Sensorimotor control of knee stability. A review

Traditionally, the concept of joint stability considered the displacement (or subluxation) of two bones relative to each other as the measurement index, and attributed the preservation of such stability in its physiologic range to the various ligaments associated with the joint. Although the ligaments are indeed the major restraints of any joint, the significant contribution of the musculature toward joint stability had been grossly overlooked or neglected until the last 15 years. The value and importance of muscular activity in that role becomes immediately apparent if one performs even a superficial functional comparison of muscles and ligaments. Ligaments are passive viscoelastic structures, whereas muscles are dynamic viscoelastic organs. The viscoelastic effects of the ligaments are activated and applied strictly upon the geometric and kinematic configuration of the joint traversing through its range of motion according to fixed force-displacement relationships. The musculature, however, can apply passive viscoelastic effects to the joint when not active (passive tone) and variable dynamic viscoelastic effects when contracting under voluntary or reflexive control, and at any desirable point in the range of motion and in response to joint speed, external load, gravity, pain, and so forth, while executing the functional objective of the movement set by the individual. Preservation of joint stability cannot be ascribed to the ligaments alone, but should be considered as a synergistic function in which bones, joint capsules, ligaments, muscles, tendons, and sensory receptors and their spinal and cortical neural projects and connections function in harmony. The objective of this report is to first review the anatomy and physiology of the various mechanoreceptors and their neural pathways about the joint, and describe some of the current concepts of the reflex arcs elicited by such receptors, with special emphasis on biomechanical outcomes relative to stability. The role of the musculature in maintaining stability while controlling joint motion is then reviewed, with data obtained from experiments performed on humans and animals. Finally, some clinical findings from patients with anterior cruciate ligament deficiency using a brace that simulates the ligament-muscle functions is described.