Knee proprioception following anterior cruciate ligament repair and reconstruction: A systematic review and network meta-analysis

Background Proprioception dysfunction, including deficits in joint position sense (JPS) and kinesthesia, is a common sequela following anterior cruciate ligament (ACL) injury. While previous studies have compared proprioceptive outcomes in ACL-injured patients undergoing different types of surgical reconstruction or repair, their findings have been inconsistent, and a systematic review is lacking. Objective To summarize and evaluate proprioceptive deficits (in JPS and kinesthesia) across different postoperative time points and joint angles in patients undergoing different types of ACL reconstruction or repair, compared to healthy controls. Literature survey A comprehensive literature search was conducted across PubMed, Embase, the Cochrane Library, CINAHL, Scopus, Web of Science, and SPORTDiscus databases using terms related to ACL injury, reconstruction or repair, and proprioception, covering all records through November 2025. Method ology: The following information was extracted from the included articles: demographic data, sample size, selection criteria, methodology, test indicators (e.g., time points and joint angles), proprioceptive test results, and other relevant variables. Network meta-analyses were conducted to synthesize proprioceptive outcomes. Results Nineteen studies were included in the network meta-analysis. No statistically significant differences were found in intermediate-angle JPS or kinesthesia among various ACL reconstruction and repair techniques when assessed beyond six months postoperatively. Notably, our analysis revealed that hamstring tendon autografts (SMD = 1.9, 95% CI = 0.3, 3.5) and tibialis anterior allografts (SMD = 1.7, 95% CI = 0.1, 3.5) were associated with inferior small-angle position perception outcomes at the six-month follow-up compared to control. Conclusion The results indicate that, in small-angle position at six-month follow-up, ACL repair may yield similar or even better proprioceptive recovery compared to hamstring tendon autografts and tibialis anterior allografts. However, different types of reconstructive grafts or repairs do not show significant differences in proprioceptive recovery from most angles. These findings suggest that ACL repair demonstrates proprioceptive outcomes similar to those of ACL reconstruction, and different graft selections for ACL reconstruction may produce similar proprioceptive outcomes, allowing graft choice to be guided by specific clinical needs.