Background: Knee-specific patient-reported outcome measures are frequently used after anterior cruciate ligament reconstruction but little is known about whether they measure outcomes important to patients.
Purpose: The aim of this study was to identify which instrument, the Knee injury and Osteoarthritis Outcome Score (KOOS) or the International Knee Documentation Committee Subjective Knee Form (IKDC), captures symptoms and disabilities most important to patients who have undergone initial anterior cruciate ligament reconstruction.
Study Design: Cross-sectional study; Level of evidence, 3.
Methods: Data were collected from 126 participants of an Internet knee forum. A self-reported online questionnaire was developed consisting of demographic and surgical data, the Tegner Activity Scale, and 49 consolidated items from the KOOS and the IKDC. Item importance, frequency, and frequency-importance product were calculated.
Results: Seventy-eight percent of the items from the IKDC were experienced by more than half of the patients, compared with 57% from the KOOS. Items extracted from the Function in Sports/Recreation and Quality of Life KOOS subscales were highly important to this group of patients. For patients 12 months or more after anterior cruciate ligament reconstruction, 94% of the IKDC items had a frequency-importance product of 1 or less compared with 86% of the KOOS items.
Conclusion: Overall, the IKDC items outperformed the KOOS items on all of the 5 criteria with the exception of the frequency-importance product for patients who were 12 months after anterior cruciate ligament reconstruction. The KOOS Function in Sports/Recreation and Knee-Related Quality of Life subscales outperformed the IKDC for the total cohort as well as for male and female subgroups. However, differences in individual items were not always evident from either total scale or subscale ratings. Studies should use patient-reported outcomes that reflect patients’ most important concerns and further prospective longitudinal research is required in this area.
AhnJHLeeYSHaHC. Comparison of revision surgery with primary anterior cruciate ligament reconstruction and outcome of revision surgery between different graft materials. Am J Sports Med. 2008;36(10):1889-1895.
2.
AndersJOVenbrocksRAWeinbergM. Proprioceptive skills and functional outcome after anterior cruciate ligament reconstruction with a bone-tendon-bone graft. Int Orthop. 2008;32(5):627-633.
3.
AndersonAFIrrgangJJKocherMSMannBJHarrastJJ, IKDC. The International Knee Documentation Committee subjective knee evaluation form: normative data. Am J Sports Med. 2006;34(1):128-135.
4.
AnderssonDSamuelssonKKarlssonJ. Treatment of anterior cruciate ligament injuries with special reference to surgical technique and rehabilitation: an assessment of randomized controlled trials. Arthroscopy. 2009;25(6):653-685.
5.
BellamyNBuchananWWGoldsmithCHCampbellJStittLW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15(12):1833-1840.
6.
BriggsKKKocherMSRodkeyWGSteadmanJR. Reliability, validity, and responsiveness of the Lysholm knee score and Tegner activity scale for patients with meniscal injury of the knee. J Bone Joint Surg Am. 2006;88(4):698-705.
7.
British Psychological Society. Report of the Working Party on Conducting Research on the Internet. Guidelines for Ethical Practice in Psychological Research Online. Leicester, United Kingdom: British Psychological Society; 2007.
8.
CarrAJHigginsonIJ. Are quality of life measures patient centred?BMJ. 2001;322(7298):1357-1360.
9.
CominsJBrodersenJKrogsgaardMBeyerN. Rasch analysis of the Knee injury and Osteoarthritis Outcome Score (KOOS): a statistical re-evaluation. Scand J Med Sci Sports. 2008;18(3):336-345.
10.
DuquinTRWindWMFinebergMSSmolinskiRJBuyeaCM. Current trends in anterior cruciate ligament reconstruction. J Knee Surg. 2009;22(1):7-12.
11.
FitzpatrickRDaveyCBuxtonMJJonesDR. Evaluating patient-based outcome measures for use in clinical trials. Health Technol Assess. 1998;2(14):i-iv, 1-74.
12.
GarrattAMBrealeySGillespieWJ, in collaboration with the DAMASK Trial Team. Patient-assessed health instruments for the knee: a structured review. Rheumatology. 2004;43(11):1414-1423.
13.
GobbiAFranciscoR. Factors affecting return to sports after anterior cruciate ligament reconstruction with patellar tendon and hamstring graft: a prospective clinical investigation. Knee Surg Sports Traumatol Arthrosc. 2006;14(10):1021-1028.
14.
GuyattGHBombardierCTugwellPX. Measuring disease-specific quality of life in clinical trials. CMAJ. 1986;134(8):889-895.
15.
GwaltneyCJShieldsALShiffmanS. Equivalence of electronic and paper-and-pencil administration of patient-reported outcome measures: a meta-analytic review. Value Health. 2008;11(2):322-333.
16.
HamblyKGrivaK. IKDC or KOOS? Which measures symptoms and disabilities most important to postoperative articular cartilage repair patients?Am J Sports Med. 2008;36(9):1695-1704.
17.
HeijneAWernerS. A 2-year follow-up of rehabilitation after ACL reconstruction using patellar tendon or hamstring tendon grafts: a prospective randomised outcome study. Knee Surg Sports Traumatol Arthrosc. 2009Oct23 [Epub ahead of print].
18.
HerringtonLWrapsonCMatthewsMMatthewsH. Anterior cruciate ligament reconstruction, hamstring versus bone-patella tendon-bone grafts: a systematic literature review of outcome from surgery. Knee. 2005;12(1):41-50.
19.
HigginsonIJCarrAJ. Measuring quality of life: using quality of life measures in the clinical setting. BMJ. 2001;322(7297):1297-1300.
20.
HyderNBollenSRSeftonGSwannAC. Correlation between arthrometric evaluation of knees using KT 1000 and Telos stress radiography and functional outcome. Knee. 1997;4(3):121-124.
21.
IrrgangJJAndersonAFBolandAL. Development and validation of the International Knee Documentation Committee subjective knee form. Am J Sports Med. 2001;29(5):600-613.
22.
JohnsonDSSmithRB. Outcome measurement in the ACL deficient knee-what’s the score?Knee. 2001;8(1):51-57.
23.
JuniperEFGuyattGHStreinerDLKingDR. Clinical impact versus factor analysis for quality of life questionnaire construction. J Clin Epidemiol. 1997;50(3):233-238.
24.
KocherMSSteadmanJRBriggsKZurakowskiDSterettWIHawkinsRJ. Determinants of patient satisfaction with outcome after anterior cruciate ligament reconstruction. J Bone Joint Surg Am. 2002;84(9):1560-1572.
25.
KostogiannisIAgebergENeumanPDahlbergLFridenTRoosH. Activity level and subjective knee function 15 years after anterior cruciate ligament injury: a prospective, longitudinal study of nonreconstructed patients. Am J Sports Med. 2007;35(7):1135-1143.
26.
KvistJEkASporrstedtKGoodL. Fear of re-injury: a hindrance for returning to sports after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2005;13(5):393-397.
27.
LindMMenhertFPedersenAB. The first results from the Danish ACL reconstruction registry: epidemiologic and 2 year follow-up results from 5,818 knee ligament reconstructions. Knee Surg Sports Traumatol Arthrosc. 2009;17(2):117-124.
MarshallSHaywoodKFitzpatrickR. Impact of patient-reported outcome measures on routine practice: a structured review. J Eval Clin Pract. 2006;12(5):559-568.
30.
MartinRLMohtadiNGSafranMR. Differences in physician and patient ratings of items used to assess hip disorders. Am J Sports Med. 2009;37:1508-1512.
31.
MoisalaASJarvelaTHarilainenASandelinJKannusPJarvinenM. The effect of graft placement on the clinical outcome of the anterior cruciate ligament reconstruction: a prospective study. Knee Surg Sports Traumatol Arthrosc. 2007;15(7):879-887.
32.
MollerEWeidenhielmLWernerS. Outcome and knee-related quality of life after anterior cruciate ligament reconstruction: a long-term follow-up. Knee Surg Sports Traumatol Arthrosc. 2009;17(7):786-794.
33.
NauTLavoiePDuvalN. A new generation of artificial ligaments in reconstruction of the anterior cruciate ligament: two-year follow-up of a randomised trial. J Bone Joint Surg Br. 2002;84(3):356-360.
34.
NovakPJBachBRJrHagerCA. Clinical and functional outcome of anterior cruciate ligament reconstruction in the recreational athlete over the age of 35. Am J Knee Surg. 1996;9(3):111-116.
35.
NylandJCottrellBHarreldKCabornD. Self-reported outcomes after anterior cruciate ligament reconstruction: an internal health locus of control score comparison. Arthroscopy. 2006;22(11):1225-1232.
36.
OttSMIrelandMLBallantyneBTWillsonJDMcClay DavisIS. Comparison of outcomes between males and females after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2003;11(2):75-80.
37.
ParadowskiPTBergmanSSunden-LundiusALohmanderLSRoosEM. Knee complaints vary with age and gender in the adult population: population-based reference data for the Knee injury and Osteoarthritis Outcome Score (KOOS). BMC Musculoskelet Disord. 2006;7:38.
38.
PoolmanRWSwiontkowskiMFFairbankJCTSchemitschEHSpragueSde VetHCW. Outcome instruments: rationale for their use. J Bone Joint Surg Am. 2009;91(Supplement 3):41-49.
39.
ReiderB. Now and later. Am J Sports Med. 2008;36(9):1673-1674.
40.
RisbergMAHolmISteenHBeynnonBD. Sensitivity to changes over time for the IKDC form, the Lysholm score, and the Cincinnati knee score: a prospective study of 120 ACL reconstructed patients with a 2-year follow-up. Knee Surg Sports Traumatol Arthrosc. 1999;7(3):152-159.
41.
RoosEMLohmanderLS. The Knee injury and Osteoarthritis Outcome Score (KOOS): from joint injury to osteoarthritis. Health Qual Life Outcomes. 2003;1(1):64.
42.
RoosEMRoosHPLohmanderLSEkdahlCBeynnonBD. Knee Injury and Osteoarthritis Outcome Score (KOOS)—development of a self-administered outcome measure. J Orthop Sports Phys Ther. 1998;28(2):88-96.
43.
RoosEMToksvig-LarsenS. Knee injury and Osteoarthritis Outcome Score (KOOS)—validation and comparison to the WOMAC in total knee replacement. Health Qual Life Outcomes. 2003;1(1):17.
44.
RoosHKarlssonJ. Anterior cruciate ligament instability and reconstruction: review of current trends in treatment. Scand J Med Sci Sports. 1998;8(6):426-431.
45.
RutaDAGarrattAMLengMRussellITMacDonaldLM. A new approach to the measurement of quality of life: the Patient-Generated Index. Med Care. 1994;32(11):1109-1126.
46.
SajovicMStrahovnikAKomadinaRDernovsekMZ. The effect of graft choice on functional outcome in anterior cruciate ligament reconstruction. Int Orthop. 2008;32(4):473-478.
47.
SalmonLJRefshaugeKMRussellVJRoeJPLinklaterJPinczewskiLA. Gender differences in outcome after anterior cruciate ligament reconstruction with hamstring tendon autograft. Am J Sports Med. 2006;34(4):621-629.
48.
SamuelssonKAnderssonDKarlssonJ. Treatment of anterior cruciate ligament injuries with special reference to graft type and surgical technique: an assessment of randomized controlled trials. Arthroscopy. 2009;25(10):1139-1174.
49.
SchultzWRCarrCF. Comparison of clinical outcomes of reconstruction of the anterior cruciate ligament: autogenous patellartendon and hamstring grafts. Am J Orthop. 2002;31(11):613-620.
50.
SloanePABrazierHMurphyAWCollinsT. Evidence based medicine in clinical practice: how to advise patients on the influence of age on the outcome of surgical anterior cruciate ligament reconstruction: a review of the literature. Br J Sports Med. 2002;36(3):200-203; discussion 204.
51.
SpindlerKPKuhnJEFreedmanKBMatthewsCEDittusRSHarrellFEJr. Anterior cruciate ligament reconstruction autograft choice: bone-tendon-bone versus hamstring: does it really matter? A systematic review. Am J Sports Med. 2004;32(8):1986-1995.
52.
SpindlerKPWarrenTACallisonJCJrSecicMFleischSBWrightRW. Clinical outcome at a minimum of five years after reconstruction of the anterior cruciate ligament. J Bone Joint Surg Am. 2005;87(8):1673-1679.
53.
SwirtunLRRenstromP. Factors affecting outcome after anterior cruciate ligament injury: a prospective study with a six-year follow-up. Scand J Med Sci Sports. 2008;18(3):318-324.
54.
TannerSMDaintyKNMarxRGKirkleyA. Knee-specific quality-of-life instruments: which ones measure symptoms and disabilities most important to patients?Am J Sports Med. 2007;35(9):1450-1458.
55.
TegnerYLysholmJ. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res. 1985;198:43-49.
56.
ThomeePWahrborgPBorjessonMThomeeRErikssonBIKarlssonJ. Self-efficacy of knee function as a pre-operative predictor of outcome 1 year after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2008;16(2):118-127.
57.
ZlowodzkiMBhandariM. Outcome measures and implications for sample-size calculations. J Bone Joint Surg Am. 2009;91(Supplement 3):35-40.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
