614 THE JOURNAL OF BONE AND JOINT SURGERY K. R. Grob, MD M. S. Kuster, MD, PD, PhD Department of Orthopaedic Surgery, Kantonsspital, CH 9001 St Gallen, Switzerland. S. A. Higgins D. G. Lloyd, PhD Department of Human Movement and Exercise Science, The University of Western Australia, Perth, Australia. H. Yata Department of Human Sciences, Wako University, Tokyo, Japan. Correspondence should be sent to Dr K. R. Grob. ©2002 British Editorial Society of Bone and Joint Surgery 0301-620X/02/411241 $2.00 Lack of correlation between different measurements of proprioception in the knee K. R. Grob, M. S. Kuster, S. A. Higgins, D. G. Lloyd, H. Yata From Kantonsspital, St. Gallen, Switzerland C urrent 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. J Bone Joint Surg [Br] 2002;84-B:614-8. Received 6 April 2000; Accepted after revision 4 April 2001 Proprioception is the sum of kinaesthesia and joint position sense. Kinaesthesia is defined as the awareness of joint movement and is dynamic. Joint position sense (JPS) is restricted to the awareness of the position of a joint in space and is a static phenomenon. Proprioception can also be defined as the cumulative neural input to the central nerv- ous system from specialised nerve endings called mechano- receptors. These are located in the joint capsules, ligaments, muscles, tendons, and skin. Some of these recep- tors (for example, Pacinian corpuscles) are stimulated in the initial and terminal stages of the range of movement of joints as well as during rapid changes in velocity and direction (kinaesthesia). On the other hand the Ruffini end organ-like receptors and Golgi tendon organ-like receptors have been associated with a response to the relative posi- tion of muscles and joints (joint position sense). However, in the literature the terms kinaesthesia, joint position sense and proprioception are often used synonymously. Depending on the type of proprioceptive test used, dif- ferent results have been observed in the same subject groups. For example, Barrett 2 showed that JPS was sig- nificantly improved by reconstruction of the cruciate liga- ments. MacDonald et al, 3 however, found that in patients with reconstruction of the anterior cruciate ligament (ACL) proprioception did not improve when measured by a kin- aesthesia test. Barrett, Cobb and Bentley 4 found an improvement in JPS after total knee replacement while Skinner et al 5 were unable to find any such improvement using a different JPS test and a kinaesthesia-based test. In a series of studies Skinner et al 5 used the same testing device for a healthy control group and the results differed by as much as 100%. 6-9 Various authors have made definite conclusions about overall proprioception using only either JPS tests or kinaesthesia tests. 2,4,10-20 Because of these contradictory results, the question arises as to whether overall proprioceptive ability can be ascertained by a single method. Our aim therefore was to compare frequently used tests of proprioception and to evaluate the correlation between them. Patients and Methods Thirty healthy volunteers (12 women, 18 men) with a mean age of 41 years (SD 13.5; range 24 to 72) participated in the