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.