Introduction: The time necessary to return to sports activities after ACL reconstruction is 6 months. Few authors have speculated on the possibility to reduce this time with accelerated rehabilitation. But nobody has considered the proprioceptive aspects. Recently some experiments have demonstrated that a perturbation training program can improve the functional stability in ACL injured and reconstructed knees. Nevertheless there are no studies showing the effects of these exercises in long period. The aim of this study was to find out if a specific proprioceptive exercise as perturbation training permits a further and durable recovery of proprioception after ACL reconstruction for an early return to agonism. Material and Methods: 70 sportsmen with an isolated ACL injury were recruited. They were undergone to arthroscopic ACL reconstruction with the ST+G tendons by the same team. At discharge they were randomly assigned to two homogeneous groups: the first one ‘self-controlled’ composed by patients that followed the standard rehabilitation protocol without any help of therapist; the second group ‘Perturbation’ constituted by patients that followed between the 2nd and the 3rd months a specific proprioceptive protocol that included perturbation exercises on support surfaces (perturbation training). They have been clinically evaluated before surgery and after 2, 3, 6 and 12 months after surgery with a kinaesthetic device constituted by a tilting platform equipped by digitalized sensor connected to a computer. The protocol included three repetition of one and two legged standing balance. The statistical analyses with t-test considered significant value of p< 0.05. Results: All the test shows a significant improvement between pre and post-operative values. The improvements in the Perturbation group are more significant than the ones in the ‘self-controlled’ group at the 3rd month (two legged stance test: p=0,001; one legged stance on the operated side: p=0,003; one legged stance on the healthy side: p=0,0001). Best results in the Perturbation group are maintained at the 6th month only in the one legged stance on healthy side (p=0,014) but any difference is still present at 12 months. Conclusion: The significant improvement of the Perturbation group’s values at 3rd month demonstrates that accelerated rehabilitation of proprioception after ACL reconstruction may enhance knee proprioception and suggests the possibility of an early return to sports activities. Nevertheless it must be considered the duration of benefits obtained is limited to the period of application. Therefore other studies are necessary to establish if it’s only a problem of time and duration of application and/or type of specific rehabilitative exercises

There has been very little documented regarding the impact of meniscal injuries on knee proprioception. The aim of this study was to investigate the proprioceptive function of patients with meniscal tears and asses the influence that arthroscopic partial menisectomy has on knee proprioception. One hundred subjects were recruited comprising an Arthroscopy group (50 patients) and a Normal Control group (50 subjects). The Biodex Balance SD System was used to assess proprioception. This equipment measures knee proprioception on an electronic platform. The balance of the subject is computed producing an Overall Stability Index (OSI). Lower scores reflect better proprioception. Knee stability was assessed clinically and with the Rolimeter knee arthrometer. The Lysholm and IKDC scoring systems were used to evaluate all the subjects. Of the 50 subjects within the Arthroscopy group (all of whom had a normal ACL confirmed) 34 were found to have meniscal tears. Twenty-nine of the 34 patients with meniscal tears returned for their follow-up review 3 months post-operatively. The proprioceptive function of the injured knee of the Arthroscopy group with meniscal tears (mean OSI 0.86) was significantly poorer compared to that of their uninjured knee (mean OSI 0.62, p< 0.001, 95%CI 0.14, 0.34) and to the Normal Control group (mean OSI 0.49, p< 0.001, 95%CI 0.21, 0.54). There was no significant improvement in their proprioceptive function following menisectomy (mean OSI 0.75, p=0.23, 95%CI −0.07, 0.28). There was a significant improvement of both the Lysholm (p=0.004) and IKDC (p=0.021) scores postoperatively. Conclusion: These results indicate that there is a demonstrable proprioceptive deficit in patients with meniscal tears even in the presence of a normal ACL. This deficiency in proprioception did not improve within three months following arthroscopic partial menisectomy despite the improvement in functional outcome measures

Purpose of Study. To investigate the proprioceptive function of patients with an ACL rupture before and after reconstruction and correlate these findings with ligament laxity testing and clinical outcome measures. Summary of Methods and Results. Fifty patients with an ACL rupture and 50 normal controls were recruited to the study. The Biodex Balance SD System was used to assess knee proprioception. This equipment measures proprioceptive function using an electronic platform. The balance of the subject is computed using stabilometry and an Overall Stability Index (OSI) is produced. A lower score reflects better proprioception. Knee stability was assessed clinically and with the Rolimeter knee arthrometer in all subjects. Participants were evaluated using the Tegner, Lysholm, Cincinnati and IKDC scoring systems. In the ACL group, 34 patients underwent ACL reconstruction and returned for their follow-up review 3 months post-operatively. The proprioceptive function of the injured knee of the ACL group (mean OSI 0.70) was significantly poorer compared to that of their uninjured knee (mean OSI 0.46, p<0.001, 95%CI 0.14, 0.34) and to the Normal Control group (mean OSI 0.49, p=0.01, 95%CI 0.05, 0.38). There was a significant improvement in proprioception of the injured knee following ACL reconstruction (mean OSI 0.47, p=0.003, 95%CI 0.10, 0.42). A significant correlation was found between pre-operative proprioception measurements and all the pre-operative knee outcome scores, however this correlation was not found post-operatively. No correlation was found between ligament laxity testing and either proprioception measurements or knee outcome scores. Conclusion. Patients with ACL ruptures were found to have a proprioceptive deficit which improved following reconstruction, the measurements of which correlated better with clinical outcome scores than instrumented ligament laxity testing

We assessed proprioception in the knee using the angle reproduction test in 20 healthy volunteers, ten patients with acute anterior instability and 20 patients with chronic anterior instability after reconstruction of the anterior cruciate ligament (ACL). In addition, the Lysholm-knee score, ligament laxity and patient satisfaction were determined. Acute trauma causes extensive damage to proprioception which is not restored by rehabilitation alone. Three months after operation, there remained a slight decrease in proprioception compared with the preoperative recordings, but six months after reconstruction, restoration of proprioception was seen near full extension and full flexion. In the mid-range position, proprioception was not restored. At follow-up, 3.7 ± 0.3 years after reconstruction, there was further improvement of proprioception in the mid-range position. There was no difference between open and arthroscopic techniques. The highest correlation was found between proprioception and patient satisfaction. After reconstruction of the ACL reduced proprioception may explain the poor functional outcome in some patients, despite restoration of mechanical stability

Decreasing proprioception of the knee is multifactorial and is a function of age and degenerative joint disease. Soft-tissue release during total knee replacement may have an influence. We have quantified soft-tissue imbalance at the time of knee replacement and attempted to eliminate it at full extension, using established methods. We studied the influence of residual soft-tissue imbalance on postoperative proprioception, assessing this in 38 patients before total knee replacement and at three and six months postoperatively. We found that proprioception improved in varus knees at three and six months after soft-tissue balancing procedures. Knees balanced in full extension and in flexion (< ±2°) showed a significant improvement in proprioception (p < 0.0005) whereas those which were not balanced in flexion but fully balanced in extension had no significant improvement. We conclude that soft-tissue balance in both flexion and extension is important to allow satisfactory postoperative proprioception of the knee

We compared joint proprioception in 12 hips in 12 patients with hemiarthroplasty after fracture of the hip, in 12 hips in 11 patients with total hip arthroplasty because of osteoarthritis and in a control group of 12 age-matched patients with no clinical complaints. There was no significant difference (p = 0.05) in joint proprioception in any of the groups. There was no decrease in joint proprioception in the group with total hip arthroplasty compared with the hemiarthroplasty group or with the control group. Other factors such as stretch receptors in the adjacent tendons and muscles may have a greater influence on proprioception in the hip than the intracapsular components

Aim: To assess shoulder proprioception before and after a new surgical treatment for multi-directional instability. Methods: A pilot study assessing shoulder proprioception in asymptomatic controls (n=6), pre-operative patients (n=7) awaiting surgery for multidirectional instability (having failed rehabilitation) and post-operative patients (n=7) having undergone thermo-capsular shrinkage and rehabilitation. Data were obtained using the Proprioception Assessment System developed at our centre following a standardised protocol to record threshold to detection of passive movement (TTDPM) and reproduction of passive position (RPP) in three positions of rotation. Results: For controls, TTDPM at 0 degrees, +30 degrees and −30 degrees was 1.08 degrees ± 1.05 degrees, 1.75 degrees ± 1.80 degrees and 1.61 degrees ± 1.68 degrees respectively. In the pre-operative group the asymptomatic shoulders had values of 2.48 degrees ± 2.22 degrees, 2.14 degrees ± 1.59 degrees and 1.51 degrees ± 0.87degrees and the symptomatic shoulders 8.59 degrees ± 12.96 degrees, 6.89 degrees ± 6.36 degrees and 4.4 degrees ± 3.45 degrees respectively. In the post-operative group, asymptomatic shoulders had values of 2.09 degrees ± 1.25 degrees, 2.31 degrees ± 1.30 degrees and 2.30 degrees ± 1.31 degrees and symptomatic shoulders 2.15 degrees ± 1.30 degrees, 2.54 degrees ± 1.43 degrees and 2.89 degrees ± 2.12 degrees respectively. With respect to RPP, controls had values at 0 degrees, +30 degrees and –30 degrees of 2.49 degrees ± 1.02 degrees, 2.58 degrees ± 1.13degrees and 2.72 degrees ± 2.11 degrees. In the pre-operative group, the results for asymptomatic shoulders were 2.48 degrees ± 0.68 degrees, 0.87 degrees ± 0.51 degrees and 3.44 degrees ± 2.41 degrees and for symptomatic shoulders 5.63 degrees ± 2.05 degrees, 3.17 degrees ± 2.05 degrees and 7.56 degrees ± 6.10 degrees respectively. In the post-operative group, the results for asymptomatic shoulders were 2.85 degrees ± 1.13 degrees, 3.78 degrees ± 1.94 degrees and 2.55 degrees ± 2.11 degrees and for symptomatic shoulders 2.28 degrees ± 0.81 degrees, 5.40 degrees ± 5.91 degrees and 3.62 degrees ± 1.63 degrees respectively. Conclusions: There were no differences between shoulders in controls and post-operative patients. Despite the small numbers, the pre-operative patients showed significant differences (p< 0.05) between shoulders in two of the six test protocols. Post-operative shoulders had means similar to controls suggesting thermo-capsular shrinkage may help regain shoulder proprioception after injuries

Aims: The purpose of this study, we need to identify the balance whether is influenced by proprioception or not? Can those be used as objective measures to predict functional stability?. Materials & Methods: Twelve young adults (10 males; 2 females) with chronic ACL deficiency (6 R’t knee; 4 L’t knee) were included this test (average time from injured to test: 12.8 months). The control group was 13 normal individuals (11 males; 2 females). There were no associated injuries in both group and no significant difference about age, height and body weight. Both groups were tested on computerized balance-testing machine system (self-design), proprioception testing apparatus (self-design) and the Isokinetic Dynamometer (Con-Trex Multi Joint System, Switzerland). Results: In ACL group, the Lachman score showed 67.7 ± 4.2 points. The difference of joint laxity between injured and uninjured knee was 9± 2 vs 3.7 ± 1.2 using K-T 1000 arthrometer. In single leg hopping test, showed significant difference (p< 0.05) between injured and uninjured leg. In proppriocetion test, the results showed significant time-delay in both TTDPM and RPP in injured knee. The results of balance test showed control group that had better tilting and unsteadiness than ACL group (P< 0.05). Correlation of TTDPM and mean tilting measurement showed significant difference (r=0.52, P< 0.05, y=0.6075x – 0.2072). There was lower correlation between RPP and mean tilting (r=0.19, p> 0.05). There was poor correlation between muscle force and mean tilting (extensor: r=0.20; flexor: r=0.22; p> 0.05). Similarly, time from injury to test correlated poorly with both proprioception (TTDPM: r=0.02; RPP: r=0.132) and balance (mean tilting: r=0.06; unsteadiness: r=0.004). Conclusion: Loss of proprioceptive sensibility had been proved by authors study, it was rarely indicated balance function in the ACL deficiency. In our study, we had proved positive correlation between proprioception and balance. We do believe poor proproception may cause of imbalance after rupture of ACL. In future rehabilitative program, balance training must be aided for restoration and recreation the proproceptive ability around knee joint

Loss of proprioception following an anterior cruciate ligament (ACL) injury has been well documented. We evaluated proprioception in both the injured and the uninjured limb in 25 patients with ACL injury and in 25 healthy controls, as assessed by joint position sense (JPS), the threshold for the detection of passive movement (TDPM) and postural sway during single-limb stance on a force plate. There were significant proprioceptive deficits in both ACL-deficient and uninjured knees compared with control knees, as assessed by the angle reproduction test (on JPS) and postural sway on single limb stance. The degree of loss of proprioception in the ACL-deficient knee and the unaffected contralateral knee joint in the same patient was similar. The TDPM in the injured knee was significantly higher than that of controls at 30° and 70° of flexion. The TDPM of the contralateral knee joint was not significantly different from that in controls. Based on these findings, the effect of proprioceptive training of the contralateral uninjured knee should be explored. Cite this article: Bone Joint J 2013;95-B:188–91

Introduction: Functional Foot Orthoses (FFO’s) have been shown to improve one element of balance, postural sway, when prescribed for patients with ankle injuries. Little is known, however, about the effect of these devices on ankle stability/proprioception, or the changes which might occur as the patient becomes habituated to using the device. We studied these effects from the time of initial application of the FFO through to regular usage at six weeks. Methods: Patients with musculoskeletal conditions affecting the lower limb that required custom made FFO’s were evaluated. A standardised protocol, using the Biodex stability system (a balance platform), to assess several stability indices was performed. Patients were assessed before fitting the orthosis, at the time of fitting and six weeks later. The American Orthopaedic Foot and ankle Society (AOFAS) score was also used to evaluate the progress of these patients. Results: There were 13 male and seven female patients, aged 10 to 64 years. Patients had a range of orthopaedic conditions and all been assessed by orthopaedic specialist and podiatrist as having correctable foot biomechanics. In 6 patients, proprioception deteriorated on initial application of FFO’s. However, all patients exhibited improved over-all stability by a mean of 2.5 points (Normal range 0.82–3.35) at 6 weeks evaluation. The mean AOFAS on presentation was 72 and the final mean score was 97, both of which were clinically and statistically significant (t test, p< 0.05). Eighteen patients had complete resolution of symptoms of pain and instability. Conclusions: FFO’s alter foot biomechanics, and in doing so appear also to improve balance and proprioception. Proprioception deteriorated in 30% of cases on initial application of orthotics, but pain and instability improved in more than 90% of patients on extended use of foot orthotics, with this improvement becoming manifest by 6 weeks after starting use of the device

The aimof this study was to assess proprioception in multi-directional instability of the shoulder before and after a new surgical treatment. A cross-sectional pilot study assessing shoulder proprioception in asymptomatic controls (n=6), pre-operative patients (n=7) awaiting surgery for atraumatic, multidirectional instability having failed a comprehensive rehabilitation programme and post-operative patients (n=7) having undergone thermo-capsular shrinkage of the shoulder and post-operative rehabilitation. Data were obtained using the Proprioception Assessment System developed at this centre following a standardised protocol to record both threshold to detection of passive movement (TTDPM) and reproduction of passive position (RPP) in three positions of rotation. Means and standard deviations are presented. There were no differences between shoulders in controls and post-operative patients. Despite the small numbers, pre-operative patients showed significant differences (p< 0.05) between shoulders in 2 of the 6 test protocols. Post-operative shoulders had means similar to controls suggesting thermo-capsular shrinkage may help regain shoulder proprioception after injury

We have assessed 45 patients who had undergone anterior cruciate reconstruction by a modified MacIntosh-Jones method. The results, using standard knee scores and clinical ligament testing, correlated poorly with the patient's own opinion and with the functional result. However, measurement of proprioception in the knee correlated well with both function (r = 0.84) and with patient satisfaction (r = 0.9). This study indicates that proprioception, rather than the clinical excellence of the repair, is a major factor in the outcome of anterior cruciate ligament reconstruction

Current methods of measurement of proprioceptive function depend on the ability to detect passive movement (kinaesthesia) or the awareness of joint position (joint position sense, JPS). However, reports of proprioceptive function in healthy and pathological joints are quite variable, which may be due to the different methods used. We have compared the validity of several frequently used methods to quantify proprioception. Thirty healthy subjects aged between 24 and 72 years underwent five established tests of proprioception. Two tests were used for the measurement of kinaesthesia (KT1 and KT2). Three tests were used for the measurement of JPS, a passive reproduction test (JPS1), a relative reproduction test (JPS2) and a visual estimation test (JPS3). There was no correlation between the tests for kinaesthesia and JPS or between the different JPS tests. There was, however, a significant correlation between the tests for kinaesthesia (r = 0.86). We conclude therefore that a subject with a given result in one test will not automatically obtain a similar result in another test for proprioception. Since they describe different functional proprioceptive attributes, proprioceptive ability cannot be inferred from independent tests of either kinaesthesia or JPS

Proprioception protects joints against injurious movements and is critical for joint stability maintenance under dynamic conditions. Knee replacement effect on proprioception in general remains elusive. This study aimed to evaluate the changes in proprioceptive performance after knee replacement; comparing Total (TKA) to Unicompartmental Knee Arthroplasty (UKA). Thirty-four patients with osteoarthritis were recruited; 15 patients underwent TKA using the AGC prosthesis and 19patients underwent UKA using the Oxford prosthesis. Both cruciate ligaments were preserved in the UKA group, while only the PCL was preserved in TKA patients. Patients’ age was similar in both groups.> Joint Position Sense (JPS) and postural sway were used as measures of proprioception. Both groups were assessed pre- and 6 months post-operatively in both limbs. JPS was measured as the error in actively and passively reproducing five randomly ordered knee flexion angles between 30 and 70°using an isokinetic dynamometer. Postural sway (area and path) was measured during single leg stance using a Balance Performance Monitor. Functional outcome was assessed using the Oxford Knee Score (OKS). Pre-operatively, no differences in JPS or sway were found between limbs in either group. No differences existed between the two groups. Post-operatively, both groups had significant improvement of JPS in the operated limb (UKA mean4.64°, SD1.44° and TKA mean5.18°, SD1.35°). No changes in JPS were seen in the control side. A significant improvement (P< 0.0001) in sway area and path was found in the UKA group only in both limbs. No significant changes in sway occurred in either limb of TKA patients. The OKS improved from 21.4 to 35.5 for TKA patients and from 23.9 to 38for UKA patients. Both UKA and TKA improve proprioception as assessed by JPS. However, UKA alone improves postural sway in both limbs. This may impart explain why UKA patients function better than TKA patients

There are various methods of measuring proprioception at the knee. Beard et al (1993) have described a delay in reflex hamstring contraction in anterior cruciate deficient knees. We have repeated their experiment and were unable to detect any significant difference in reflex hamstring contraction between the injured and uninjured legs. We discuss possible neurophysiological and biomechanical causes for the conflicting results and conclude that this method may not be a valid measure of proprioception

Introduction: ACL injury is very common among sport activities. The incidence is very high and causes an important disorder in the articular function. Some articles have been published in the recent years about the risks to suffer this injury and its consequences in the biomechanics and proprioception of the limb. Although most of them were performed in animals and cadaver specimens and a few of them were realized in patients for a dynamic evaluation. Purpose: The objective was to analyze in a longitudinal and prospective manner the changes in proprioception (muscular latency in the muscles span the knee in front of a stimulus load) occurred in the joint in 25 patients undergone an ACL injury before and after ACL reconstruction using the contra lateral knee as control. Material and Methods: The study was performed in an experimental task pre and 4 and 6 months post surgery. Clinical Tegner, Lysholm, IKDC and SF12 evaluation, motion analysis system (EliteR) and surface electromyography was performed in a synchronized manner during a single leg jump before and after a fatigue exercise of a 10 seconds repetitive single leg jump. The muscles studied were anterior rectus, lateral and medial vastus, semitendinous and femoral biceps of both knees. Statistical analysis was performed and a P value < 0.05 was considered significant. Results: Statistical significant larger latency times in each muscle but lateral vastus was observed in the affected knee in the preoperative period with improvement in the first period of 4 months postoperatively reaching measures of the normal contralateral knee without further improvement at the 6 month period. Vastus medialis was the muscle more affected before surgery and semitendinous, although improved, never reached a normal reactivity. Extensor muscles of the normal knee presented in all the periods of the study similar results but flexor muscles showed significant better propioceptive function in the 4th and 6th month post surgery. Improvement in latency time of muscle reactivity correlated with better scores in the Lysholm, IKDC and SF12 scores, although the SF12 mental status didn’t change. Conclusion: Operated knees improve their neuromuscular activity relatively fast during the first 4th months. Therefore, specifically talking about neuromuscular function normal physical activity may be can be allowed at the 4th month and that means two months before usually normal activity level is permitted. Preoperative rehabilitation would have to insist to get better medialis vastus function. The mental status didn’t correlate with the neuromuscular status that means that psychologic aspects must be treated simultaneously with the physical training. Synergy among neurological pathways would exist, appreciating improved response in flexor muscles in the contralateral knee during the rehabilitation period

To investigate whether the harvesting of Hamstring graft in ACL reconstruction results in compromised knee flexion strength and proprioception, and hence knee function?, a prospective study, approved by the local Ethics Committee, to assess the function and strength of the knee joint in patients who had ACL reconstruction done using a four-strand Hamstring graft. The control group was the contra lateral knees. 28 knee joints were studied with mean follow-up of 70.1 weeks (52–156). All operated knees received an extensive set regime of pre-and post-operative physiotherapy. Assessment tools were clinical examination, Laxometer arthrometry for measured anterior draw, Biodex dynamometry and Stabilometry for Hamstring and quadriceps strength and proprioception. The knee function was assessed using a questionnaire incorporating IKDC (International knee documentation committee) performa, Lysholm 2 score, Tegner’s activity scale and Oxford knee score. Following reconstruction (mean 70.1 weeks postop), objective assessment using Biodex dynamometer showed that mean peak flexion torque around the knee joint was 69.8 N-m and 76.2 N-m in the operated and non-operated knee respectively. There was no difference in flexion torque in both groups. Mean Flexion: Extension ratio around the knee joint was 53.9% in the operated and 53.2% in non-operated sides. Mean stability index, measured using open eye stabilometry, was 3.5 (SD 2.4) in the operated side and 3.1 (SD1.8) in the non-operated side, with no significant difference demonstrable (p< 0.05). The mean age of patients was 28.3 years (18–44). Mean IKDC score following reconstruction was 74.8 (49–100), SD18.5. Mean Tegner’s activity scale improved from 2.5(3–7) pre-operative to post-operative 5.4(3–7), p< 0.01. Mean Lysholm 2 score improved from 53.4(41–76) pre-operatively to 85(64–100) post-operatively, p< 0.01. Subjective function of the knee on a scale of 0–10 improved from pre-operative 3.1 to post-operative 7.7 (p< 0.01). Arthrometry at 25-degree flexion and 130 N force using Laxometer showed mean anterior laxity 5.3mm on the operated side and 3.1 on the healthy side (side to side difference 2.2mm). Conclusion: The function of the knee improved significantly following ACL reconstruction both objectively and subjectively. The harvesting of Hamstring as a graft neither compromises the flexion torque nor the proprioception around the knee joint

Failure of conservative treatment is the usual indication for the reconstruction of a knee with deficiency of the anterior cruciate ligament (ACL) and this depends on subjective judgement. The ability of muscles to protect the subluxing joint by reflex contraction could provide an objective measurement. We have studied 30 patients with unilateral ACL deficiency by measuring the latency of reflex hamstring contraction. We found that the mean latency in the injured leg was nearly twice that in the unaffected limb (99 ms and 53 ms respectively). There was a significant correlation between the differential latency and the frequency of 'giving way' indicating that functional instability may be due, in part, to loss of proprioception. Measures of proprioception, including reflex hamstring latency, may be useful in providing an objective assessment of the efficacy of conservative treatment and the need for surgery

Aims: Whether the harvesting of Hamstring graft for ACL reconstruction results in compromised knee flexion strength and proprioception, and hence knee function?. Methods: A prospective study, approved by the local Ethics committee, was undertaken to assess the function and strength of the knee joint in patients who had ACL reconstruction performed using a four-strand Hamstring graft. The contra lateral knee acted as control. 28 knee joints were studied with mean follow up 70.1 weeks (range 52–156). All operated knees received an extensive set regime of pre and post-operative physiotherapy. Assessment tools were Biodex dynamometry and stabilometery for hamstring and quadriceps strength and proprioception, clinical examination, Laxometer arthrometry for measured anterior draw. The knee function was assessed using a questionnaire incorporating International knee documentation committee (IKDC) proforma, Lysholm 2 score and Tegner’s activity scale. Results: Objective assessment using Biodex dynamometer pre-operatively showed that mean peak flexion torque was 67.86 N-m (SD± 24) in the involved knee and 76.1 N-m (SD± 22.2) in the healthy knee. Following reconstruction (mean 70.1 weeks post-op), mean peak flexion torque around the knee joint was 69.8 N-m (SD± 20.6) and 76.2 N-m (SD ±22.1) in the operated and non-operated knee (control) respectively. Flexion torque in the operated knee was as good as the control and not significantly different from the pre-operative levels. Mean Flexion: Extension ratio around the knee joint was 53.9% in the operated and 53.2% in non-operated sides. Mean stability index, measured using open eye stabilometery, was 3.5 (SD±2.4) on the operated and 3.1 (SD±1.8) on the non-operated side, with no significant difference demonstrable. The mean age of patients was 28.3 (range 18–44) years. Mean IKDC score following reconstruction was 74.8 (range 49–100), SD±18.5. There was significant improvement in pre and post reconstruction mean Lysholm 2 and Tegner’s activity scores (p< 0.01). Subjective function of the knee on a scale of 0–10 improved from pre-operative 3.1 to post-operative 7.7 (p< 0.01). Arthrometry at 25-degree flexion and 130 N force using Laxometer showed mean anterior laxity 5.3mm on the operated side and 3.1 on the healthy side (side to side difference 2.2mm). Conclusion: The function of the knee improved significantly following ACL reconstruction both objectively and subjectively. The harvesting of Hamstring as a graft neither compromises the flexion torque nor the proprioception around the knee joint

We performed a prospective, double-blind, randomised, clinical trial to investigate the efficacy of two regimes of rehabilitation for knees with anterior cruciate ligament deficiency (ACLD). Fifty ACLD patients were randomly allocated to one of two treatment groups: a programme of muscle strengthening (T) or a programme designed to enhance proprioception and improve hamstring contraction reflexes (P). An indirect measure of proprioception, the reflex hamstring contraction latency (RHCL), and a functional scoring system were used to record the status of the knee before and after the 12-week course of physiotherapy. Sagittal knee laxity was also measured. There was improvement in mean RHCL and in the mean functional score in both groups after treatment. The improvement in group P was significantly greater than that in group T. There was no significant change in joint laxity after treatment in either group. In both groups there was a positive correlation between improvement in RHCL and functional gain