{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,13]],"date-time":"2026-11-13T07:21:00Z","timestamp":1794554460093,"version":"4.9.1"},"reference-count":65,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2021,5,16]],"date-time":"2021-05-16T00:00:00Z","timestamp":1621123200000},"content-version":"unspecified","delay-in-days":15,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100005350","name":"Centrum f\u00f6r idrottsforskning","doi-asserted-by":"publisher","award":["CIF P2019 0068"],"award-info":[{"award-number":["CIF P2019 0068"]}],"id":[{"id":"10.13039\/501100005350","id-type":"DOI","asserted-by":"publisher"}]},{"name":"ALF","award":["7002795"],"award-info":[{"award-number":["7002795"]}]},{"name":"ALF","award":["7003575"],"award-info":[{"award-number":["7003575"]}]},{"name":"ALF","award":["VLL-358901"],"award-info":[{"award-number":["VLL-358901"]}]},{"name":"King Gustaf V and Queen Victoria\u2019s Foundation of Freemasons 2019"},{"DOI":"10.13039\/501100004359","name":"Vetenskapsr\u00e5det","doi-asserted-by":"publisher","award":["2017-00892"],"award-info":[{"award-number":["2017-00892"]}],"id":[{"id":"10.13039\/501100004359","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2021,4,15]]},"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To systematically review and summarise the evidence for the effects of neuromuscular training compared with any other therapy (conventional training\/sham) on knee proprioception following anterior cruciate ligament (ACL) injury.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Systematic Review.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data sources<\/jats:title>\n                    <jats:p>PubMed, CINAHL, SPORTDiscus, AMED, Scopus and Physical Education Index were searched from inception to February 2020.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Eligibility criteria<\/jats:title>\n                    <jats:p>Randomised controlled trials (RCTs) and controlled clinical trials investigating the effects of neuromuscular training on knee-specific proprioception tests following a unilateral ACL injury were included.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data extraction and synthesis<\/jats:title>\n                    <jats:p>Two reviewers independently screened and extracted data and assessed risk of bias of the eligible studies using the Cochrane risk of bias 2 tool. Overall certainty in evidence was determined using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) tool.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 2706 articles retrieved, only 9 RCTs, comprising 327 individuals with an ACL reconstruction (ACLR), met the inclusion criteria. Neuromuscular training interventions varied across studies: whole body vibration therapy, Nintendo-Wii-Fit training, balance training, sport-specific exercises, backward walking, etc. Outcome measures included joint position sense (JPS; n=7), thresholds to detect passive motion (TTDPM; n=3) or quadriceps force control (QFC; n=1). Overall, between-group mean differences indicated inconsistent findings with an increase or decrease of errors associated with JPS by \u22642\u00b0, TTDPM by \u22641.5\u00b0 and QFC by \u22646\u2009Nm in the ACLR knee following neuromuscular training. Owing to serious concerns with three or more GRADE domains (risk of bias, inconsistency, indirectness or imprecision associated with the findings) for each outcome of interest across studies, the certainty of evidence was very low.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The heterogeneity of interventions, methodological limitations, inconsistency of effects (on JPS\/TTDPM\/QFC) preclude recommendation of one optimal neuromuscular training intervention for improving proprioception following ACL injury in clinical practice. There is a need for methodologically robust RCTs with homogenous populations with ACL injury (managed conservatively or with reconstruction), novel\/well-designed neuromuscular training and valid proprioception assessments, which also seem to be lacking.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PROSPERO registration number<\/jats:title>\n                    <jats:p>CRD42018107349.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2021-049226","type":"journal-article","created":{"date-parts":[[2021,5,18]],"date-time":"2021-05-18T11:51:30Z","timestamp":1621338690000},"page":"e049226","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":57,"title":["Effects of neuromuscular training on knee proprioception in individuals with anterior cruciate ligament injury: a systematic review and GRADE evidence synthesis"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5795-3812","authenticated-orcid":false,"given":"Ashokan","family":"Arumugam","sequence":"first","affiliation":[{"name":"Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, UAE"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Bj\u00f6rklund","sequence":"additional","affiliation":[{"name":"Department of Community Medicine and Rehabilitation \u2013 Physiotherapy Section, Ume\u00e5 University, Ume\u00e5, Sweden"},{"name":"Centre for Musculoskeletal Research, Department of Occupational Health Sciences and Psychology, Faculty of Health and Occupational Studies, University of G\u00e4vle, G\u00e4vle, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanna","family":"Mikko","sequence":"additional","affiliation":[{"name":"Department of Community Medicine and Rehabilitation \u2013 Physiotherapy Section, Ume\u00e5 University, Ume\u00e5, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte K","family":"H\u00e4ger","sequence":"additional","affiliation":[{"name":"Department of Community Medicine and Rehabilitation \u2013 Physiotherapy Section, Ume\u00e5 University, Ume\u00e5, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,5,18]]},"reference":[{"key":"2025121600505133000_11.5.e049226.1","doi-asserted-by":"publisher","DOI":"10.1177\/0363546509343201"},{"key":"2025121600505133000_11.5.e049226.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.physio.2013.11.002"},{"key":"2025121600505133000_11.5.e049226.3","doi-asserted-by":"publisher","DOI":"10.1177\/0363546516629944"},{"key":"2025121600505133000_11.5.e049226.4","first-page":"669","article-title":"Mechanisms of the anterior cruciate ligament injury in sports activities: a twenty-year clinical research of 1,700 athletes","volume":"9","author":"Kobayashi","year":"2010","journal-title":"J Sports Sci Med"},{"key":"2025121600505133000_11.5.e049226.5","doi-asserted-by":"crossref","first-page":"862","DOI":"10.1177\/0363546518756328","article-title":"Video analysis of anterior cruciate ligament tears in professional American football athletes","volume":"46","author":"Johnston","year":"2018","journal-title":"Am J Sports Med"},{"key":"2025121600505133000_11.5.e049226.6","doi-asserted-by":"publisher","DOI":"10.1249\/JSR.0000000000000053"},{"key":"2025121600505133000_11.5.e049226.7","doi-asserted-by":"publisher","DOI":"10.1177\/0363546514563282"},{"key":"2025121600505133000_11.5.e049226.8","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1016\/j.arthro.2015.07.010","article-title":"A morphologic and quantitative study of mechanoreceptors in the remnant stump of the human anterior cruciate ligament","volume":"32","author":"Gao","year":"2016","journal-title":"Arthroscopy"},{"key":"2025121600505133000_11.5.e049226.9","first-page":"38","article-title":"Differences among mechanoreceptors in healthy and injured anterior cruciate ligaments and their clinical importance","volume":"2","author":"Dhillon","year":"2012","journal-title":"Muscles Ligaments Tendons J"},{"key":"2025121600505133000_11.5.e049226.10","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1016\/j.math.2015.01.008","article-title":"Proprioception in musculoskeletal rehabilitation. Part 1: basic science and principles of assessment and clinical interventions","volume":"20","author":"R\u00f6ijezon","year":"2015","journal-title":"Man Ther"},{"key":"2025121600505133000_11.5.e049226.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.mehy.2006.01.063"},{"key":"2025121600505133000_11.5.e049226.12","doi-asserted-by":"publisher","DOI":"10.1136\/jisakos-2016-000087"},{"key":"2025121600505133000_11.5.e049226.13","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2018-027241","article-title":"Psychometric properties of knee proprioception tests targeting healthy individuals and those with anterior cruciate ligament injury managed with or without reconstruction: a systematic review protocol","volume":"9","author":"Arumugam","year":"2019","journal-title":"BMJ Open"},{"key":"2025121600505133000_11.5.e049226.14","doi-asserted-by":"crossref","first-page":"78","DOI":"10.3109\/21679169.2013.791718","article-title":"Deficits in single-limb stance more than 20 years after ACL injury","volume":"15","author":"Stensdotter","year":"2013","journal-title":"European Journal of Physiotherapy"},{"key":"2025121600505133000_11.5.e049226.15","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1007\/s00167-018-5166-1","article-title":"Muscle hypotrophy, not inhibition, is responsible for quadriceps weakness during rehabilitation after anterior cruciate ligament reconstruction","volume":"27","author":"Fukunaga","year":"2019","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"2025121600505133000_11.5.e049226.16","doi-asserted-by":"publisher","DOI":"10.1177\/0363546509335000"},{"key":"2025121600505133000_11.5.e049226.17","doi-asserted-by":"crossref","first-page":"180","DOI":"10.2519\/jospt.2017.7003","article-title":"Neuroplasticity associated with anterior cruciate ligament reconstruction","volume":"47","author":"Grooms","year":"2017","journal-title":"J Orthop Sports Phys Ther"},{"key":"2025121600505133000_11.5.e049226.18","doi-asserted-by":"publisher","DOI":"10.2519\/jospt.2015.5549"},{"key":"2025121600505133000_11.5.e049226.19","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1016\/j.math.2015.01.009","article-title":"Proprioception in musculoskeletal rehabilitation. Part 2: clinical assessment and intervention","volume":"20","author":"Clark","year":"2015","journal-title":"Man Ther"},{"key":"2025121600505133000_11.5.e049226.20","doi-asserted-by":"publisher","DOI":"10.2519\/jospt.2001.31.11.620"},{"key":"2025121600505133000_11.5.e049226.21","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1016\/j.physio.2015.11.001","article-title":"What is the effect of sensori-motor training on functional outcome and balance performance of patients' undergoing TKR? A systematic review","volume":"102","author":"Moutzouri","year":"2016","journal-title":"Physiotherapy"},{"key":"2025121600505133000_11.5.e049226.22","doi-asserted-by":"crossref","first-page":"531","DOI":"10.3233\/BMR-140553","article-title":"The effect of proprioception exercises on functional status in patients with anterior cruciate ligament reconstruction","volume":"28","author":"Ordahan","year":"2015","journal-title":"J Back Musculoskelet Rehabil"},{"key":"2025121600505133000_11.5.e049226.23","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1000097"},{"key":"2025121600505133000_11.5.e049226.24","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l6890"},{"key":"2025121600505133000_11.5.e049226.25","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-014-0579-0"},{"key":"2025121600505133000_11.5.e049226.26","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l4898"},{"key":"2025121600505133000_11.5.e049226.27","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39489.470347.AD"},{"key":"2025121600505133000_11.5.e049226.28","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-012-2034-2"},{"key":"2025121600505133000_11.5.e049226.29","doi-asserted-by":"publisher","DOI":"10.1136\/bjsm.2007.038554"},{"key":"2025121600505133000_11.5.e049226.30","doi-asserted-by":"publisher","DOI":"10.1177\/0363546513476473"},{"key":"2025121600505133000_11.5.e049226.31","first-page":"1","article-title":"Effects of backward walking on knee proprioception after ACL reconstruction","author":"Shen","year":"2019","journal-title":"Physiother Theory Pract"},{"key":"2025121600505133000_11.5.e049226.32","first-page":"1","article-title":"Effects on lower extremity neuromuscular control exercises on knee proprioception, muscle strength, and functional level in patients with ACL reconstruction","volume":"2019","author":"Kaya","year":"2019","journal-title":"Biomed Res Int"},{"key":"2025121600505133000_11.5.e049226.33","doi-asserted-by":"crossref","first-page":"1609","DOI":"10.1007\/s00421-018-3892-1","article-title":"Cross-education does not accelerate the rehabilitation of neuromuscular functions after ACL reconstruction: a randomized controlled clinical trial","volume":"118","author":"Zult","year":"2018","journal-title":"Eur J Appl Physiol"},{"key":"2025121600505133000_11.5.e049226.34","doi-asserted-by":"crossref","first-page":"1239","DOI":"10.1589\/jpts.25.1239","article-title":"Effects of closed kinetic chain exercises on proprioception and functional scores of the knee after anterior cruciate ligament reconstruction","volume":"25","author":"Cho","year":"2013","journal-title":"J Phys Ther Sci"},{"key":"2025121600505133000_11.5.e049226.35","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1186\/s40634-019-0174-8","article-title":"Evaluation kinaesthetic proprioceptive deficit after knee anterior cruciate ligament (ACL) reconstruction in athletes","volume":"6","author":"Laboute","year":"2019","journal-title":"J Exp Orthop"},{"key":"2025121600505133000_11.5.e049226.36","doi-asserted-by":"publisher","DOI":"10.1177\/0363546510396180"},{"key":"2025121600505133000_11.5.e049226.37","doi-asserted-by":"publisher","DOI":"10.1177\/036354658601400412"},{"key":"2025121600505133000_11.5.e049226.38","doi-asserted-by":"crossref","first-page":"233","DOI":"10.3233\/BMR-2008-21403","article-title":"Effects of a balance training protocol on knee joint proprioception after anterior cruciate ligament reconstruction","volume":"21","author":"Vathrakokilis","year":"2008","journal-title":"J Back Musculoskelet Rehabil"},{"key":"2025121600505133000_11.5.e049226.39","doi-asserted-by":"crossref","first-page":"226","DOI":"10.5958\/0973-5674.2015.00128.8","article-title":"A study on the role of proprioceptive training in non operative ACL injury rehabilitation","volume":"9","author":"Saha","year":"2015","journal-title":"Indian J Physiother Occup Ther"},{"key":"2025121600505133000_11.5.e049226.40","doi-asserted-by":"crossref","first-page":"421","DOI":"10.3233\/BMR-181237","article-title":"Isokinetic knee strength and proprioception before and after anterior cruciate ligament reconstruction: a comparison between home-based and supervised rehabilitation","volume":"32","author":"Lim","year":"2019","journal-title":"J Back Musculoskelet Rehabil"},{"key":"2025121600505133000_11.5.e049226.41","doi-asserted-by":"publisher","DOI":"10.1034\/j.1600-0838.2003.02113.x"},{"key":"2025121600505133000_11.5.e049226.42","doi-asserted-by":"crossref","first-page":"1400","DOI":"10.1249\/MSS.0000000000000249","article-title":"Effects of pivoting neuromuscular training on pivoting control and proprioception","volume":"46","author":"Lee","year":"2014","journal-title":"Med Sci Sports Exerc"},{"key":"2025121600505133000_11.5.e049226.43","doi-asserted-by":"crossref","first-page":"61","DOI":"10.3389\/fsurg.2017.00061","article-title":"Comparison of an innovative rehabilitation, combining reduced conventional rehabilitation with balneotherapy, and a conventional rehabilitation after anterior cruciate ligament reconstruction in athletes","volume":"4","author":"Peultier-Celli","year":"2017","journal-title":"Front Surg"},{"key":"2025121600505133000_11.5.e049226.44","first-page":"69","article-title":"Proprioceptive training after ACL reconstruction: standard versus stump preservation technique","volume":"40","author":"Faggal","year":"2019","journal-title":"Physiother Pract Res"},{"key":"2025121600505133000_11.5.e049226.45","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0205658","article-title":"Knee sensorimotor control following anterior cruciate ligament reconstruction: a comparison between reconstruction techniques","volume":"13","author":"San Mart\u00edn-Mohr","year":"2018","journal-title":"PLoS One"},{"key":"2025121600505133000_11.5.e049226.46","doi-asserted-by":"crossref","first-page":"160","DOI":"10.5606\/tftrd.2019.2798","article-title":"Effects of tai chi on partial anterior cruciate ligament injury: a single-blind, randomized-controlled trial","volume":"65","author":"B\u00fcy\u00fckturan","year":"2019","journal-title":"Turk J Phys Med Rehabil"},{"key":"2025121600505133000_11.5.e049226.47","doi-asserted-by":"crossref","first-page":"2084","DOI":"10.1589\/jpts.28.2084","article-title":"Immediate effects of neuromuscular joint facilitation intervention after anterior cruciate ligament reconstruction","volume":"28","author":"Wang","year":"2016","journal-title":"J Phys Ther Sci"},{"key":"2025121600505133000_11.5.e049226.48","doi-asserted-by":"publisher","DOI":"10.2522\/ptj.20060041"},{"key":"2025121600505133000_11.5.e049226.49","doi-asserted-by":"publisher","DOI":"10.1177\/0363546511422349"},{"key":"2025121600505133000_11.5.e049226.50","doi-asserted-by":"publisher","DOI":"10.1002\/art.20545"},{"key":"2025121600505133000_11.5.e049226.51","doi-asserted-by":"publisher","DOI":"10.1080\/15438620590956197"},{"key":"2025121600505133000_11.5.e049226.52","doi-asserted-by":"publisher","DOI":"10.1179\/108331903225001363"},{"key":"2025121600505133000_11.5.e049226.53","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-200012000-00020"},{"key":"2025121600505133000_11.5.e049226.54","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1016\/j.jshs.2014.10.004","article-title":"Assessing proprioception: a critical review of methods","volume":"5","author":"Han","year":"2016","journal-title":"J Sport Health Sci"},{"key":"2025121600505133000_11.5.e049226.55","doi-asserted-by":"crossref","first-page":"1218","DOI":"10.1002\/jor.20127","article-title":"An investigation into the effect of number of trials during proprioceptive testing in patients with patellofemoral pain syndrome","volume":"24","author":"Selfe","year":"2006","journal-title":"J Orthop Res"},{"key":"2025121600505133000_11.5.e049226.56","doi-asserted-by":"publisher","DOI":"10.1016\/S0079-6123(08)60413-6"},{"key":"2025121600505133000_11.5.e049226.57","doi-asserted-by":"crossref","first-page":"614","DOI":"10.1017\/S0140525X0007254X","article-title":"Does the nervous system depend on kinesthetic information to control natural limb movements?","volume":"15","author":"Gandevia","year":"1992","journal-title":"Behav Brain Sci"},{"key":"2025121600505133000_11.5.e049226.58","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1016\/j.ptsp.2015.06.005","article-title":"Reliability and measurement precision of concentric-to-isometric and eccentric-to-isometric knee active joint position sense tests in uninjured physically active adults","volume":"18","author":"Clark","year":"2016","journal-title":"Phys Ther Sport"},{"key":"2025121600505133000_11.5.e049226.59","doi-asserted-by":"crossref","first-page":"2997","DOI":"10.1519\/JSC.0b013e318243fb48","article-title":"The effects of passive warm-up vs. whole-body vibration on high-intensity performance during sprint cycle exercise","volume":"26","author":"Avelar","year":"2012","journal-title":"J Strength Cond Res"},{"key":"2025121600505133000_11.5.e049226.60","first-page":"403","article-title":"Effects of whole body vibration on spinal proprioception in healthy individuals","volume":"61","author":"Chow","year":"2018","journal-title":"Work"},{"key":"2025121600505133000_11.5.e049226.61","doi-asserted-by":"publisher","DOI":"10.1016\/j.knee.2008.11.014"},{"key":"2025121600505133000_11.5.e049226.62","doi-asserted-by":"publisher","DOI":"10.1038\/sc.2010.151"},{"key":"2025121600505133000_11.5.e049226.63","doi-asserted-by":"crossref","first-page":"170","DOI":"10.2519\/jospt.2015.4986","article-title":"Optimization of the anterior cruciate ligament injury prevention paradigm: novel feedback techniques to enhance motor learning and reduce injury risk","volume":"45","author":"Benjaminse","year":"2015","journal-title":"J Orthop Sports Phys Ther"},{"key":"2025121600505133000_11.5.e049226.64","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.81B5.9202"},{"key":"2025121600505133000_11.5.e049226.65","doi-asserted-by":"publisher","DOI":"10.1080\/09593985.2016.1194646"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2021-049226","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T08:51:13Z","timestamp":1765875073000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2021-049226"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5]]},"references-count":65,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2021,5,18]]},"published-print":{"date-parts":[[2021,5]]}},"alternative-id":["10.1136\/bmjopen-2021-049226"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2021-049226","relation":{"has-part":[{"id-type":"doi","id":"https:\/\/doi.org\/10.1136\/bmjopen-2021-049226.supp1","asserted-by":"subject"},{"id-type":"doi","id":"https:\/\/doi.org\/10.1136\/bmjopen-2021-049226.supp2","asserted-by":"subject"}]},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5]]}}}