View Full Version : Summary of responses RE: Subjective knee scoring scales

Chris Carty
04-02-2003, 09:10 PM
Thank you everyone who responded to my posting. Below is the original
posting and a summary of the replies.


Hi All,

Currently I am working with a group of orthopaedic surgeons in Brisbane.
We are trying to assess which questionnaires are most commonly being used to
assess pre and post operative function of the knee.

I have conducted a literature review on the test-retest reliability,
validity and responsiveness for a number of questionnaires. The results
suggested that the International Knee Document Committees (IKDC - 2000)
Subjective Knee Evaluation Form, the Lysholm Knee Rating Scale, the American
Academy of Orthopaedic Surgeons (AAOS) Knee Rating Scale and the Oxford Knee
Rating Scale were the most reliable, valid and responsive. It appears that
these scales provide better coverage in the areas of function, pain,
swelling, stability and locking.

In addition, relating to sports function, Marx et al (2000) published an
article suggesting their new activity rating scale was more valid and
reliable than the Tegner activity scale.

I was interested in gathering information on which questionnaires are most
commonly being used. If anyone is involved in pre and/or postoperative
assessment could you please let me know which questionnaires you are
currently using to asses knee function.


>From the replies it appears that the most widely used questionnaires are the
IKDC, the Cincinnati, the WOMAC and for TKA the HSS.

My research has revealed the most reliable, valid and responsive knee scales
in order to be:
- The Lysholm knee scoring scale:
Lysholm J, Gillquist J. Evaluation of knee ligament surgery results with
special emphasis on use of a scoring scale. American Journal of Sports
Medicine 10: 150-154, 1982

- The IKDC subjective knee evaluation form
Irrgang JJ, Anderson AF, Boland AL et al. Development and valadation of the
International Knee Document Committee Subjective Knee form. The Americal
Journal of Sports Medicine. 29(5) 600-619 (2001)

- The activities of daily living scale of the Knee outcome survey
Irrgang JJ, Snyder-Mackler L, Wainner RS, Fu FH, Hamer CD. Development of a
patient reported measure of function of the knee. Journal of one and joint
Surgery (Am). 1998;80 1132-1145

- The American Academy of Orthopaedic surgeons sports knee rating scale
American Academy of Orthopaedic Surgeons. Scoring algorithms for the lower
limb outcomes data collection instrument version 2.0. Rosmont, IL: American
Academy of Orthopedic Surgeons 1998

In particular reference to functional activity the best scale was found to
be The activity Rating scale
Marx RG, Stump TJ, Jones EC, Wickiewicz TL, Warren RF. Development and
evaluation of an activity rating scale for disorders of the knee. American
Journal of Sports Medicine. 2001: 29(2):213-8

In particular reference to TKA I found the Oxford scale to be superior.
Dawson J, Fitzpatrick R, Murray D & Carr A. Questionnaire on the perceptions
of patients about total knee replacement. Journal of Bone and Joint Surgery.
80B 63-69 (1998)

In addition we have done a comprehensive search of medline knee related
articles for 2002. The results revealed 452 possible matches with 108
articles using knee questionnaires. Out of the 108:
- 32 used the Lysholm
- 17 used the KSS
- 16 used the IKDC
- 14 used the Tegner
- 10 used the HSS
- 5 used the WOMAC
- 4 used the Cincinnati
- 1 used the KOOS, AAOS, Bristol

Hope this information is helpful


Chris Carty


Dear Chris, For ACL reconstruction, I use the Cincinnati Knee Rating System
(Noyes F, Barber SD, Mooar LA. A rationale for assessing sports activity
levels and limitations in knee disorders. Clin Orthop Rel Res 246:238-249,
1989). For other knee problems, the Lysholm Knee Rating Scale.


Shaw Bronner PT, MHS, EdM, OCS Director Analysis of Dance and Movement
(ADAM) Center Long Island University 122 Ashland Place #1A Brooklyn, NY
11201 718-246-6377 Fax 718-246-6383 E-mail: sbronner@liu.edu

Our team uses HSS .
Sandra Martelli

Dr. Sandra Martelli
Istituti Ortopedici Rizzoli
Lab. Biomechanics http://www.ior.it/biomec
via di Barbiano 1/10 tel. +39 - 051 - 6366.520
I-40136 BOLOGNA fax +39 - 051 - 583 . 789

ISAKOS comitee have done some work on standards and scores . Have you
checked their web page.
sandra Martelli

Dr. Sandra Martelli
Istituti Ortopedici Rizzoli
Lab. Biomechanics http://www.ior.it/biomec
via di Barbiano 1/10 tel. +39 - 051 - 6366.520
I-40136 BOLOGNA fax +39 - 051 - 583 . 789

We are doing research relative to knee function involving pre & post-op
conditions so are interested in your findings. Have you published your
literature review- if so where. If not, would you be willing to share it. I
also would like to obtain, in particular references related to the five knee
function assessment instruments you found to be most reliable and valid.
Also, could you provide the full reference for the Marx et al (2000) article
to which you referred related to sports function. Thank you for you
willingness to share your findings and information.

Robert H. Deusinger, PT, PhD Washington University School of Medicine 4444
Forest Park Blvd./Campus Box 8502 St. Louis, MO 63108 (314) 286-1426 (314)
286-1410 (FAX) email: deusingerb@msnotes.wustl.edu

Would you consider the WOMAC a knee questionnaire. It has very good
responsiveness and its reliability has been studied extensively. The
McMaster group also developed the patient-specific index and used it at the
knee. You might also be interested in the lower extremity functional scale.
I look forward to your summary.

Eric ----- Original Message ----- From: "chris carty"
To: Sent: Tuesday, March
25, 2003 5:41 PM Subject: [BIOMCH-L] Subjective Knee Questionnaires

For our ACL studies, we use a modified version of the IKDC forms to
correlate subjective findings with our biomechanical data pre- & post- ACL
reconstruction. Irrgang et al. (Knee Surg Sports Traum Arthos, 6(2),
107-114, 1998) provide an adequate description of the forms' applicability.
The Cincinnati rating system is another one that has been used. However,
many have compared subjective findings with relatively objective data (ie,
KT-1000, Cybex, etc.) between ACL patient groups and found similar patterns,
regardless of the scoring system used. Hopefully, with more dynamic
biomechanical data from our current motion analysis study on ACL patients,
we hope to shed more light on the "validity" of the IKDC forms and other
popular rating systems. Good luck!

Arnel ---- Arnel Aguinaldo, MA, ATC Biomechanical Engineer Motion Analysis
Laboratory & Center for Human Performance Children's Hospital San Diego |
San Diego, CA USA (858) 966-5807 | www.sandiegogaitlab.com


Hi Chris, one score that is commonly used for pre/post TKR is the knee
society score (ref: Insall JN, Door MD, Scott RD, et al. Rationale of the
knee society clinical rating system. Clin Orthop, 1989, 248: 13-14) Cheers
Erin Mr E Parish, MHSc (Exericse and Sports Science) AIMS Research Research
Assistant 286 Pacific Highway, Crows Nest, Sydney, Australia, 2065 Phone:
+61 2 9437 5999 Fax: +61 2 9906 1060 eparish@nsosmc.com.au


Hello Chris

The orthopod I am working with in Toronto as a writer/editor has just
finished sending a paper out on a survey re: the use of common
patient-centred knee measures for pre/post TKA. A survey of several hundred
Canadian orth. surgeons has revealed the 4 most popular knee measures
preferred and used, in order,are:

1 - WOMAC (Western Ontario and McMaster)
2 - Knee Society Score
3 - HSS (Hospital for Special Surgery)
4 - HSS 2 (Modified HSS)

I cannot give away too many more details re: the paper as it is being
reviewed and there are all sorts of confidentiality issues around that
process as you know.

Hope this helps.

Rad Zdero, PhD


Hi there chris
Many people around here use the WOMAC- western ontario and macmaster
arthritis c?

Alison McConnell
Research Engineer
MOBL- Martin Orthopaedic Biomechanics Laboratory
St Michael's Hospital - affiliated with the University of Toronto
30 Bond St, West Annex 1027
Toronto, Ontario, Canda
M5B 1W8

1 416 864-5579 (office)
1 416 864-5482 (lab)
1 416 359-1601 (fax)


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