Factors that influence the angular error in active knee angle reproduction tests: A systematic review and meta-analysis

IF 2 Q2 ORTHOPEDICS Journal of Experimental Orthopaedics Pub Date : 2024-07-24 DOI:10.1002/jeo2.12091

Juliane Wieber, Leon Müller-Rahmel, Rüdiger Reer, Robert Rein, Bjoern Braunstein

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Abstract

Purpose

The systematic review and meta-analysis investigated subject-independent test factors that influence the absolute angle error in active knee angle reproduction tests.

Methods

Five electronic databases were searched to identify relevant studies published before 20 December 2023. Studies were included that were published in either English or German and that investigated joint proprioception in the healthy knee. Included studies were also required to have participants 18–60 years old and free of lower-limb injury, neurological disorders and diseases affecting joint position sense. Risk of bias was assessed using a Cochrane risk-of-bias tool.

Results

Of the 2023 articles identified, 26 studies (1082 participants) were included in the meta-analysis. The meta-analysis showed a significant pooled standard mean difference in the absolute angular error for body orientation, direction of movement and fatigue. Active knee angle reproduction tests were found to have a lower absolute angular error when performed in the sitting position compared to the prone position (SMD = −0.56; 95% CI = −1.00 to −0.12). The absolute angular error was found to be greater in cases of knee flexion compared to knee extension (SMD = 0.71; 95% CI = 0.18–1.24). General and local muscle fatigue were found to result in a higher absolute angular error (SMD = 1.39; 95% CI = 1.04–1.75).

Conclusion

Hence, fatigue, body orientation and direction of movement influence the extent of the absolute angular error in active knee angle reproduction tests. Practitioners should be aware that the test conditions and the patient's level of fatigue can affect the results of such tests and that directly comparing results obtained using different test protocols may not be appropriate. The test protocol should be well documented and applied consistently in the clinical setting.

Level of Evidence

Level III, systematic review with meta-analysis.

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影响主动膝关节角度再现测试中角度误差的因素：系统回顾与荟萃分析。

目的：该系统综述和荟萃分析研究了影响主动膝关节角度再现测试绝对角度误差的受试者无关测试因素：检索了五个电子数据库，以确定 2023 年 12 月 20 日之前发表的相关研究。所纳入的研究均以英语或德语发表，并调查了健康膝关节的关节本体感觉。纳入的研究还要求参与者年龄在 18-60 岁之间，没有下肢损伤、神经系统疾病和影响关节位置感的疾病。使用 Cochrane 偏倚风险工具对偏倚风险进行了评估：在已确定的 2023 篇文章中，有 26 项研究（1082 名参与者）被纳入荟萃分析。荟萃分析表明，身体方位、运动方向和疲劳的绝对角度误差存在显著的集合标准平均差。研究发现，与俯卧位相比，坐位进行主动膝关节角度再现测试时，绝对角度误差较小（SMD = -0.56；95% CI = -1.00 至 -0.12）。与膝关节伸展相比，膝关节屈曲时的绝对角度误差更大（SMD = 0.71；95% CI = 0.18-1.24）。全身和局部肌肉疲劳会导致更大的绝对角度误差（SMD = 1.39；95% CI = 1.04-1.75）：因此，疲劳、身体方向和运动方向会影响主动膝关节角度再现测试中绝对角度误差的程度。从业人员应注意，测试条件和患者的疲劳程度会影响此类测试的结果，直接比较不同测试方案得出的结果可能并不合适。测试方案应妥善记录，并在临床环境中一致应用：证据等级：III级，系统综述与荟萃分析。

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