1581.e12.
18.	Donoghue JP, Sanes JN. Motor areas of the cerebral cortex. J Clin Neurophysiol, 1994, 11(4): 382-396.
19.	Picton LD, Bertuzzi M, Pallucchi I, et al. A spinal organ of proprioception for integrated motor action feedback. Neuron, 2021, 109(7): 1188-1201.e7.
20.	Nascimento AI, Mar FM, Sousa MM. The intriguing nature of dorsal root ganglion neurons: linking structure with polarity and function. Prog Neurobiol, 2018, 168: 86-103.
21.	Mizuguchi N, Nakagawa K, Tazawa Y, et al. Functional plasticity of the ipsilateral primary sensorimotor cortex in an elite long jumper with below-knee amputation. Neuroimage Clin, 2019, 23: 101847.
22.	Kapreli E, Athanasopoulos S. The anterior cruciate ligament deficiency as a model of brain plasticity. Med Hypotheses, 2006, 67(3): 645-650.
23.	van Melick N, van Cingel RE, Brooijmans F, et al. Evidence-based clinical practice update: practice guidelines for anterior cruciate ligament rehabilitation based on a systematic review and multidisciplinary consensus. Br J Sports Med, 2016, 50(24): 1506-1515.
24.	Sonnery-Cottet B, Saithna A, Quelard B, et al. Arthrogenic muscle inhibition after ACL reconstruction: a scoping review of the efficacy of interventions. Br J Sports Med, 2019, 53(5): 289-298.
25.	Bodkin SG, Norte G, Hart J. Corticospinal excitability can discriminate quadriceps strength indicative of knee function after ACL‐reconstruction. Scand J Med Sci Sports, 2019, 29(5): 716-724.
26.	Andriacchi TP, Koo S, Scanlan SF. Gait mechanics influence healthy cartilage morphology and osteoarthritis of the knee. J Bone Joint Surg Am, 2009, 91(Suppl 1): 95-101.
27.	Decker LM, Moraiti C, Stergiou N, et al. New insights into anterior cruciate ligament deficiency and reconstruction through the assessment of knee kinematic variability in terms of nonlinear dynamics. Knee Surg Sports Traumatol Arthrosc, 2011, 19(10): 1620-1633.
28.	Lepley AS, Ly MT, Grooms DR, et al. Corticospinal tract structure and excitability in patients with anterior cruciate ligament reconstruction: a DTI and TMS study. Neuroimage Clin, 2020, 25: 102157.
29.	Ardern CL, Taylor NF, Feller JA, et al. Fifty-five per cent return to competitive sport following anterior cruciate ligament reconstruction surgery: an updated systematic review and meta-analysis including aspects of physical functioning and contextual factors. Br J Sports Med, 2014, 48(21): 1543-1552.
30.	Dargo L, Robinson KJ, Games KE. Prevention of knee and anterior cruciate ligament injuries through the use of neuromuscular and proprioceptive training: an evidence-based review. J Athl Train, 2017, 52(12): 1171-1172.
31.	郭韵, 杜良杰, 李建军, 等. 前交叉韧带重建术后膝关节的神经肌肉功能重塑. 中国康复理论与实践, 2016(1): 65-68.
32.	Takeoka A, Arber S. Functional local proprioceptive feedback circuits initiate and maintain locomotor recovery after spinal cord injury. Cell Rep, 2019, 27(1): 71-85.e73.
33.	Dos’Santos T, Thomas C, Comfort P, et al. The effect of training interventions on change of direction biomechanics associated with increased anterior cruciate ligament loading: a scoping review. Sports Med, 2019, 49(12): 1837-1859.
34.	Mickle KJ, Munro BJ, Steele JR. Gender and age affect balance performance in primary school-aged children. J Sci Med Sport, 2011, 14(3): 243-248.
35.	McGuine TA, Keene JS. The effect of a balance training program on the risk of ankle sprains in high school athletes. Am J Sports Med, 2006, 34(7): 1103-1111.
36.	Andrade R, Pereira R, van Cingel R, et al. How should clinicians rehabilitate patients after ACL reconstruction? A systematic review of clinical practice guidelines (CPGs) with a focus on quality appraisal (AGREE Ⅱ). Br J Sports Med, 2020, 54(9): 512-519.
37.	Sasaki S, Tsuda E, Yamamoto Y, et al. Core-muscle training and neuromuscular control of the lower limb and trunk. J Athl Train, 2019, 54(9): 959-969.
38.	Zemková E, Zapletalová L. The role of neuromuscular control of postural and core stability in functional movement and athlete performance. Front Physiol, 2022, 13: 796097.
39.	Jeong J, Choi DH, Shin CS. Core strength training can alter neuromuscular and biomechanical risk factors for anterior cruciate ligament injury. Am J Sports Med, 2021, 49(1): 183-192.
40.	Ippersiel P, Robbins SM, Dixon PC. Lower-limb coordination and variability during gait: the effects of age and walking surface. Gait Posture, 2021, 85: 251-257.
41.	Johnston PT, McClelland JA, Webster KE. Lower limb biomechanics during single-leg landings following anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Sports Med, 2018, 48(9): 2103-2126.
42.	Gatti AA, Keir PJ, Noseworthy MD, et al. Hip and ankle kinematics are the most important predictors of knee joint loading during bicycling. J Sci Med Sport, 2021, 24(1): 98-104.
43.	Hewett TE, Ford KR, Hoogenboom BJ, et al. Understanding and preventing acl injuries: current biomechanical and epidemiologic considerations - update 2010. N Am J Sports Phys Ther, 2010, 5(4): 234-251.
44.	Buckthorpe M. Optimising the late-stage rehabilitation and return-to-sport training and testing process after ACL reconstruction. Sports Med, 2019, 49(7): 1043-1058.
45.	Diermeier T, Rothrauff BB, Engebretsen L, et al. Treatment after anterior cruciate ligament injury: panther symposium ACL treatment consensus group. Knee Surg Sports Traumatol Arthrosc, 2020, 28(8): 2390-2402.
46.	Buckthorpe M. Recommendations for movement re-training after ACL reconstruction. Sports Med, 2021, 51(8): 1601-1618.
47.	Nagelli C, Wordeman SC, Di Stasi S, et al. Biomechanical deficits at the hip in athletes with ACL reconstruction are ameliorated with neuromuscular Training. Am J Sports Med, 2018, 46(11): 2772-2779.

1. Spencer L, Burkhart TA, Tran MN, et al. Biomechanical analysis of simulated clinical testing and reconstruction of the anterolateral ligament of the knee. Am J Sports Med, 2015, 43(9): 2189-2197.
2. Zhang S, Huang Q, Xie J, et al. Factors influencing postoperative length of stay in an enhanced recovery after surgery program for primary total knee arthroplasty. J Orthop Surg Res, 2018, 13(1): 29.
3. Petersen W, Zantop T. Partial rupture of the anterior cruciate ligament. Arthroscopy, 2006, 22(11): 1143-1145.
4. 刘俊华, 杨凌, 杨冬. 本体感觉与运动控制研究进展. 生理科学进展, 2021, 52(4): 259-264.
5. Kaya D, Guney-Deniz H, Sayaca C, et al. 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.
6. Skoglund S. Anatomical and physiological studies of knee joint innervation in the cat. Acta Physiol Scand Suppl, 1956, 36(124): 1-101.
7. Arumugam A, Björklund M, Mikko S, et al. Effects of neuromuscular training on knee proprioception in individuals with anterior cruciate ligament injury: a systematic review and GRADE evidence synthesis. BMJ Open, 2021, 11(5): e049226.
8. Bragonzoni L, Rovini E, Barone G, et al. How proprioception changes before and after total knee arthroplasty: a systematic review. Gait Posture, 2019, 72: 1-11.
9. Wilson WT, Hopper GP, Banger MS, et al. Anterior cruciate ligament repair with internal brace augmentation: a systematic review. Knee, 2022, 35: 192-200.
10. Kosy JD, Mandalia VI. Anterior cruciate ligament mechanoreceptors and their potential importance in remnant-preserving reconstruction: a review of basic science and clinical findings. J Knee Surg, 2018, 31(8): 736-746.
11. Strong A, Arumugam A, Tengman E, et al. Properties of knee joint position sense tests for anterior cruciate ligament injury: a systematic review and meta-analysis. Orthop J Sports Med, 2021, 9(6): 23259671211007878.
12. Alahmari KA, Silvian P, Ahmad I, et al. Effectiveness of low-frequency stimulation in proprioceptive neuromuscular facilitation techniques for post ankle sprain balance and proprioception in adults: a randomized controlled trial. Biomed Res Int, 2020, 2020: 9012930.
13. Hu X, Li J, Wang L. Sex differences in lower limb proprioception and mechanical function among healthy adults. Motor Control, 2020, 24(4): 571-587.
14. Tayfur B, Charuphongsa C, Morrissey D, et al. Neuromuscular function of the knee joint following knee injuries: does it ever get back to normal? A systematic review with meta-analyses. Sports Med, 2021, 51(2): 321-338.
15. Konishi Y, Fukubayashi T, Takeshita D. Mechanism of quadriceps femoris muscle weakness in patients with anterior cruciate ligament reconstruction. Scand J Med Sci Sports, 2002, 12(6): 371-375.
16. Meier ML, Vrana A, Schweinhardt P. Low back pain: the potential contribution of supraspinal motor control and proprioception. Neuroscientist, 2019, 25(6): 583-596.
17. Kao TC, Sadabadi MS, Hennequin G. Optimal anticipatory control as a theory of motor preparation: a thalamo-cortical circuit model. Neuron, 2021, 109(9): 1567-1581.e12.
18. Donoghue JP, Sanes JN. Motor areas of the cerebral cortex. J Clin Neurophysiol, 1994, 11(4): 382-396.
19. Picton LD, Bertuzzi M, Pallucchi I, et al. A spinal organ of proprioception for integrated motor action feedback. Neuron, 2021, 109(7): 1188-1201.e7.
20. Nascimento AI, Mar FM, Sousa MM. The intriguing nature of dorsal root ganglion neurons: linking structure with polarity and function. Prog Neurobiol, 2018, 168: 86-103.
21. Mizuguchi N, Nakagawa K, Tazawa Y, et al. Functional plasticity of the ipsilateral primary sensorimotor cortex in an elite long jumper with below-knee amputation. Neuroimage Clin, 2019, 23: 101847.
22. Kapreli E, Athanasopoulos S. The anterior cruciate ligament deficiency as a model of brain plasticity. Med Hypotheses, 2006, 67(3): 645-650.
23. van Melick N, van Cingel RE, Brooijmans F, et al. Evidence-based clinical practice update: practice guidelines for anterior cruciate ligament rehabilitation based on a systematic review and multidisciplinary consensus. Br J Sports Med, 2016, 50(24): 1506-1515.
24. Sonnery-Cottet B, Saithna A, Quelard B, et al. Arthrogenic muscle inhibition after ACL reconstruction: a scoping review of the efficacy of interventions. Br J Sports Med, 2019, 53(5): 289-298.
25. Bodkin SG, Norte G, Hart J. Corticospinal excitability can discriminate quadriceps strength indicative of knee function after ACL‐reconstruction. Scand J Med Sci Sports, 2019, 29(5): 716-724.
26. Andriacchi TP, Koo S, Scanlan SF. Gait mechanics influence healthy cartilage morphology and osteoarthritis of the knee. J Bone Joint Surg Am, 2009, 91(Suppl 1): 95-101.
27. Decker LM, Moraiti C, Stergiou N, et al. New insights into anterior cruciate ligament deficiency and reconstruction through the assessment of knee kinematic variability in terms of nonlinear dynamics. Knee Surg Sports Traumatol Arthrosc, 2011, 19(10): 1620-1633.
28. Lepley AS, Ly MT, Grooms DR, et al. Corticospinal tract structure and excitability in patients with anterior cruciate ligament reconstruction: a DTI and TMS study. Neuroimage Clin, 2020, 25: 102157.
29. Ardern CL, Taylor NF, Feller JA, et al. Fifty-five per cent return to competitive sport following anterior cruciate ligament reconstruction surgery: an updated systematic review and meta-analysis including aspects of physical functioning and contextual factors. Br J Sports Med, 2014, 48(21): 1543-1552.
30. Dargo L, Robinson KJ, Games KE. Prevention of knee and anterior cruciate ligament injuries through the use of neuromuscular and proprioceptive training: an evidence-based review. J Athl Train, 2017, 52(12): 1171-1172.
31. 郭韵, 杜良杰, 李建军, 等. 前交叉韧带重建术后膝关节的神经肌肉功能重塑. 中国康复理论与实践, 2016(1): 65-68.
32. Takeoka A, Arber S. Functional local proprioceptive feedback circuits initiate and maintain locomotor recovery after spinal cord injury. Cell Rep, 2019, 27(1): 71-85.e73.
33. Dos’Santos T, Thomas C, Comfort P, et al. The effect of training interventions on change of direction biomechanics associated with increased anterior cruciate ligament loading: a scoping review. Sports Med, 2019, 49(12): 1837-1859.
34. Mickle KJ, Munro BJ, Steele JR. Gender and age affect balance performance in primary school-aged children. J Sci Med Sport, 2011, 14(3): 243-248.
35. McGuine TA, Keene JS. The effect of a balance training program on the risk of ankle sprains in high school athletes. Am J Sports Med, 2006, 34(7): 1103-1111.
36. Andrade R, Pereira R, van Cingel R, et al. How should clinicians rehabilitate patients after ACL reconstruction? A systematic review of clinical practice guidelines (CPGs) with a focus on quality appraisal (AGREE Ⅱ). Br J Sports Med, 2020, 54(9): 512-519.
37. Sasaki S, Tsuda E, Yamamoto Y, et al. Core-muscle training and neuromuscular control of the lower limb and trunk. J Athl Train, 2019, 54(9): 959-969.
38. Zemková E, Zapletalová L. The role of neuromuscular control of postural and core stability in functional movement and athlete performance. Front Physiol, 2022, 13: 796097.
39. Jeong J, Choi DH, Shin CS. Core strength training can alter neuromuscular and biomechanical risk factors for anterior cruciate ligament injury. Am J Sports Med, 2021, 49(1): 183-192.
40. Ippersiel P, Robbins SM, Dixon PC. Lower-limb coordination and variability during gait: the effects of age and walking surface. Gait Posture, 2021, 85: 251-257.
41. Johnston PT, McClelland JA, Webster KE. Lower limb biomechanics during single-leg landings following anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Sports Med, 2018, 48(9): 2103-2126.
42. Gatti AA, Keir PJ, Noseworthy MD, et al. Hip and ankle kinematics are the most important predictors of knee joint loading during bicycling. J Sci Med Sport, 2021, 24(1): 98-104.
43. Hewett TE, Ford KR, Hoogenboom BJ, et al. Understanding and preventing acl injuries: current biomechanical and epidemiologic considerations - update 2010. N Am J Sports Phys Ther, 2010, 5(4): 234-251.
44. Buckthorpe M. Optimising the late-stage rehabilitation and return-to-sport training and testing process after ACL reconstruction. Sports Med, 2019, 49(7): 1043-1058.
45. Diermeier T, Rothrauff BB, Engebretsen L, et al. Treatment after anterior cruciate ligament injury: panther symposium ACL treatment consensus group. Knee Surg Sports Traumatol Arthrosc, 2020, 28(8): 2390-2402.
46. Buckthorpe M. Recommendations for movement re-training after ACL reconstruction. Sports Med, 2021, 51(8): 1601-1618.
47. Nagelli C, Wordeman SC, Di Stasi S, et al. Biomechanical deficits at the hip in athletes with ACL reconstruction are ameliorated with neuromuscular Training. Am J Sports Med, 2018, 46(11): 2772-2779.

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