Research progress on proprioceptive dysfunction and rehabilitation intervention in patients with knee osteoarthritis_West China Medical Journal

Authors：

ZHANG Jie ,  ZHENG Jiejiao

Department of Rehabilitation Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai 200040, P. R. China;

Corresponding?author：

ZHENG Jiejiao, Email: zjjcss@163.com

Keywords：

Knee osteoarthritis; proprioception; sensorimotor control; neuromuscular training; rehabilitation

DOI：

10.7507/1002-0179.202606023

Video：

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Knee osteoarthritis (KOA) is characterized not only by joint structural degeneration and pain but also by proprioceptive deficits and impaired sensorimotor control, which may further compromise joint stability and functional performance. Proprioceptive dysfunction in KOA may involve multiple mechanisms, including altered peripheral sensory input, pain-related modulation, muscle weakness, impaired neuromuscular control, and altered central sensorimotor integration. However, there are still limitations to various training methods, including inconsistent assessment protocols, limited methodological quality, and insufficient evidence regarding long-term effectiveness. Future high-quality studies based on clinical phenotype stratification are needed to advance precision rehabilitation strategies for KOA. This article summarizes the assessment methods, underlying mechanisms, and advances in rehabilitation interventions for proprioceptive dysfunction in KOA from the perspective of sensorimotor control, with the aim of providing a reference for its assessment and individualized rehabilitation.

Citation： ZHANG Jie, ZHENG Jiejiao. Research progress on proprioceptive dysfunction and rehabilitation intervention in patients with knee osteoarthritis. West China Medical Journal, 2026, 41(9): 1533-1537. doi: 10.7507/1002-0179.202606023 Copy

1.	Long H, Zeng X, Liu Q, et al. Burden of osteoarthritis in China, 1990-2017: findings from the global burden of disease study 2017[J]. Lancet Rheumatol, 2020, 2(3): e164-e172.
2.	Cross M, Smith E, Hoy D, et al. The global burden of hip and knee osteoarthritis: estimates from the Global Burden of Disease 2010 study[J]. Ann Rheum Dis, 2014, 73(7): 1323-1330.
3.	Hurley MV, Scott DL, Rees J, et al. Sensorimotor changes and functional performance in patients with knee osteoarthritis[J]. Ann Rheum Dis, 1997, 56(11): 641-648.
4.	Knoop J, Steultjens MP, van der Leeden M, et al. Proprioception in knee osteoarthritis: a narrative review[J]. Osteoarthritis Cartilage, 2011, 19(4): 381-388.
5.	van der Esch M, Knoop J, van der Leeden M, et al. The association between proprioception, muscle strength, and functional performance in knee osteoarthritis patients[J]. J Orthop Sports Phys Ther, 2013, 43(4): 215-223.
6.	Sherrington CS. The integrative action of the nervous system. New Haven: Yale University Press, 1906.
7.	Riemann BL, Lephart SM. The sensorimotor system, part I: the physiologic basis of functional joint stability[J]. J Athl Train, 2002, 37(1): 71-79.
8.	Proske U, Gandevia SC. The proprioceptive senses: their roles in signaling body shape, body position and movement, and muscle force[J]. Physiol Rev, 2012, 92(4): 1651-1697.
9.	Riemann BL, Lephart SM. The sensorimotor system, part II: the role of proprioception in motor control and functional joint stability[J]. J Athl Train, 2002, 37(1): 80-84.
10.	Grigg P. Peripheral neural mechanisms in proprioception[J]. J Sport Rehabil, 1994, 3(1): 2-17.
11.	van der Esch M, Steultjens M, Harlaar J, et al. Joint proprioception, muscle strength, and functional ability in patients with osteoarthritis of the knee[J]. Arthritis Care Res, 2007, 57(5): 787-793.
12.	Barrett DS, Cobb AG, Bentley G. Joint proprioception in normal, osteoarthritic and replaced knees[J]. J Bone Joint Surg Br, 1991, 73(1): 53-56.
13.	陳瑤, 俞泳, 何成奇. 膝骨關節炎患者本體感覺、肌力及關節功能的相關性研究[J]. 四川大學學報 (醫學版), 2015, 46(6): 880-884.
14.	石靜楠, 薛雅月, 張寬, 等. 膝骨關節炎患者本體感覺特征[J]. 醫用生物力學, 2022, 37(2): 355-360.
15.	李擎, 謝連紅, 楊堅, 等. 膝骨性關節炎患者動態平衡能力變化[J]. 中國組織工程研究, 2013, 17(22): 4176-4180.
16.	中華醫學會物理醫學與康復學分會, 四川大學華西醫院. 中國膝骨關節炎康復治療指南 (2023 版)[J]. 中國循證醫學雜志, 2024, 24(1): 1-14.
17.	Mills K, Hunt MA, Ferber R. Biomechanical deviations during level walking associated with knee osteoarthritis: a systematic review and meta-analysis[J]. Arthritis Care Res (Hoboken), 2013, 65(10): 1643-1665.
18.	Rose MJ, Costello KE, Eigenbrot S, et al. Inertial measurement units and application for remote health care in hip and knee osteoarthritis: narrative review[J]. JMIR Rehabil Assist Technol, 2022, 9(2): e33521.
19.	Lee S, Neogi T, Costello KE, et al. Association of mechanical temporal summation of pain with muscle co-contraction during walking in people with knee osteoarthritis[J]. Clin Biomech (Bristol), 2023, 110: 106105.
20.	Culvenor AG, Ruhdorfer A, Juhl C, et al. Knee extensor strength and risk of structural, symptomatic, and functional decline in knee osteoarthritis: a systematic review and meta-analysis[J]. Arthritis Care Res (Hoboken), 2017, 69(5): 649-658.
21.	Hubley-Kozey CL, Deluzio KJ, Landry SC, et al. Co-activation differences in lower limb muscles between asymptomatic controls and those with varying degrees of knee osteoarthritis during walking[J]. Clin Biomech (Bristol), 2009, 24(5): 407-414.
22.	Heiden TL, Lloyd DG, Ackland TR. Knee joint kinematics, kinetics and muscle co-contraction in knee osteoarthritis patient gait[J]. Clin Biomech (Bristol), 2009, 24(10): 833-841.
23.	Zeng Z, Shan J, Zhang Y, et al. Asymmetries and relationships between muscle strength, proprioception, biomechanics, and postural stability in patients with unilateral knee osteoarthritis[J]. Front Bioeng Biotechnol, 2022, 10: 922832.
24.	Shanahan CJ, Hodges PW, Wrigley TV, et al. Organisation of the motor cortex differs between people with and without knee osteoarthritis[J]. Arthritis Res Ther, 2015, 17(1): 164.
25.	Mao C, Yang H, Dong T, et al. Thalamocortical dysconnectivity is associated with pain in patients with knee osteoarthritis[J]. Eur J Neurosci, 2024, 60(8): 5831-5848.
26.	Smith TO, King JJ, Hing CB. The effectiveness of proprioceptive-based exercise for osteoarthritis of the knee: a systematic review and meta-analysis[J]. Rheumatol Int, 2012, 32(11): 3339-3351.
27.	Wang Y, Wu Z, Chen Z, et al. Proprioceptive training for knee osteoarthritis: a systematic review and meta-analysis of randomized controlled trials[J]. Front Med (Lausanne), 2021, 8: 699921.
28.	Lin Y, Yu D, Chen X, et al. Effects of proprioceptive exercise for knee osteoarthritis: a systematic review and meta-analysis[J]. Front Rehabil Sci, 2025, 6: 1596966.
29.	Fadil A, Muaidi QI, Alayat MS, et al. The effectiveness of closed kinetic chain exercises in individuals with knee osteoarthritis: a systematic review and meta-analysis[J]. PLoS One, 2025, 20(5): e0322475.
30.	Guede-Rojas F, Benavides-Villanueva A, Salgado-González S, et al. Effect of strength training on knee proprioception in patients with knee osteoarthritis: a systematic review and meta-analysis[J]. Sports Med Health Sci, 2024, 6(2): 101-110.
31.	Bennell KL, Kyriakides M, Metcalf B, et al. Neuromuscular versus quadriceps strengthening exercise in patients with medial knee osteoarthritis and varus malalignment: a randomized controlled trial[J]. Arthritis Rheumatol, 2014, 66(4): 950-959.
32.	Fitzgerald GK, Piva SR, Gil AB, et al. Agility and perturbation training techniques in exercise therapy for reducing pain and improving function in people with knee osteoarthritis: a randomized clinical trial[J]. Phys Ther, 2011, 91(4): 452-469.
33.	白海軍. 平衡墊訓練對女性膝骨關節炎患者膝關節本體感覺影響的研究[J]. 成都體育學院學報, 2012, 38(5): 91-94.
34.	王健, 許翠平. 負荷控制下的本體感覺訓練在膝骨性關節炎中的應用[J]. 中國臨床研究, 2015, 28(12): 1621-1623.
35.	陳鶴, 李雪媚, 鄺雪輝, 等. 關刺法聯合本體感覺訓練對膝骨關節炎患者的影響[J]. 康復學報, 2024, 34(2): 140-144, 152.
36.	陳丹, 祁芳, 朱琳, 等. 電針聯合全身振動訓練對中度膝骨關節炎患者本體感覺及運動功能的影響[J]. 湖南中醫藥大學學報, 2023, 43(9): 1699-1703.
37.	Qiu CG, Chui CS, Chow SKH, et al. Effects of whole-body vibration therapy on knee osteoarthritis: a systematic review and meta-analysis of randomized controlled trials[J]. J Rehabil Med, 2022, 54: jrm00266.
38.	Wei W, Tang H, Luo Y, et al. Efficacy of virtual reality exercise in knee osteoarthritis rehabilitation: a systematic review and meta-analysis[J]. Front Physiol, 2024, 15: 1424815.
39.	陳佳意, 朱思憶, 朱林森, 等. 《中國膝骨關節炎康復治療指南 (2023 版)》解讀[J]. 華西醫學, 2025, 40(6): 853-858.
40.	Ageberg E, Roos EM. Neuromuscular exercise as treatment of degenerative knee disease[J]. Exerc Sport Sci Rev, 2015, 43(1): 14-22.
41.	鞏尊科, 翟宏偉, 陳偉, 等. 本體感覺強化訓練對膝骨性關節炎的影響[J]. 中國康復理論與實踐, 2010, 16(2): 158-160.
42.	中國骨關節炎診療指南專家組, 中國老年保健協會疼痛病學分會, 黃東, 等. 中國骨關節炎診療指南(2024 版)[J]. 中華疼痛學雜志, 2024, 20(3): 323-338.
43.	Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee[J]. Arthritis Care Res (Hoboken), 2020, 72(2): 149-162.
44.	Bartels EM, Juhl CB, Christensen R, et al. Aquatic exercise for the treatment of knee and hip osteoarthritis[J]. Cochrane Database Syst Rev, 2016, 3(3): CD005523.

1. Long H, Zeng X, Liu Q, et al. Burden of osteoarthritis in China, 1990-2017: findings from the global burden of disease study 2017[J]. Lancet Rheumatol, 2020, 2(3): e164-e172.
2. Cross M, Smith E, Hoy D, et al. The global burden of hip and knee osteoarthritis: estimates from the Global Burden of Disease 2010 study[J]. Ann Rheum Dis, 2014, 73(7): 1323-1330.
3. Hurley MV, Scott DL, Rees J, et al. Sensorimotor changes and functional performance in patients with knee osteoarthritis[J]. Ann Rheum Dis, 1997, 56(11): 641-648.
4. Knoop J, Steultjens MP, van der Leeden M, et al. Proprioception in knee osteoarthritis: a narrative review[J]. Osteoarthritis Cartilage, 2011, 19(4): 381-388.
5. van der Esch M, Knoop J, van der Leeden M, et al. The association between proprioception, muscle strength, and functional performance in knee osteoarthritis patients[J]. J Orthop Sports Phys Ther, 2013, 43(4): 215-223.
6. Sherrington CS. The integrative action of the nervous system. New Haven: Yale University Press, 1906.
7. Riemann BL, Lephart SM. The sensorimotor system, part I: the physiologic basis of functional joint stability[J]. J Athl Train, 2002, 37(1): 71-79.
8. Proske U, Gandevia SC. The proprioceptive senses: their roles in signaling body shape, body position and movement, and muscle force[J]. Physiol Rev, 2012, 92(4): 1651-1697.
9. Riemann BL, Lephart SM. The sensorimotor system, part II: the role of proprioception in motor control and functional joint stability[J]. J Athl Train, 2002, 37(1): 80-84.
10. Grigg P. Peripheral neural mechanisms in proprioception[J]. J Sport Rehabil, 1994, 3(1): 2-17.
11. van der Esch M, Steultjens M, Harlaar J, et al. Joint proprioception, muscle strength, and functional ability in patients with osteoarthritis of the knee[J]. Arthritis Care Res, 2007, 57(5): 787-793.
12. Barrett DS, Cobb AG, Bentley G. Joint proprioception in normal, osteoarthritic and replaced knees[J]. J Bone Joint Surg Br, 1991, 73(1): 53-56.
13. 陳瑤, 俞泳, 何成奇. 膝骨關節炎患者本體感覺、肌力及關節功能的相關性研究[J]. 四川大學學報 (醫學版), 2015, 46(6): 880-884.
14. 石靜楠, 薛雅月, 張寬, 等. 膝骨關節炎患者本體感覺特征[J]. 醫用生物力學, 2022, 37(2): 355-360.
15. 李擎, 謝連紅, 楊堅, 等. 膝骨性關節炎患者動態平衡能力變化[J]. 中國組織工程研究, 2013, 17(22): 4176-4180.
16. 中華醫學會物理醫學與康復學分會, 四川大學華西醫院. 中國膝骨關節炎康復治療指南 (2023 版)[J]. 中國循證醫學雜志, 2024, 24(1): 1-14.
17. Mills K, Hunt MA, Ferber R. Biomechanical deviations during level walking associated with knee osteoarthritis: a systematic review and meta-analysis[J]. Arthritis Care Res (Hoboken), 2013, 65(10): 1643-1665.
18. Rose MJ, Costello KE, Eigenbrot S, et al. Inertial measurement units and application for remote health care in hip and knee osteoarthritis: narrative review[J]. JMIR Rehabil Assist Technol, 2022, 9(2): e33521.
19. Lee S, Neogi T, Costello KE, et al. Association of mechanical temporal summation of pain with muscle co-contraction during walking in people with knee osteoarthritis[J]. Clin Biomech (Bristol), 2023, 110: 106105.
20. Culvenor AG, Ruhdorfer A, Juhl C, et al. Knee extensor strength and risk of structural, symptomatic, and functional decline in knee osteoarthritis: a systematic review and meta-analysis[J]. Arthritis Care Res (Hoboken), 2017, 69(5): 649-658.
21. Hubley-Kozey CL, Deluzio KJ, Landry SC, et al. Co-activation differences in lower limb muscles between asymptomatic controls and those with varying degrees of knee osteoarthritis during walking[J]. Clin Biomech (Bristol), 2009, 24(5): 407-414.
22. Heiden TL, Lloyd DG, Ackland TR. Knee joint kinematics, kinetics and muscle co-contraction in knee osteoarthritis patient gait[J]. Clin Biomech (Bristol), 2009, 24(10): 833-841.
23. Zeng Z, Shan J, Zhang Y, et al. Asymmetries and relationships between muscle strength, proprioception, biomechanics, and postural stability in patients with unilateral knee osteoarthritis[J]. Front Bioeng Biotechnol, 2022, 10: 922832.
24. Shanahan CJ, Hodges PW, Wrigley TV, et al. Organisation of the motor cortex differs between people with and without knee osteoarthritis[J]. Arthritis Res Ther, 2015, 17(1): 164.
25. Mao C, Yang H, Dong T, et al. Thalamocortical dysconnectivity is associated with pain in patients with knee osteoarthritis[J]. Eur J Neurosci, 2024, 60(8): 5831-5848.
26. Smith TO, King JJ, Hing CB. The effectiveness of proprioceptive-based exercise for osteoarthritis of the knee: a systematic review and meta-analysis[J]. Rheumatol Int, 2012, 32(11): 3339-3351.
27. Wang Y, Wu Z, Chen Z, et al. Proprioceptive training for knee osteoarthritis: a systematic review and meta-analysis of randomized controlled trials[J]. Front Med (Lausanne), 2021, 8: 699921.
28. Lin Y, Yu D, Chen X, et al. Effects of proprioceptive exercise for knee osteoarthritis: a systematic review and meta-analysis[J]. Front Rehabil Sci, 2025, 6: 1596966.
29. Fadil A, Muaidi QI, Alayat MS, et al. The effectiveness of closed kinetic chain exercises in individuals with knee osteoarthritis: a systematic review and meta-analysis[J]. PLoS One, 2025, 20(5): e0322475.
30. Guede-Rojas F, Benavides-Villanueva A, Salgado-González S, et al. Effect of strength training on knee proprioception in patients with knee osteoarthritis: a systematic review and meta-analysis[J]. Sports Med Health Sci, 2024, 6(2): 101-110.
31. Bennell KL, Kyriakides M, Metcalf B, et al. Neuromuscular versus quadriceps strengthening exercise in patients with medial knee osteoarthritis and varus malalignment: a randomized controlled trial[J]. Arthritis Rheumatol, 2014, 66(4): 950-959.
32. Fitzgerald GK, Piva SR, Gil AB, et al. Agility and perturbation training techniques in exercise therapy for reducing pain and improving function in people with knee osteoarthritis: a randomized clinical trial[J]. Phys Ther, 2011, 91(4): 452-469.
33. 白海軍. 平衡墊訓練對女性膝骨關節炎患者膝關節本體感覺影響的研究[J]. 成都體育學院學報, 2012, 38(5): 91-94.
34. 王健, 許翠平. 負荷控制下的本體感覺訓練在膝骨性關節炎中的應用[J]. 中國臨床研究, 2015, 28(12): 1621-1623.
35. 陳鶴, 李雪媚, 鄺雪輝, 等. 關刺法聯合本體感覺訓練對膝骨關節炎患者的影響[J]. 康復學報, 2024, 34(2): 140-144, 152.
36. 陳丹, 祁芳, 朱琳, 等. 電針聯合全身振動訓練對中度膝骨關節炎患者本體感覺及運動功能的影響[J]. 湖南中醫藥大學學報, 2023, 43(9): 1699-1703.
37. Qiu CG, Chui CS, Chow SKH, et al. Effects of whole-body vibration therapy on knee osteoarthritis: a systematic review and meta-analysis of randomized controlled trials[J]. J Rehabil Med, 2022, 54: jrm00266.
38. Wei W, Tang H, Luo Y, et al. Efficacy of virtual reality exercise in knee osteoarthritis rehabilitation: a systematic review and meta-analysis[J]. Front Physiol, 2024, 15: 1424815.
39. 陳佳意, 朱思憶, 朱林森, 等. 《中國膝骨關節炎康復治療指南 (2023 版)》解讀[J]. 華西醫學, 2025, 40(6): 853-858.
40. Ageberg E, Roos EM. Neuromuscular exercise as treatment of degenerative knee disease[J]. Exerc Sport Sci Rev, 2015, 43(1): 14-22.
41. 鞏尊科, 翟宏偉, 陳偉, 等. 本體感覺強化訓練對膝骨性關節炎的影響[J]. 中國康復理論與實踐, 2010, 16(2): 158-160.
42. 中國骨關節炎診療指南專家組, 中國老年保健協會疼痛病學分會, 黃東, 等. 中國骨關節炎診療指南(2024 版)[J]. 中華疼痛學雜志, 2024, 20(3): 323-338.
43. Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee[J]. Arthritis Care Res (Hoboken), 2020, 72(2): 149-162.
44. Bartels EM, Juhl CB, Christensen R, et al. Aquatic exercise for the treatment of knee and hip osteoarthritis[J]. Cochrane Database Syst Rev, 2016, 3(3): CD005523.

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