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

Abstract

Knee joint proprioception is an important component of sensorimotor control and contributes to balance, functional stability, and coordinated lower extremity movement. This narrative review summarizes current evidence on knee proprioception in aging, knee osteoarthritis, and postoperative orthopedic rehabilitation. Age-related sensory and neuromuscular changes may impair joint position and movement perception, while proprioceptive dysfunction in knee osteoarthritis may be associated with pain, effusion, muscle inhibition, and structural joint changes. Following total knee arthroplasty, anterior cruciate ligament reconstruction, and meniscal surgery, alterations in afferent input and neuromuscular control may influence proprioceptive recovery. Clinical assessment should consider proprioception alongside balance, gait, muscle strength, and functional performance. Proprioceptive and neuromuscular exercises may support rehabilitation when they are individualized and integrated into strengthening and functional training. Wearable sensors, telerehabilitation, and other digital technologies offer opportunities for monitoring and personalization; however, limitations related to clinical validation, accessibility, patient adherence, and data privacy should be considered before widespread clinical implementation.

Key Words: Knee proprioception; Sensorimotor control; Orthopedic rehabilitation; Knee osteoarthritis; Aging; Postoperative rehabilitation; Neuromuscular training; Digital health technologies

Core Tip: Knee proprioception contributes to sensorimotor control across aging, knee osteoarthritis, and postoperative recovery. This review highlights the clinical value of interpreting proprioceptive findings alongside assessments of balance, gait, strength, and functional performance, and of integrating targeted sensorimotor training into individualized rehabilitation. Emerging digital technologies may support monitoring and personalization, but their routine use requires adequate clinical validation and consideration of accessibility, adherence, and data privacy.

INTRODUCTION

The knee joint plays a central role in essential lower extremity functions, including bearing weight, walking, negotiating stairs, squatting, maintaining balance, and changing direction. The safe and controlled performance of these functions depends on joint range of motion, muscle strength, pain control, and proprioception, which enables the perception of joint position, movement, and force and supports movement regulation and functional joint stability[1-4]. Although knee function in orthopedic rehabilitation is commonly evaluated through pain, range of motion, strength, balance, and functional performance, proprioceptive deficits may impair joint positioning, timely muscular responses, and movement safety during functional activities[2]. Therefore, knee proprioception should be considered in clinical decision-making, risk identification, and individualized rehabilitation planning[2,4].

Knee proprioception may be affected by different mechanisms with aging, in knee osteoarthritis, and during the postoperative period after orthopedic surgery. In aging, changes in sensorimotor integration, muscle function, and postural control may occur, whereas in knee osteoarthritis, pain, muscle weakness, inflammation, and structural joint changes may impair proprioceptive accuracy[5-8]. Following total knee arthroplasty (TKA), anterior cruciate ligament reconstruction (ACLR), and meniscal surgery, pain, effusion, muscle inhibition, tissue healing, and alterations in afferent sensory input may also influence sensorimotor control[9,10]. Accordingly, the assessment of knee proprioception may contribute to a better understanding of functional recovery and movement safety across different orthopedic populations.

In recent years, digital health technologies have provided new opportunities for the assessment of knee proprioception and the monitoring of rehabilitation processes. Wearable sensors, smartphone applications, telerehabilitation systems, and artificial intelligence-supported approaches may contribute to more objective and long-term monitoring of movement quality, functional performance, physical activity level, and treatment adherence[11-13].

This narrative review aims to discuss the clinical importance of knee joint proprioception in the context of aging, knee osteoarthritis, and postoperative orthopedic rehabilitation, in light of current evidence. Accordingly, the following topics will be addressed: The role of proprioception in sensorimotor control; assessment methods; age- and sex-related changes; proprioceptive alterations in knee osteoarthritis and after orthopedic surgery; rehabilitation approaches; and future digital perspectives.

Previous reviews have addressed proprioceptive dysfunction in knee osteoarthritis[5], proprioceptive training in knee osteoarthritis[8,14], proprioceptive changes following TKA[9], proprioceptive training after ACLR[10], and rehabilitation following meniscal surgery[15]. In contrast, the distinctive contribution of the present narrative review is a clinically oriented, cross-condition synthesis spanning aging, knee osteoarthritis, TKA, ACLR, and meniscal surgery. Specifically, this synthesis compares the mechanisms of sensorimotor impairment with procedure-specific rehabilitation priorities; distinguishes direct measures of joint position, movement, and force sense from associated outcomes such as balance, gait, pain, and function, while treating adherence separately as an implementation-related outcome; and evaluates the practical implications for clinically feasible assessment, progressive sensorimotor training, and the cautious use of digital monitoring technologies. By integrating these perspectives, the review aims to clarify heterogeneous findings and identify areas where direct proprioceptive evidence is insufficient in clinical settings.

This article was designed as a narrative review to provide a clinically oriented synthesis of the literature on knee joint proprioception across aging, knee osteoarthritis, and postoperative orthopedic rehabilitation. Relevant literature published up to June 30, 2026 was identified primarily through searches of PubMed, Scopus, and Web of Science. Google Scholar, DergiPark, and ResearchGate were used as complementary sources to identify potentially relevant publications and facilitate retrieval of pertinent literature. Search terms were selected according to the major topics addressed in the review and included combinations of terms related to “knee proprioception”, “joint position sense”, “kinesthesia”, “sensorimotor control”, “aging”, “older adults”, “knee osteoarthritis”, “total knee arthroplasty”, “anterior cruciate ligament reconstruction”, “meniscal surgery”, “proprioceptive training”, “neuromuscular training”, “rehabilitation”, “wearable sensors”, “telerehabilitation”, and “artificial intelligence”.

Priority was given to recent peer-reviewed systematic reviews, meta-analyses, clinical studies, and relevant clinical guidelines. Earlier publications were also considered when they provided fundamental physiological or methodological information necessary for interpreting knee proprioception and sensorimotor control. Publications were selected according to their relevance to the clinical assessment, mechanisms, rehabilitation, or technological monitoring of knee proprioception. Because this work was designed as a narrative review rather than a systematic or scoping review, study identification and selection did not follow a formal systematic review protocol, predefined inclusion and exclusion criteria were not applied, and no formal risk of bias assessment or quantitative evidence synthesis was performed. Consequently, the literature selection may be subject to bias, and relevant studies may not have been identified or included. The findings should therefore be interpreted as a descriptive and clinically oriented synthesis of the available literature rather than as a quantitative or exhaustive synthesis of the evidence.

KNEE JOINT PROPRIOCEPTION AND SENSORIMOTOR CONTROL

Proprioception is one of the fundamental sensory systems that enables the perception of the position and movement of body segments, the force applied, and the sense of effort generated during movement[1]. This system is not limited to joint position sense alone, but also includes movement sense, force sense, and an integrated sensory awareness of the spatial orientation of the extremity[1,2]. Therefore, proprioception should not be regarded as a passive sensory component of musculoskeletal function, but rather as a dynamic neurophysiological process that plays an active role in the planning, control, and correction of movement[3,4].

Proprioceptive information is primarily generated through the integration of afferent input from muscle spindles, Golgi tendon organs, joint receptors, and cutaneous receptors by the central nervous system[1,16]. Muscle spindles provide information about muscle length and changes in length, whereas Golgi tendon organs contribute to the perception of tension and force changes within the muscle-tendon unit[1,16]. Receptors located in the joint capsule and ligaments also play a supportive role in generating sensory input related to joint range of motion, mechanical loading, and joint stability[1,3]. These afferent signals are processed at spinal, subcortical, and cortical levels, contributing to appropriate muscle activation, postural regulation, and the maintenance of joint stability[3,4].

Sensorimotor control refers to the processing of sensory input by the central nervous system and the generation of appropriate motor responses[3]. In this process, proprioceptive input is integrated with visual and vestibular information to support postural control, balance, gait, and the safe execution of functional movements[3,4]. Functional joint stability is therefore not determined solely by passive anatomical structures, but is also closely related to the timing and coordination of muscle activation and the neuromuscular responses that occur during movement[3,4]. Consequently, impairments in the proprioceptive system may lead to altered muscle activation strategies, insufficient joint control, and reduced quality of functional movement[2,4] (Figure 1).

Figure 1 Knee proprioception: Possible mechanisms and associated clinical findings. ACL: Anterior cruciate ligament; ACLR: Anterior cruciate ligament reconstruction; KOA: Knee osteoarthritis; TKA: Total knee arthroplasty.

Proprioceptive information from the knee joint is important not only for local joint stability, but also for hip, knee, and ankle alignment, lower extremity kinetic chain function, and whole-body postural control[3,4]. Sensory input provided by the muscles, ligaments, joint capsule, and cutaneous structures around the knee contributes to the perception of joint position and the generation of appropriate muscular responses during movement[1,16]. Thus, knee proprioception is a key concept for understanding sensorimotor control and evaluating functional movement quality in orthopedic rehabilitation[2,4].

ASSESSMENT METHODS OF KNEE PROPRIOCEPTION

The assessment of knee proprioception is important for understanding sensorimotor function and guiding rehabilitation goals. Because proprioception is a multidimensional process, no single test can fully capture all of its components; joint position sense, movement sense, and force sense should be considered separately[2,17]. Therefore, the selected method should be interpreted in relation to the proprioceptive component measured, the reliability of the test, and its clinical applicability[18,19].

Joint position sense is commonly assessed using active or passive repositioning tests, in which the difference between the target angle and the reproduced angle reflects proprioceptive accuracy[2,18]. Absolute, relative, and variable errors may provide information about the magnitude, direction, and consistency of repositioning performance[2]. Movement sense, or kinesthesia, is often evaluated using the threshold to detection of passive motion, which reflects the ability to perceive small changes in joint movement but usually requires controlled speed, standardized conditions, and specialized equipment[17,20]. Force sense assessment, although less frequently used, may provide additional information about the ability to perceive and reproduce muscle force during functional loading[2,17].

Several tools can be used to assess knee proprioception, including isokinetic dynamometers, robotic systems, electronic goniometers, motion analysis systems, goniometers, inclinometers, and smartphone-based applications[2,17,21] (Figure 2). However, protocol-related factors such as target angle, active or passive movement, visual input, tested limb, number of trials, movement velocity, and starting position may affect the results[18,20,22]. For this reason, repeated assessments should be performed under similar conditions when monitoring change over time[2,19].

Figure 2 Conceptual overview of knee proprioception assessment. ACLR: Anterior cruciate ligament reconstruction; IKDC: International Knee Documentation Committee; JPR: Joint position reproduction; KOA: Knee osteoarthritis; KOOS: Knee Injury and Osteoarthritis Outcome Score; TTDPM: Threshold to detection of passive motion; TKA: Total knee arthroplasty.

Practical implementation depends on available equipment, staff expertise, consultation time, and patient access. Specialist centers may use robotic systems, isokinetic dynamometers, and motion-analysis equipment for instrumented assessment under controlled conditions. These resources facilitate detailed testing, but equipment availability alone does not ensure valid measurement; protocol selection and measurement properties remain important[18,19].

In routine outpatient services, a brief, standardized joint-position reproduction task may provide a more feasible assessment. The patient perceives a target knee position and then attempts to reproduce it; the angular error is recorded using an appropriate measurement tool. Smartphone-based measurement may improve accessibility, although supporting evidence from healthy participants should not be generalized automatically to postoperative or older populations[21]. Repeated assessments should use consistent positioning, target angles, visual conditions, and instructions[18]. Rehabilitation can emphasize a manageable selection of exercises linked to the patient’s deficits and goals, with supervised, group-based, or home-based delivery selected according to individual needs and available services[23].

In resource-limited settings, implementation may prioritize low-equipment exercises, such as supported weight shifting, sit-to-stand practice, and controlled stepping, following appropriate clinical assessment. Clear instructions, safe support surfaces, and planned reassessment are practical priorities. Digital delivery should depend on actual access to suitable devices, connectivity, and assistance rather than being assumed feasible for every patient[23,24]. Across settings, exercise progression should respect symptoms, fall risk, and postoperative loading restrictions. Accessible assessment methods can support clinical monitoring, but should not be assumed equivalent to laboratory measurements, and balance or functional tests should not be presented as direct measures of proprioception[2,17,18].

In clinical practice, proprioceptive impairment may be particularly relevant in patients presenting with balance problems, movement insecurity, recurrent tripping or falls, difficulty changing direction, impaired stair control, or reduced movement quality during functional activities[5,6]. Accordingly, the choice and interpretation of proprioceptive assessments should be guided by the specific sensory component being examined and the patient’s broader functional presentation. In intervention studies, joint-position reproduction, threshold-to-detection-of-passive-motion, and force-reproduction tasks assess specific proprioceptive components directly, whereas balance, gait, pain, and functional measures provide complementary, indirect clinical outcomes. Adherence reflects treatment exposure and implementation rather than proprioceptive acuity. Improvements in these other outcomes should not be presented as direct sensory recovery without corresponding proprioceptive testing[2,17].

AGE- AND SEX-RELATED DIFFERENCES IN KNEE PROPRIOCEPTION

Aging may affect knee joint proprioception through changes in both peripheral and central components of the proprioceptive system. Age-related alterations in muscle spindles, joint receptors, tendon structures, afferent neural pathways, muscle strength, reaction time, and sensory integration may reduce proprioceptive accuracy and impair postural control, gait safety, and functional movement performance[6,7,25,26].

At the peripheral level, aging is associated with structural and functional alterations in muscle spindles and their afferent pathways. Human postmortem studies have demonstrated age-related changes in muscle spindle morphology, including increased capsular thickness and reductions in intrafusal fiber number, while age-related loss of large-diameter peripheral nerve fibers may reduce the availability and fidelity of Ia afferent input[6]. In addition, slower conduction velocity of proprioceptive afferents and age-related alterations in spinal transmission may increase the latency and reduce the efficiency of reflex responses. These peripheral changes occur alongside alterations in central processing. At the spinal and supraspinal levels, aging may affect the integration and processing of proprioceptive signals, including cortical processing of proprioceptive input, thereby reducing the sensitivity, acuity, and integration of proprioceptive information[6]. Collectively, these changes provide a neurophysiological explanation for why older adults may show less accurate joint position and movement perception and a reduced ability to use proprioceptive information efficiently for postural control[6].

Age-related decline in knee joint position sense has been reported in older adults, and reduced proprioceptive input may contribute to increased postural sway, delayed balance responses, and greater difficulty maintaining movement safety during daily activities[6,7,25].

Findings regarding sex-related differences in knee proprioception are heterogeneous. Some studies report no clear differences between women and men, whereas others suggest that sex may influence proprioceptive performance depending on sample characteristics, physical activity level, limb dominance, target angle, testing position, and measurement method[27-29]. Sex-related differences in the distribution of non-contact anterior cruciate ligament (ACL) injuries between the preferred kicking and supporting legs have been reported in soccer players[30]. However, these findings do not directly establish sex-related differences in knee proprioceptive acuity.

Kürklü et al[27] evaluated knee joint position sense at 15°, 30°, 45°, and 60° and knee movement sense at 60° and 90° in healthy adults grouped according to age and sex. Their findings showed higher position errors particularly in individuals aged 45 years and older, while movement sense differed by age but not by sex. Overall, age appears to be a clinically relevant factor in knee proprioception, whereas sex-related differences should be interpreted according to the proprioceptive component measured and the testing protocol used[27,29].

KNEE PROPRIOCEPTION IN KNEE OSTEOARTHRITIS

Knee osteoarthritis is a common degenerative joint disease characterized by pain, joint stiffness, reduced muscle strength, balance deficits, and functional limitations[31,32]. Although conventional clinical assessment often focuses on pain, joint range of motion, muscle strength, and radiological findings, proprioceptive function may also be substantially affected in individuals with knee osteoarthritis[5,8]. Therefore, knee osteoarthritis should not be considered only as a structural joint disorder or a pain-related condition, but also as a multidimensional clinical condition that affects sensorimotor control[5,14].

Proprioceptive impairment in knee osteoarthritis may result from the interaction of several mechanisms. Degeneration of articular cartilage, mechanical changes in the capsule and ligamentous structures, synovial inflammation, pain, effusion, and muscle inhibition may alter the quality of afferent information originating from the periarticular tissues[5,8]. In particular, pain and effusion may reduce quadriceps activation, impair neuromuscular control around the knee, and make accurate perception of joint position more difficult[5]. This indicates that proprioceptive loss extends beyond peripheral receptor damage and represents a complex process associated with pain, muscle function, and central sensorimotor integration[2,5].

Proprioceptive impairment may have clinically meaningful consequences for activities of daily living in individuals with knee osteoarthritis. Reduced joint position sense may make it more difficult for patients to accurately perceive the position of the knee during loading and movement, thereby compromising movement safety during activities such as stair negotiation, rising from a chair, walking, squatting, and changing direction[5,8]. Proprioceptive deficits may also be associated with a feeling of knee instability, balance problems, and compensatory movement strategies[5,33]. Therefore, proprioception in knee osteoarthritis should be considered not merely as an outcome affected by the disease, but as a clinical factor that interacts with pain, function, and movement quality[5,14].

Because proprioceptive impairment may contribute to balance and functional limitations in knee osteoarthritis, interventions targeting proprioceptive and neuromuscular function have received increasing clinical attention; the evidence supporting these rehabilitation approaches is discussed in “REHABILITATION APPROACHES TARGETING KNEE PROPRIOCEPTION”.

Balance function is a clinically relevant outcome closely related to proprioception in knee osteoarthritis. Reduced proprioceptive input may make it more difficult to maintain postural control, thereby negatively affecting static and dynamic balance performance[5,33]. Recent meta-analytic findings indicate that structured exercise approaches may improve balance function in individuals with knee osteoarthritis and that multicomponent exercise programs may be particularly effective in this regard[33]. These findings support the consideration of proprioception in knee osteoarthritis not only as a sensory measure, but also as a rehabilitation target associated with balance and functional performance[5,33]. Nevertheless, improved balance performance alone does not indicate improved joint-position or movement sense unless these are assessed directly.

Clinical guidelines for the management of knee osteoarthritis recognize exercise as a core component of treatment[31,32,34]. Exercise approaches may include strengthening, aerobic exercise, neuromuscular training, balance exercises, aquatic exercise, and individually tailored therapeutic exercise programs[23,31]. Although these recommendations are not always presented directly under the heading of proprioception, approaches targeting neuromuscular control, balance, and functional movement quality support the clinical relevance of the proprioceptive system in knee osteoarthritis[23,31].

Taken together, these findings indicate that proprioceptive dysfunction in knee osteoarthritis is clinically relevant because it interacts with pain, neuromuscular control, balance, and functional performance rather than representing an isolated sensory impairment[5,33].

KNEE PROPRIOCEPTION AFTER ORTHOPEDIC SURGERY

Assessing proprioceptive function after orthopedic knee surgeries is important for understanding functional recovery. Although TKA, ACLR, and meniscal surgeries involve different mechanical and biological processes, postoperative pain, effusion, muscle inhibition, tissue healing, fear of movement, and alterations in afferent sensory input may affect sensorimotor control[4,9].

Proprioception after TKA

TKA is a widely performed surgical procedure used to reduce pain and improve function in advanced knee osteoarthritis[9]. However, preoperative pain, muscle weakness, joint stiffness, effusion, and sensorimotor control deficits in this patient population may influence the course of postoperative proprioceptive recovery[5,9]. Therefore, proprioceptive performance after TKA should not be interpreted solely as a direct consequence of the surgical procedure, but should also be considered in relation to the preoperative osteoarthritic process and postoperative neuromuscular adaptations[9].

After TKA, replacement of the articular surfaces, involvement of the capsule and ligamentous structures, preservation or sacrifice of the posterior cruciate ligament in some cases, and postoperative pain and swelling may alter the quality of afferent information originating from the knee joint[9]. Nevertheless, reduced pain and improved joint mechanics may have beneficial effects on balance and movement safety in some patients[9,35]. Therefore, the effect of TKA on proprioception is not uniform across all patients and may vary depending on surgical technique, prosthesis design, preoperative functional status, muscle strength, and the rehabilitation process[9,36].

The heterogeneity of proprioceptive outcomes after TKA is likely multifactorial. Preoperative proprioceptive and sensorimotor status may influence postoperative findings because patients enter surgery with different degrees of osteoarthritis-related proprioceptive impairment, lower-limb deformity, joint laxity, and neuromuscular dysfunction[9,37]. Surgical factors may also contribute, although their effects should not be overstated. Preservation of the posterior cruciate ligament theoretically retains a source of mechanoreceptive input; however, current evidence does not demonstrate a consistent proprioceptive advantage of posterior-cruciate-retaining over posterior-cruciate-substituting designs, suggesting that prosthesis design alone does not explain postoperative differences[37,38]. Surgical approach and the extent of periarticular tissue disruption may also influence postoperative sensorimotor recovery, but their independent effects on proprioception remain insufficiently established[38]. Pain relief after TKA may facilitate movement and functional performance by reducing pain-related inhibition, whereas residual pain, stiffness, and muscle weakness may continue to compromise neuromuscular control[9,38]. Postoperative rehabilitation is another potential source of heterogeneity because recovery occurs alongside progressive restoration of strength, balance, mobility, and sensorimotor function; however, the specific contribution of rehabilitation to measured proprioceptive recovery remains variable across studies[36,38,39]. Variability in rehabilitation adherence and treatment exposure should also be considered as potential contributors to between-patient differences in postoperative sensorimotor recovery, although their specific effects on proprioceptive outcomes after TKA remain insufficiently established. Therefore, some patients may experience improved functional stability and movement confidence as pain decreases and mechanical function recovers, while others may retain proprioceptive deficits because of persistent preoperative sensorimotor impairment, residual symptoms, altered afferent input, weakness, or incomplete functional recovery[9,38]. These interacting patient-, surgical-, and rehabilitation-related factors may help explain why proprioception can improve at the group level after TKA while clinically relevant deficits persist in some individuals[9,38].

Proprioception after ACL injury and reconstruction

The ACL contributes to both mechanical knee stability and proprioceptive function because of the mechanoreceptors it contains[40,41]. Ruffini endings, Pacinian corpuscles, and Golgi-like receptors provide afferent information to the central nervous system regarding knee joint position, movement, and tension[40]. Therefore, ACL injury may result in mechanical instability as well as a sensorimotor control deficit affecting joint position sense, movement sense, dynamic stability, and neuromuscular responses[22,41,42].

Although ACLR aims to restore mechanical stability, recovery of proprioceptive function is a more complex process. Biological integration of the graft, potential reinnervation, central nervous system adaptations, muscle strength, and the quality of rehabilitation may all influence proprioceptive recovery[40,41]. Recent meta-analyses have reported that proprioceptive training may have beneficial effects on knee proprioception and functional performance after ACLR[10,43]. Accordingly, joint-position tests should be reported as direct sensory outcomes, whereas hop and balance tests should be presented separately as functional outcomes[10,22,43].

Proprioception after meniscal injuries and surgeries

The menisci contribute to load transmission, shock absorption, joint congruency, and stability in the knee joint[44]. In addition, mechanoreceptors located within meniscal tissue contribute to proprioceptive control of the knee joint[44]. Therefore, meniscal injuries and meniscal surgical procedures may affect not only mechanical load distribution, but also the sensory feedback mechanisms of the knee joint[15,44].

Proprioceptive outcomes after meniscal surgery may vary depending on the surgical technique used. Although partial meniscectomy may provide short-term symptomatic relief, reduction of meniscal tissue may be disadvantageous in terms of joint biomechanics and sensory feedback[44]. Meniscal repair, in appropriate cases, may help preserve mechanical and proprioceptive function by maintaining meniscal tissue[44]. Başar et al[44] reported that, in patients with ACL injury accompanied by meniscal tear, meniscal repair may be associated with better knee function and proprioception compared with partial meniscectomy. Based on very low-certainty evidence, adding proprioceptive training to conventional rehabilitation may improve knee proprioception and functional recovery after arthroscopic partial meniscectomy[15].

Procedure-specific mechanisms and rehabilitation implications

Proprioceptive recovery after knee surgery should be interpreted according to the anatomical structures affected and the sensorimotor demands of each procedure. Following TKA, proprioceptive recovery occurs in the context of pre-existing osteoarthritic sensorimotor impairment and substantial alterations of joint anatomy and biomechanics. Resection or modification of articular and periarticular tissues, changes in ligamentous input, prosthesis design, postoperative pain and effusion, and subsequent neuromuscular adaptation may all influence afferent information and functional knee control[9]. At the same time, pain reduction and improved mechanical alignment may facilitate functional recovery in some patients, which may partly explain the heterogeneous proprioceptive outcomes reported after TKA[9,35]. Postoperative biomechanics may also vary according to factors such as patellofemoral mechanics. Bi et al[45] demonstrated associations between postoperative radiological indices of patellar height and clinical outcomes, including knee function, range of motion, patient-reported joint awareness, and episodes of giving way, supporting the broader relevance of postoperative biomechanical characteristics when interpreting functional recovery after TKA. Following TKA, progressive balance and sensorimotor exercises may be considered alongside range-of-motion, strengthening, gait, and functional mobility training, based on the patient’s deficits and goals. Their additional benefits over conventional rehabilitation remain uncertain, and progression should be adapted to pain, swelling, movement quality, and functional status[36,39,46].

In contrast, ACLR addresses a structure that has both mechanical and sensory functions. ACL injury disrupts mechanoreceptor-derived afferent input, while reconstruction restores mechanical stability without necessarily producing immediate normalization of sensorimotor function[40-42]. Proprioceptive recovery may therefore depend on graft integration, possible reinnervation, neuromuscular adaptation, and central neuroplastic processes in addition to mechanical stability[40,41]. Depending on the patient’s impairments, recovery stage, and activity goals, rehabilitation may include joint-position and movement-control tasks, dynamic balance, perturbation-based training, landing and directional-control exercises, and progressively sport-specific sensorimotor demands when appropriate[10,43]. Functional progression should be based on adequate stability, movement quality, strength, and task-specific control, rather than on postoperative time alone.

Meniscal surgery involves a different mechanism: Preservation of native meniscal tissue may influence both knee biomechanics and sensory feedback. The menisci contain mechanoreceptors and contribute to load transmission, joint congruency, and stability; therefore, tissue loss after partial meniscectomy may alter both mechanical and proprioceptive contributions of the meniscus[44]. In patients undergoing ACLR with concomitant meniscal treatment, Başar et al[44] reported better functional and proprioceptive outcomes following meniscal repair than partial meniscectomy, supporting tissue preservation when clinically appropriate. Rehabilitation after meniscal surgery should therefore respect procedure-specific tissue-healing and loading restrictions while progressively restoring weight transfer, balance, joint-position control, lower-extremity strength, and task-specific movement. The rate of progression should be individualized according to whether the procedure involved meniscal repair or tissue resection, concomitant procedures, and clinical recovery.

Taken together, these procedures should not be expected to follow the same proprioceptive recovery pathway. TKA involves adaptation to major changes in joint structure and biomechanics superimposed on pre-existing osteoarthritic sensorimotor deficits; ACLR involves restoration of mechanical stability alongside recovery and central compensation for disrupted ligamentous afferent input; meniscal procedures differ according to whether native tissue contributing to mechanical and sensory function is preserved or lost. These mechanistic distinctions provide a rationale for tailoring rehabilitation to the surgical procedure, tissue-healing constraints, and individual impairments. However, this rationale should not be interpreted as evidence that a particular proprioceptive rehabilitation protocol is superior for a specific procedure, because comparative evidence remains limited[10,36,39,43,46] (Figure 3).

Figure 3 Conceptual comparison of sensorimotor considerations after knee surgery. ACL: Anterior cruciate ligament; ACLR: Anterior cruciate ligament reconstruction; TKA: Total knee arthroplasty.

REHABILITATION APPROACHES TARGETING KNEE PROPRIOCEPTION

Knee proprioception should be considered a modifiable sensorimotor target in orthopedic rehabilitation. Rehabilitation aims to improve joint position perception, timely neuromuscular responses, dynamic knee control, and movement safety during functional tasks[2,4]. Because proprioceptive deficits arise from different mechanisms across knee osteoarthritis, ligament injury, aging, and postoperative recovery, interventions should be individualized and integrated with strengthening, balance, and functional training rather than used as isolated exercises[8,10,14]. The main rehabilitation approaches targeting knee proprioception are summarized in Table 1. Table 2 summarizes the evidence addressing major intervention questions, including the populations studied, comparator treatments, assessed outcomes, assessment timing, principal findings, and limitations.

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.

In clinical practice, proprioceptive rehabilitation should be individualized according to the underlying condition, stage of recovery, symptom response, and functional demands rather than applied as a uniform exercise protocol. Early proprioceptive exercises may emphasize controlled joint-position reproduction, weight shifting, and stable weight-bearing tasks. As control improves, the sensorimotor demand can be increased through progression from bilateral to unilateral tasks, from stable to more challenging support conditions, and from relatively predictable static tasks to dynamic and multidirectional activities. Manipulation of visual input and the addition of concurrent functional tasks can provide further sensory and motor challenges. Balance and proprioceptive exercises should be integrated with strengthening and motor-control training rather than used as substitutes for these components. Progression to more demanding functional activities should depend on adequate symptom control, strength, postural stability, and movement quality. Because substantial heterogeneity exists in the frequency, duration, and intensity of proprioceptive interventions reported in the literature, these parameters should be individualized rather than interpreted as a single standardized dosage applicable across knee conditions[8,10]. Perturbation-based training is a specialized form of neuromuscular training designed to challenge dynamic knee stability through controlled disturbances of the support surface. Initiation of postoperative ACLR rehabilitation should be based on both time and functional readiness. The published ACL-SPORTS protocol specified that athletes were eligible for enrollment at least 12 weeks after ACLR if they demonstrated a quadriceps strength index of ≥ 80% and minimal knee joint effusion[47]. The program consisted of 10 supervised sessions performed twice weekly over approximately 5 weeks, with perturbation training added to strengthening, agility, plyometric, and secondary-prevention exercises[47]. Perturbations were performed on unstable surfaces and progressed according to the athlete’s response rather than session number. Progression included advancement from bilateral to unilateral support, increases in perturbation speed, magnitude, and direction, and the addition of rotational, functional, and sport-specific challenges[47]. Symptom response should also guide progression; published ACL-SPORTS protocols used soreness and effusion guidelines to determine whether training could be progressed or required modification[47]. These parameters provide a clinically applicable example of perturbation-based rehabilitation after ACLR; however, they should not be interpreted as a universally established protocol for all postoperative knee conditions. In clinical practice, perturbation exercises should be modified, regressed, or temporarily discontinued if they provoke increased pain or effusion, recurrent instability, deterioration in movement quality, or an inability to maintain safe postural control.

Balance and neuromuscular training are central components. Static and dynamic balance tasks, weight shifting, single-leg stance, step-up and squat-based activities, landing control, and direction-changing exercises may improve postural control, lower extremity alignment, muscle activation timing, and dynamic knee stability[4,33,46]. Perturbation-based tasks can be added in advanced phases, particularly during return-to-sport rehabilitation after ACLR, but should be progressed according to pain, swelling, stability, and functional capacity[10,43].

Strengthening and closed kinetic chain exercises provide the functional basis of proprioceptive rehabilitation because effective sensorimotor control requires both accurate sensory input and an appropriate motor response[2,4]. Training the quadriceps, hamstrings, hip abductors, and hip extensors through mini-squats, step-ups, sit-to-stand exercises, controlled lunges, and weight-shifting activities may support alignment, load transfer, and coordination during daily activities[8,14,31].

Evidence on proprioceptive interventions should be interpreted according to the outcomes actually measured rather than the intervention label. In knee osteoarthritis, Wang et al[8] reported improvements in directly assessed joint position sense, alongside separate analyses of pain, mobility, and self-reported function. By contrast, Lin et al[14] primarily synthesized Timed Up and Go (TUG) performance, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) outcomes, and pain. These clinically relevant outcomes do not, by themselves, establish improved proprioceptive acuity. Thus, the two reviews should not be interpreted as offering equivalent evidence for direct sensory recovery.

Following ACLR, Huang et al[43] found benefits for passive joint position sense, while active joint position sense and kinesthesia did not show clear improvements; hop-test and patient-reported functional outcomes were assessed separately. Chen et al[10] also reported a beneficial pooled effect for an outcome labeled knee proprioception, but the contributing measures included both joint-position errors and balance or stability indices. Accordingly, this pooled result should not be treated exclusively as a direct estimate of proprioceptive acuity. Differences in measurement selection and outcome definitions limit comparability across syntheses.

After joint arthroplasty, systematic reviews have predominantly emphasized balance and clinical function[39,46]. Domínguez-Navarro et al[46] reported improvements in balance and self-reported function after total knee replacement, whereas Qu et al[39] found no consistent superiority over conventional training for most outcomes in a synthesis including both hip and knee replacement. Neither finding alone establishes recovery of knee joint position or movement sense. Balance and proprioceptive exercises may therefore complement strengthening, gait, and functional training, but claims of direct proprioceptive benefit require studies using appropriate sensory measurements.

Exercise progression should be gradual and based on clinical response. Early rehabilitation may begin with stable, double-limb, low-risk activities, whereas single-leg tasks, dynamic balance exercises, direction changes, closed kinetic chain exercises, and task-oriented activities can be added in later phases[8,10]. Pain, swelling, fatigue, movement quality, postural control, and safety should be monitored throughout the program, particularly in older adults, individuals with advanced osteoarthritis, and patients in the early postoperative period[31,39].

As rehabilitation becomes increasingly individualized, digital technologies may provide additional opportunities to monitor these clinical and functional parameters beyond conventional in-clinic assessment.

DIGITAL AND FUTURE PERSPECTIVES

Digital technologies may support the assessment of selected proprioceptive components and the monitoring of rehabilitation, but the specific outcome to be measured must be identified. Wearable sensors, smartphone applications, inertial measurement units, pressure-sensing systems, and motion-tracking technologies may allow parameters such as knee function, gait, balance, joint range of motion, physical activity level, and rehabilitation adherence to be evaluated outside the clinical setting[11,12]. A device used for a validated, standardized joint-position reproduction task may provide a direct assessment of joint position sense[18,21,22]. In contrast, routine sensor-derived gait or balance metrics and records of pain, function, or adherence are indirect clinical or implementation outcomes and cannot by themselves establish improved proprioceptive acuity[2,11,12].

Wearable sensors and smartphone-based systems offer important opportunities, particularly for the long-term monitoring of movement quality and functional performance. These tools can record data such as gait speed, step count, movement symmetry, postural sway, activity level, and exercise adherence, thereby helping clinicians evaluate short-term performance in the clinic as well as real-life movement behavior in daily living[11,12]. In postoperative processes such as TKA, these data may also support the monitoring of mobility level, functional progress, and rehabilitation adherence; however, further high-quality studies are needed to determine which sensor-derived parameters can directly guide clinical decision-making[11,12].

Telerehabilitation is an important digital health approach that may support exercise continuity in conditions requiring long-term follow-up, such as knee osteoarthritis and postoperative orthopedic rehabilitation. Exercise-based telerehabilitation may allow patients to continue therapeutic exercises at home, be monitored remotely by clinicians, and have their programs updated when needed[48,49]. Because proprioceptive and neuromuscular exercises require proper movement quality, appropriate progression, and safe performance, visual feedback, video-based guidance, and sensor-supported monitoring systems may become particularly important in remote applications[12,48]. Nevertheless, because of potential risks such as loss of balance, increased pain, or incorrect exercise performance, telerehabilitation programs should be supported by patient safety considerations, appropriate patient selection, and clinical assessment[48,49].

Artificial intelligence-supported systems represent an emerging area that may contribute to the development of personalized care models in knee osteoarthritis and orthopedic rehabilitation. Artificial intelligence algorithms may use clinical data, imaging findings, pain and function scores, physical activity data, and sensor-based measurements to help predict the patient’s risk profile, recovery trajectory, or rehabilitation needs[13,50]. Large language models and artificial intelligence-supported decision-support systems are also being discussed as supportive tools for patient education, exercise adherence, clinical follow-up, and rehabilitation program development[13,51]. However, these systems should not replace clinical reasoning; rather, they should be regarded as auxiliary tools that are transparent, auditable, and used under clinician supervision[13,50].

Challenges and limitations

Despite the growing potential of wearable sensors, smartphone applications, telerehabilitation platforms, and artificial intelligence to support knee rehabilitation, several challenges currently limit their widespread implementation in routine clinical practice. Accessibility is an important consideration, as technology-assisted rehabilitation may depend on access to appropriate devices, reliable internet or telecommunications infrastructure, and the ability to use digital platforms effectively. In telerehabilitation for knee osteoarthritis, reported implementation barriers have included internet access, availability of telecommunication devices, and adequate remote monitoring of exercise programs[24]. These factors may be particularly relevant when digital rehabilitation is delivered primarily in the home environment.

Clinical validation and standardization remain additional concerns. A systematic review of wearable movement sensors used in knee rehabilitation identified only six studies addressing the reliability of the sensors after knee surgery and reported substantial methodological heterogeneity in sensor technology, analysis software, sensor placement, testing protocols, and measured outcomes. The authors concluded that further high-quality studies in clinical settings are required before transparent recommendations for routine clinical use can be established[52]. More recent evidence in TKA also demonstrates considerable diversity in the applications of smartphone and wearable technologies, including monitoring, rehabilitation, compliance, and remote care, despite encouraging findings regarding their clinical utility[11]. Therefore, promising technical performance should not automatically be interpreted as evidence of established clinical effectiveness across devices, populations, and rehabilitation settings.

Patient adherence and usability are equally important for real-world implementation. Evidence from knee osteoarthritis indicates that adherence to wearable technology, user experience, instructions for device use, and feasibility barriers are frequently underreported, limiting understanding of how consistently these technologies can be used outside controlled research environments[53]. In postoperative TKA rehabilitation, smartphone applications and wearable devices have shown potential to improve patient engagement and adherence; however, further research has been recommended regarding long-term outcomes, implementation economics, and optimization of compliance and device accuracy[11]. Thus, the effectiveness of digital rehabilitation may depend on technological performance, sustained patient engagement, and the practical feasibility of using the technology over time.

Data privacy and security should also be considered when wearable sensors and digital rehabilitation platforms collect, store, or transmit health- and movement-related information. Digital rehabilitation systems may generate substantial volumes of patient-specific data, making secure data handling and appropriate governance important considerations for clinical implementation[12]. These concerns become increasingly relevant when remotely collected data are integrated with cloud-based platforms or artificial intelligence–supported decision systems. Consequently, future implementation should consider technical performance together with secure data management and responsible use of patient-generated health information[12].

Overall, the successful translation of digital technologies into routine knee rehabilitation will require attention to accessibility; clinical validation and standardization; patient adherence and usability; and data privacy and security. Future studies should therefore move beyond technical feasibility and evaluate these technologies under real-world clinical conditions, with particular attention to sustained engagement, generalizability, and clinically meaningful outcomes[11,12,52,53].

Future research priorities

Future research should address several clinically relevant gaps in the evidence on knee proprioception. First, standardized assessment protocols and age- and disease-specific reference values for knee proprioception should be established to improve interpretation of proprioceptive deficits in healthy aging, knee osteoarthritis, and postoperative populations. Second, adequately powered head-to-head randomized controlled trials are needed to determine whether different surgical techniques, including approaches that differ in ligament or tissue preservation, result in clinically meaningful differences in proprioceptive recovery. Third, wearable sensor-based home monitoring protocols should undergo prospective clinical validation to determine their measurement reliability, their ability to detect meaningful changes in sensorimotor function, their effects on rehabilitation outcomes and on patient adherence, and their cost-effectiveness compared with conventional follow-up. Addressing these priorities would facilitate the transition from heterogeneous research findings toward standardized assessments, procedure-specific rehabilitation, and clinically validated digital monitoring of knee proprioception.

DISCUSSION

The central issue emerging from this review is the distinction between the clinical relevance of knee proprioception and the certainty of the evidence supporting specific interventions. Proprioceptive impairment may accompany aging, knee osteoarthritis, and postoperative recovery, but identifying this impairment does not establish which treatment will provide additional benefit. Similarly, improvements in balance or functional performance do not necessarily demonstrate restoration of proprioceptive acuity. Clinical interpretation therefore requires attention to what was measured, what treatment was compared, and which patient population was studied[2,8,20,22].

Conflicting findings are particularly apparent after TKA. Xue et al[9] identified pooled improvements in joint position sense and static balance after surgery, whereas Bragonzoni et al[38] found no consistent direction of change across the available literature. These findings suggest that postoperative improvement and persistent impairment are not mutually exclusive: Average gains may coexist with residual deficits in individual patients. Evidence concerning rehabilitation is similarly mixed. Domínguez-Navarro et al[46] reported benefits for balance and self-reported function after knee replacement, while Qu et al[39] found no advantage over conventional training for most outcomes in older adults undergoing hip or knee arthroplasty. Differences in populations, comparator treatments, outcome selection, and follow-up may contribute to these discrepancies. The inclusion of hip- and knee-arthroplasty populations also warrants caution in applying pooled findings specifically to TKA.

The comparator is equally important when interpreting exercise effects. In knee osteoarthritis, benefits over no intervention do not necessarily imply superiority over another active exercise program[8]. Lin et al[14] reported improvements in TUG performance and WOMAC total scores, but not in the individual WOMAC pain, stiffness, or function subscales, illustrating the outcome-dependent nature of the findings. After ACLR, Huang et al[43] identified benefits for passive joint position sense without corresponding significant improvements in active joint position sense. Following partial meniscectomy, potential benefits were supported by very low-certainty evidence[15]. Together, these findings favour a selective, outcome-specific interpretation rather than a general conclusion that proprioceptive training improves all aspects of knee recovery.

Measurement limitations further complicate this interpretation. Joint position reproduction and passive movement detection assess different sensory capacities, whereas balance and functional tasks also depend on strength, pain, attention, and other sensory inputs. Consequently, disagreement between tests may reflect differences in the constructs assessed rather than contradictory treatment effects[2,17]. Reviews of knee proprioception testing have also identified limitations in reliability, validity, measurement error, and responsiveness[18,20,22]. A statistically significant change should therefore be considered alongside measurement uncertainty and functional relevance, rather than automatically interpreted as meaningful sensory recovery.

These considerations support individualized assessment and rehabilitation while limiting claims of procedure-specific superiority. Anatomical and tissue-healing differences provide a rationale for adapting exercise selection and progression, but comparative evidence remains limited regarding which proprioceptive rehabilitation approach offers the greatest additional benefit within each surgical population. This interpretation must also account for the limitations of the present narrative review, including potential selection bias, the absence of a formal risk-of-bias assessment, and the lack of quantitative synthesis. The clinical value of the available evidence lies in informing patient-specific decisions while preserving uncertainty about the mechanisms, magnitude, and additional benefits of treatment.

CONCLUSION

Knee joint proprioception is an important sensorimotor component of orthopedic rehabilitation that contributes to movement safety, balance, functional stability, and activities of daily living. Across aging, in knee osteoarthritis, and during postoperative recovery, proprioceptive impairment should be interpreted in relation to the patient’s ability to perceive, control, and safely perform movement, rather than as an isolated sensory deficit. Accordingly, knee proprioception represents a clinically relevant rehabilitation target that should be considered alongside pain, joint range of motion, muscle strength, balance, and functional performance[2,4]. These considerations support the integration of proprioceptive assessment and targeted sensorimotor rehabilitation into individualized orthopedic care.