Knee joint proprioception in aging, osteoarthritis, and postoperative orthopedic rehabilitation: Current evidence and future directions—a narrative review

Table 1 Rehabilitation approaches targeting knee proprioception

Approach	Main target	Example components	Potential clinical applications	Key clinical point
Balance training[8,31,42,43]	Postural control, weight transfer, alignment	Supported/unsupported stance; reaching; compliant surfaces; stepping	KOA; older adults; TKA; postoperative rehabilitation	Progress surface and support level; monitor fall risk, pain, fatigue, and movement quality
Neuromuscular training[4,10,30,39]	Activation timing, coordination, dynamic knee control	Squat/lunge control; step-up/down; gait, landing, and alignment retraining	KOA; ACLR; postoperative functional recovery	Prioritize movement quality; correct valgus collapse, trunk compensation, and poor alignment
Perturbation-based training[4,10,39,49]	Reactive postural response and dynamic stability	Manual perturbations; unstable support; sudden direction changes; reactive drills	Advanced ACLR rehabilitation; return-to-sport preparation	Use after adequate strength, ROM, and safety control; avoid early painful or unstable phases
Strengthening and closed kinetic chain exercise[10,28,33,35,41]	Motor response capacity and load control	Quadriceps, hamstring, and hip strengthening; mini-squat; sit-to-stand; step-up; lunge	KOA; TKA; meniscal surgery; ACLR	Dose according to pain, swelling, and postoperative restrictions; progress loading gradually
Task-oriented functional training[2,8,10,35,42]	Transfer to daily activities and sport-related tasks	Walking; stairs; sit-to-stand; turning; squatting; directional change; hopping when appropriate	Mobility limitation; balance deficit; postoperative decline; return-to-activity goals	Match tasks to real-life demands; progress complexity, speed, dual-task load, and environment
Proprioceptive-specific sensory training[2,15-18]	Joint position sense, kinesthesia, force sense	Target-angle reproduction; repositioning; slow knee movement; eyes-closed tasks; force matching	Documented proprioceptive deficits; giving-way; poor movement awareness	Standardize testing/training conditions; interpret together with balance and functional tests
Telerehabilitation and digital monitoring[11-13,44,45]	Adherence, remote feedback, movement-quality monitoring	Video-supervised exercise; smartphone applications; wearable sensors; sensor-based feedback	Home-based KOA care; TKA follow-up; long-term monitoring	Requires safety screening, digital literacy, data privacy, and clinician oversight

The listed applications and exercise components are illustrative clinical options rather than a ranking of effectiveness or evidence of procedure-specific superiority. Selection, dosage, and progression should be individualized according to assessment findings, symptoms, tissue-healing restrictions, and functional goals. ACLR: Anterior cruciate ligament reconstruction; KOA: Knee osteoarthritis; ROM: Range of motion; TKA: Total knee arthroplasty.

Table 2 Evidence summary for major intervention questions in knee proprioceptive rehabilitation

Ref.	Population and evidence source	Intervention	Comparator	Primary/main outcomes1	Follow-up/assessment timing	Principal findings	Principal limitations
Wang et al[8], 2021	Knee osteoarthritis; 24 RCTs; 1275 participants	Proprioceptive training alone or added to other exercise or physiotherapy	No intervention, non-proprioceptive exercise, or conventional physiotherapy	Primary: Pain, stiffness, physical function. Secondary: JPS, strength, mobility, ROM, balance	Reported assessment/follow-up: 2-52 weeks. Interventions: 2-16 weeks	Benefits depended on the comparator. Improvements over no intervention were broader; superiority over active exercise was less consistent. JPS improved across several comparisons	Methodological weaknesses; heterogeneous interventions; limited subgroup analyses; only two studies assessed outcomes at one year
Lin et al[14], 2025	Knee osteoarthritis; 22 RCTs	Proprioceptive, sensorimotor, or related exercise, alone or as an adjunct	Conventional physiotherapy, other exercise, or control activities	TUG; WOMAC total and subscales; NRS/VAS pain	Assessment timing varied. Most interventions lasted ≤ 8 weeks; longest intervention: 12 months. A distinct post-treatment follow-up range was not summarized	Improved TUG and WOMAC total scores; no significant pooled improvements in individual WOMAC pain, stiffness, or function subscales. Pain findings varied by measure and intervention duration	Low-certainty evidence; risk-of-bias concerns; heterogeneous programs and comparators; uncertain persistence of benefits after treatment
Chen et al[10], 2025	After ACLR; 13 RCTs; 529 participants	Proprioceptive, balance, neuromuscular, aquatic, or neurocognitive training	Conventional rehabilitation	Subjective knee function; single-leg hop performance; proprioception; ROM; knee flexion strength	Postoperative assessment timing varied; no consolidated post-treatment follow-up range was provided	Improved subjective function, hop performance, and pooled proprioceptive outcomes; no significant effects on ROM or knee flexion strength	Heterogeneous training and postoperative stages; differing proprioceptive measures, including balance/stability indices; limited evidence on sustained effects
Domínguez-Navarro et al[46], 2018	Hip or knee replacement; postoperative benefits identified after knee replacement 8 trials; 567 participants	Balance/proprioceptive training added to conventional care	Conventional care	Primary: Self-reported function and balance. Additional: Knee function, pain, falls, quality of life	Short- and mid-term assessments; timing differed across trials	Improved balance and self-reported function after knee replacement; balance benefits persisted at mid-term. Preoperative training did not improve outcomes after hip replacement	Small evidence base; differing procedures, intervention timing, and outcome measures; limited support for hip-specific and preoperative effects
Ma et al[15], 2022	After arthroscopic partial meniscectomy; 9 RCTs; 453 participants	Proprioceptive/balance/neuromuscular training, usually added to conventional rehabilitation	Conventional rehabilitation; some trials used no-intervention controls	Proprioception; knee flexor/extensor strength; knee function scores	Mainly end-of-treatment assessments after 8-12-week programs; mid- and long-term efficacy insufficiently assessed	Potential improvements in proprioception and strength; functional recovery findings require cautious interpretation	Very low-certainty evidence; small studies; inconsistent intervention initiation and control conditions; limited blinding and follow-up

¹Outcomes are identified as primary only where explicitly designated by the review; otherwise, the main assessed outcomes are listed. Intervention duration is distinguished from post-treatment follow-up. Limitations and certainty statements reflect the cited reviews; no independent evidence grading was performed for this narrative review.

RCT: Randomized controlled trial; ACLR: Anterior cruciate ligament reconstruction; JPS: Joint position sense; ROM: Range of motion; TUG: Timed Up and Go; WOMAC: Western Ontario and McMaster Universities Osteoarthritis Index; NRS: Numerical Rating Scale; VAS: Visual Analog Scale.