Italian version of the International Knee Documentation Committee Subjective Knee Form: cross-cultural adaptation and validation

Are leukocyte-poor or multiple injections of platelet-rich plasma more effective than hyaluronic acid for knee osteoarthritis? A systematic review and meta-analysis of randomized controlled trials

INTRODUCTION

Platelet-rich plasma (PRP) has gained popularity as a treatment option for knee osteoarthritis; however, its efficacy remains controversial. The optimal leukocyte concentration and number of injections have not been well investigated. This study was, therefore, designed to provide clinical evidence on the leukocyte concentration and number of intra-articular injections of PRP via a meta-analysis of randomized controlled trials (RCTs).

METHODS

The MEDLINE, Embase, Cochrane Library, CINAHL, and Scopus databases were searched and RCTs comparing PRP and hyaluronic acid (HA) for treating knee osteoarthritis were included. Clinical outcomes, including visual analog scale (VAS) score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and adverse reactions, were evaluated.

RESULTS

A total of 138 studies were screened, of which 21 level 1 RCTs (2086 knees; 1077 PRP and 1009 HA) were included. PRPs showed significant improvement in pain according to the VAS score compared to HA at 6 and 12 months, regardless of leukocyte concentration. Both single and multiple injections of PRP improved pain better than HA at 12 months. Regarding function, both single and multiple injections of leukocyte-poor PRP and leukocyte-rich PRP led to significantly better improvement in total WOMAC score compared with HA at 6 months. There was no significant difference in procedure-related knee pain or swelling between the PRP and HA groups. Leukocyte-rich PRP had a significantly higher odds ratio for procedure-related knee pain or swelling compared to HA (odds ratio, 3.3 [95% confidence interval, 1.1-10.2], P = .037).

CONCLUSION

Based on evidence from Level 1 studies, intra-articular injection of PRP improves pain and function in patients with knee osteoarthritis for up to 12 months and is superior to HA, regardless of leukocyte concentration or number of injections. The findings of this study support the routine clinical use of intra-articular injections of PRP for the treatment of knee osteoarthritis, regardless of the type and frequency of PRP injection.

LEVEL OF EVIDENCE

Meta-analysis of level I studies.

Translation, cross-cultural adaptation and reliability of the International Knee Documentation Committee (IKDC) subjective knee form and the tampa scale for kinesiophobia (TSK) into Hebrew

INTRODUCTION

The International Knee Documentation Committee-Subjective Form (IKDC-SF) is one of the most used measures for evaluating the quality of life among people experiencing knee pain but is not yet available in Hebrew. Similarly, the Tampa Scale for Kinesiophobia (TSK), used to evaluate fear of movement, is not available in Hebrew. This study aimed to determine the reliability and construct validity of the Hebrew IKDC-SF and TSK among people experiencing chronic knee pain.

MATERIALS AND METHODS

Translation and cultural adaptation of the IKDC-SF and TSK questionnaires, followed by test-retest reliability within a two-week interval. We report on internal consistency, construct validity, and the psychometric properties of both questionnaires.

RESULTS

Both questionnaires showed high internal consistency (Cronbach's α = 0.85 and 0.89, respectively) and test-retest reliability, expressed by the Intra-Class Correlation Coefficient (ICC = 0.89 and 0.80 respectively). The standard error of measurement, group smallest real difference and minimal detectable change for the IKDC-SF were 4.66, 9.13, and 12.91 points, and 3.64, 7.13, and 10.08 points for the TSK, respectively.

CONCLUSION

We demonstrated that the Hebrew version of the IKDC-SF and TSK is reliable and valid for assessing QoL, function, and kinesiophobia among people experiencing chronic knee pain.

Hamstring tendon autografts and allografts show comparable clinical outcomes and knee stability after anterior cruciate ligament reconstruction in patients over fifty years old with no signs of osteoarthritis progression

Purpose

The aim of this study is to compare the functional outcomes and osteoarthritis (OA) progression after anterior cruciate ligament (ACL) reconstruction with either hamstring autografts or allografts in people over 50.

Methods

The clinical records of two consecutive cohorts of 61 cases in total over 50 years of age, undergoing ACL reconstruction, were included. The first cohort consisted of 29 allografts; the second cohort consisted of 32 autologous hamstring tendon grafts. The cases were evaluated pre- (T0) and post-operatively at six months (T1), 12 months (T2) and 24 months (T3). Clinical examination included the Lachman test, pivot shift test and objective (Objective IKDC [The International Knee Documentation Committee] score) and subjective clinical scores (Subjective IKDC score, Lysholm score and Tegner activity score). The degree of OA was evaluated using the Kellgren-Lawrence system at the time of the final follow-up, compared to the pre-operative condition.

Results

No pre-operative difference was found between the two groups (p > 0.05). No statistical difference was noted between the two groups at each follow-up (p > 0.05). At the final follow-up, both the groups significantly improved statistically in all the clinical and functional scores (p < 0.05). In both groups, one graft re-rupture was noted. No progression of OA was noted in both groups at final follow-up (p > 0.05).

Conclusion

The graft choice does not influence the outcomes two years after ACL reconstruction in people over 50; thus, both treatments help in regaining knee stability with no signs of OA progression.

Registration

Researchregistry7539–www.researchregistry.com.

Translation, cross-cultural adaptation and validation of the Italian version of the anterior cruciate ligament-return to sport after injury (ACL-RSI) scale

PURPOSE

To translate and culturally adapt the anterior cruciate ligament-return to sport after injury (ACL-RSI) scale into Italian (ACL-RSI(IT)) and examine and evaluate the psychometric properties of the Italian version in individuals who have undergone anterior cruciate ligament (ACL) reconstruction.

METHODS

The ACL-RSI was forward and back translated, culturally adapted and validated one hundred and twenty nine Italian individuals who had undergone ACL reconstruction (94 males, 35 females; age 28 ± 9 years). All patients completed the translated ACL-RSI, Knee injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee subjective knee form (IKDC), Tampa Scale of Kinesiophobia (TSK) and the 12-item short form health survey (SF-12). We then analysed the internal consistency, reliability and validity of the newly formed ACLRSI (IT).

RESULTS

The ACL- RSI(IT) showed excellent internal consistency (Cronbach's alpha 0.94) and was significantly correlated with the KOOS 'quality of life' (r = 0.61, p < 0.00001), 'symptoms' (r = 0.34, p < 0.00001), 'pain' (r = 0.44, p < 0.00001), and 'sports' (r = 0.40, p < 0.00001) subscales. The ACL-RSI(IT) also correlated significantly with the IKDC (r = 0.34, p < 0.001), TSK (r = - 0.48, p < 0.00001) and SF-12 (r = - 0.40, p < 0.0001) scores.

CONCLUSION

The Italian version of the ACL-RSI scale was valid, discriminant, consistent and reliable in patients who had undergone ACL reconstruction. This score could be useful to evaluate the effect of psychological factors on return to sport following ACL surgery.

LEVEL OF EVIDENCE

II.

Translation, Cross-Cultural Adaptation, Validity, and Reliability of the Indonesian Version of the IKDC Subjective Knee Form

Background:

No questionnaire is currently available for use in patients with anterior cruciate ligament (ACL) injuries in an Indonesian population. The most-used questionnaire in clinical research for these patients is the International Knee Documentation Committee (IKDC) Subjective Knee Form, as its psychometric properties are considered to be excellent.

Purpose:

To translate the IKDC into Indonesian and assess its validity for use in Indonesian-speaking patients with ACL injuries.

Study Design:

Cohort study (diagnosis); Level of evidence, 2.

Methods:

After a forward-and-backward translation procedure and cross-cultural adaptation, the validity and reliability of the questionnaire were investigated. The responses of ACL injury patients on 3 questionnaires, the Indonesian-IKDC (I-IKDC), 36-Item Short Form Health Survey, and Kujala Anterior Knee Pain Scale, were compared. Following consensus-based standards for the selection of health measurement instruments guidelines, construct validity, test-retest reliability, internal consistency, floor and ceiling effects, and measurement error were determined. The Bland-Altman method was used to explore absolute agreement.

Results:

Of 253 ACL injury patients, 106 (42%) responded to the invitation. Construct validity was considered good, as all predefined hypotheses on correlations between the I-IKDC and other scores were confirmed. Reliability proved excellent, with a high test-retest correlation (intraclass correlation coefficient = 0.99). Bland-Altman analyses showed no systematic bias between test and retest. Internal consistency was good (Cronbach α = .90). There were no floor or ceiling effects. Standard error of measurement was 2.1, and the minimal detectable change was 5.8 at the individual level and 0.7 at the group level.

Conclusion:

The I-IKDC, as developed, appeared to be a good evaluation instrument for Indonesian patients with ACL injuries.

Adverse Reactions and Clinical Outcomes for Leukocyte-Poor Versus Leukocyte-Rich Platelet-Rich Plasma in Knee Osteoarthritis: A Systematic Review and Meta-analysis

Background:

Platelet-rich plasma (PRP) has gained attention as a therapeutic option for knee osteoarthritis; however, its efficacy varies widely. Leukocytes in PRP raise the concern of aggravating proinflammatory activity. To date, PRP has rarely been investigated with regard to leukocyte concentration.

Purpose:

To provide clinical evidence of the intra-articular injection of PRPs containing different leukocyte concentrations.

Study Design:

Systematic review; Level of evidence, 4.

Methods:

We systematically searched the MEDLINE, Embase, Cochrane Library, CINAHL, and Scopus databases. PRP was classified into leukocyte-poor (LP-PRP) and leukocyte-rich (LR-PRP). Clinical outcomes including Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), visual analog scale (VAS) for pain score, International Knee Documentation Committee (IKDC) subjective score, and adverse reactions were evaluated. The Methodological Index for Non-Randomized Studies criteria were used for quality assessment.

Results:

Included were 32 studies with an evidence level between 1 and 4. Both LP-PRP and LR-PRP showed improvements above the minimal clinically important difference (MCID) in VAS pain score. No significant intergroup difference was seen at 3, 6, or 12 months of follow-up. Regarding function, both LP-PRP and LR-PRP showed improvements above the MCID in the WOMAC and IKDC scores, with no significant difference between the groups. Adverse reactions for pain were significantly higher in LR-PRP than in LP-PRP (odds ratio, 1.64; 95% confidence interval, 1.29-2.10; P = .01). After intra-articular PRP injection, LR-PRP showed a significantly higher rate of swelling than LP-PRP (odds ratio, 1.56; 95% confidence interval, 1.22-1.99; P = .02). The mean Methodological Index for Non-Randomized Studies score of the included studies was 18.6 (range, 10-24).

Conclusion:

Intra-articular PRP injection resulted in improvements above the MCID in terms of pain and function in patients with knee osteoarthritis up to 12 months. The risk of local adverse reactions appeared to be increased after LR-PRP compared with LP-PRP injection. The findings of this review can support the potential use of intra-articular PRP injection for the treatment of knee osteoarthritis. In clinical application, clinicians need to consider selecting a specific type of PRP for knee osteoarthritis.

ACL reconstruction using a bone patellar tendon bone (BPTB) allograft or a hamstring tendon autograft (GST): a single-center comparative study

Background and aim of the work: There is still debate on which graft is better indicated for anterior cruciate ligament (ACL) surgical reconstruction. The objective of this study was to evaluate the medium-term clinical outcomes of ACL reconstruction comparing patients managed with bone patellar tendon bone allograft (BPTB) versus patients treated with hamstring autograft (GST). Methods: Patients enrolled during the period 2013-2016 underwent a personal interview with the use of specific evaluation questionnaires (Tegner e Lyshom, Knee Injury and Osteoarthritis Outcome Score, International Knee Documentation Committee), a clinical evaluation with the use of objective functional tests (Lachman test, pivot-shift) and a physical examination of the knee. Results: In this study 43 patients were enrolled: 21 patients were treated by autograft and 22 patients by allograft. Patients who received allograft ACL reconstruction returned to normal sport activity earlier than patients operated on using autograft (11.7±10.3 vs 17.9±14.6 weeks, p<0.05). Data obtained with subjective tests, clinical and physical examination were positive overall, with no differences observed between the two groups. Finally, 15 allograft patients and 12 autograft patients accepted to perform the proprioceptive tests: no difference was found between the two groups. Conclusions: At follow-up evaluation after ACL reconstruction, both BPTB allograft and GST autograft patient groups showed similar results at subjective, objective clinical evaluation and proprioceptive properties of the limb. In particular, the use of allogenic BPTB allowed the patients to return earlier to normal activities of daily-living and sport activity. (www.actabiomedica.it)

Cross-cultural adaptation and validation of the Italian versions of the Kujala, Larsen, Lysholm and Fulkerson scores in patients with patellofemoral disorders

BACKGROUND

The Kujala, Fulkerson, Larsen and Lysholm questionnaires have been demonstrated to be reliable and sensitive in assessing patients with patellofemoral pathology. The purpose of this study is to translate and cross-culturally adapt into Italian the English versions of the Kujala, Fulkerson, Larsen and Lysholm questionnaires, and undertake reliability and validity evaluations of the Italian versions of these scores in patients with patellofemoral pathology.

MATERIALS AND METHODS

The cross-cultural adaptation process was carried out following the simplified Guillemin criteria. The questionnaires were administered to 63 patients with either patellar instability or painful patella syndrome. To assess the validity of the questionnaires, they were compared with the Oxford knee score. The questionnaires were administered to a subsample of 33 patients 5 days later to assess test-retest reliability.

RESULTS

The interclass coefficient correlation was 0.96 for the Kujala score, 0.92 for the Larsen score, 0.96 for the Lysholm score, 0.94 for the Fulkerson score (P < 0.01), and 0.83 for the Oxford score. Pearson's correlation was0.96 between the Kujala and Oxford scores, 0.90 between the Larsen and Oxford scores, 0.94 between the Lysholm and Oxford score, and 0.93 between the Fulkerson and Oxford scores. Responsiveness, calculated by standardized response mean, was 1.2, and effect size was 1.4.

CONCLUSIONS

The Italian versions of the Kujala, Larsen, Lysholm and Fulkerson scoring systems were shown to be equivalent to their English versions and demonstrated good validity, reliability and responsiveness to surgical treatment of patellofemoral pathology. To the best of the authors' knowledge, this is the first attempt to adapt four of the most common patellofemoral-specific scoring scales to the Italian language.

LEVEL OF EVIDENCE

Level II.

Measurement properties of the German version of the IKDC subjective knee form (IKDC-SKF)

Purpose

To examine the measurement properties of the German International Knee Documentation Committee Subjective Knee Form (IKDC-SKF) in knee disorder patients.

Methods

Three hundred twelve consecutive patients undergoing surgery for anterior cruciate ligament, meniscus and/or cartilage injuries completed the IKDC-SKF, Lysholm Score, Tegner Activity Scale, and Short Form-12 Health Survey before and 6 months post-surgery. IKDC-SKF measurement properties were calculated and patients were also asked to rate the relevance/comprehensibility of the questionnaire items.

Results

Reliability was good with high Cronbach's alpha and intraclass correlation coefficients, and standard error of measurement values of 4.4 to 6.0. The smallest detectable change (SDC) ranged from 12.3 to 16.7 points. Validity was good with 90% of all hypotheses confirmed. Confirmatory factor analysis did not show adequate fitting indices within the model. Over half of the items were rated as essential, and all were well comprehended. The majority of hypotheses for responsiveness were confirmed. No floor and ceiling effects were observed. The area under the curve ranged from 0.82 to 0.89 and the minimal important difference was smaller than the SDC.

Conclusions

The German IKDC-SKF is a reliable outcome measure with good hypotheses testing and responsiveness, but its MIC and structural/content validity need further analysis.

Factors Affecting Subjective and Objective Outcomes and Return to Play in Anterior Cruciate Ligament Reconstruction: A Retrospective Cohort Study

Purpose  To analyze the prognostic factors influencing subjective and objective outcomes and return to play (RTP) after anterior cruciate ligament reconstruction (ACL-R).

Methods  Primary ACL-Rs using a transtibial technique performed between 2008 and 2012 were included. Data regarding patients, surgery, sports, and rehabilitation, including an on-field rehabilitation (OFR) and duration of the rehabilitation program, were collected. The International Knee Documentation Committee (IKDC) subjective and objective evaluation forms, and the Knee Injury and Osteoarthritis Outcome Score and Lysholm questionnaires were used for the assessment of subjective and objective outcomes. The Subjective Patient Outcome for Return to Sports and ACL–return to sport after injury (RSI) scores were used for RTP evaluation. Several potential predictors of outcome were tested with a univariate analysis. All the variables with p  < 0.1 were retested in a logistic regression model to evaluate their association with the outcomes.

Results  In total, 176 cases were included with an average follow-up of 44.1 months. Of the patients, 92.2% were rated as normal or nearly normal at the IKDC evaluation. In addition, 90.1% of the patients returned to sport, with 57.6% returning to the same preinjury level. Objective outcomes were negatively influenced by late rehabilitation (odds ratio [OR] = 2.75). Performing an OFR phase during the rehabilitation was associated with better subjective outcomes (OR = 2.71). Length of rehabilitation strongly influenced the RTP rate (OR = 13.16). Conversely, higher ACL-RSI score was inversely related to RTP. Objective IKDC score was inversely related to the ACL-RSI (OR = 0.31), whereas subjective score was correlated with both the total ACL-RSI score (OR = 0.15) and the level of activity (OR = 0.20).

Conclusion  This study confirmed the role of rehabilitation on subjective and objective outcomes and on RTP. Particularly, the complete adherence to a rehabilitation program, including an OFR phase, resulted in better subjective outcomes and higher RTP rate. The relationship between psychological factors, measured through the ACL-RSI score, and RTP was confirmed.

Level of Evidence  Level III, observational study without a control group.

Comparing the Chinese versions of two knee-specific questionnaires (IKDC and KOOS): reliability, validity, and responsiveness

BACKGROUND

The International Knee Documentation Committee Subjective Knee Form (IKDC) and the Knee Injury and Osteoarthritis Outcome Score (KOOS) are knee-specific questionnaires that have been widely used and translated into numerous languages. However, the differences in the psychometric properties between the Chinese IKDC and KOOS remain unclear. The purpose of this study was to conduct a cross-cultural adaptation of the Chinese IKDC and Chinese KOOS and to compare the psychometric properties of these two measures in patients with various knee injuries from the acute stage up to 12 weeks after receiving treatment.

METHODS

The original IKDC and KOOS were translated into Chinese based on the guidelines of cross-cultural adaptation and translation protocols. One hundred and seventy-three patients with various knee injuries were recruited in this study and completed both Chinese IKDC and Chinese KOOS as well as a generic health status questionnaire (Chinese Short Form-36 [SF-36]). The reliability, internal consistency, content validity, convergent and divergent validity and responsiveness of both IKDC and KOOS were assessed with appropriate indices.

RESULTS

The Chinese IKDC showed excellent reliability (ICC = 0.97) and strong internal consistency (Cronbach alpha = 0.87). The Chinese KOOS also presented good reliability with ICCs ranging from 0.89 to 0.95 and internal consistency (Cronbach alpha coefficients ranging from 0.76 to 0.97). The content validity of these two questionnaires were excellent, yielding no floor or ceiling effects. Both the Chinese IKDC and KOOS were highly associated with the physical component summary (PCS) score and weakly related to the mental component summary (MCS) score of the SF-36. Responsiveness to change was large (effect size =0.95) for the Chinese IKDC and moderate (effect sizes = 0.49~0.60) at 12-week after physical therapy.

CONCLUSION

Both the Chinese IKDC and KOOS demonstrated good psychometric properties. However, the Chinese IKDC was more sensitive to changes over a period of 2, 4, 8, 12 weeks of physical therapy than the Chinese KOOS. The ROC analyses revealed a value of area under the curve (0.83 for the Chinese IKDC and 0.67-0.79 for the subscales of Chinese KOOS). Minimal clinically important difference values were 9.8 for the Chinese IKDC and 0.79, 0.76, 0.76, 0.76, 0.67 for the Symptoms, Pain, Activities of Daily Living, Sport/Recreation, and Quality of Life subscales of Chinese KOOS, respectively. The current study provides information for clinicians and researchers to use these appraisal tools for Chinese-speaking patients with various knee disorders.

The Maryland Orthopaedic Registry (MOR): Design and baseline characteristics of a prospective registry

BACKGROUND

Utilization of patient-reported outcome tools allows a more accurate assessment of the efficacy of treatment, which is critical to comparative effectiveness research.

OBJECTIVES

The Maryland Orthopaedic Registry (MOR) was established to assess post-surgical outcomes related to patients' pain, functional status, met expectations, and satisfaction using an electronic data collection system. Secondary aims of the registry include assessment of patient expectations of treatment, activity level, and general health status.

METHODS

Adult patients enrolled in this prospective observational study completed self-report measures assessing pre-operative pain, function, treatment expectations, and activity levels during the perioperative period. MOR utilizes the Patient-Reported Outcomes Measurement Information System (PROMIS^®)'computer adaptive testing for physical function, pain interference, fatigue, social satisfaction, anxiety, and depression. Perioperative data is extracted from the medical record.

RESULTS

300 patients (40% of eligible) have been enrolled into the initial cohort. Most patients (94.1%) were aged 18-65, and 57% were male. Fifty-seven percent of enrollees were White, 33% Black, and 4% Asian. PROMIS physical function and social satisfaction were both more than half a standard deviation below the population mean. Participants reported PROMIS anxiety scores that were half a standard deviation above the population mean and pain interference scores that were more than a standard deviation above the mean. Physical function scores were significantly worse among participants with lower extremity orthopaedic issues, but scores on other measures were similar between participants undergoing lower or upper extremity surgery.

CONCLUSIONS

MOR provides a comprehensive assessment of patients undergoing orthopaedic surgery. The utilization of electronic clinical assessment tools as well as computer adaptive testing allows for time-efficient data collection. The diverse population is a particular strength of MOR.

The influence of graft placement on clinical outcome in anterior cruciate ligament reconstruction

PURPOSE

the aim of the present study was to investigate the influence of graft tunnel position on both clinical outcome and instrumental knee stability in patients submitted to arthroscopic ACL reconstruction using a bone-patellar tendon-bone (BPTB) graft.

METHODS

thirty patients (24 men and 6 women) who underwent ACL reconstruction performed using an autologous bone-patellar tendon-bone graft were studied at a mean follow-up of 18 months. Clinical outcome was assessed on the basis of the Lysholm score, Tegner activity level, International Knee Documentation Committee (IKDC) subjective form and the Short Form-36. Clinical outcomes were correlated with both femoral and tibial tunnel placement measured on standard anteroposterior and lateral knee radiographs, in accordance with established guidelines.

RESULTS

tibial tunnel position on the lateral view correlated significantly with both the IKDC subjective form (r = -0.72; p<0.05) and the Lysholm score (r=-0.73; p<0.05). Tibial tunnel position on the lateral view also correlated with stability measured using a KT-1000 arthrometer at 30N of force (r=0.57; p<0.05). No correlation was found between α angle and anteroposterior (AP) laxity measured by KT-1000 arthrometer. No significant correlation was found between femoral tunnel position (on either view) and Lysholm score, IKDC score and Tegner activity level. Similarly, no correlation was found between AP laxity measured by KT-1000 arthrometer and femoral tunnel position.

CONCLUSIONS

these results suggest that the more anterior the placement of the tibial tunnel, the better the clinical outcome will be. On the basis of literature data and our findings, we discuss the hypothesis that there exists a "correct area" for tunnel placement, making it possible to obtain the best results.

LEVEL OF EVIDENCE

Level IV, case series.

The International Knee Documentation Committee (IKDC) Subjective Short Form: a validity and reliability study

PURPOSE

The purpose of the present research was to translate the original English version of International Knee Documentation Committee (IKDC) Subjective Short Form to Persian and to assess validity and reliability of it in Iranian patients with ACL injury.

METHOD

The Persian version of the IKDC Subjective Short Form was administered to 145 patients including 111 men (76 %) and 34 women (24 %) with the clinical diagnosis of knee ACL tear that were referred to our Knee and Shoulder Center at Mashhad University of Medical Sciences, Mashhad, Iran. The Persian IKDC Subjective Short Form and Persian SF-36 questionnaire were completed by patients in the clinic before beginning any treatment intervention. Patients filled out the Persian IKDC 72 h again before receiving a major treatment; we were then able to use the test-retest method to calculate reliability.

RESULTS

The average age of the subjects was 30.9 ± 10.4 years. The calculated ICC with 95 % confidence interval was 0.845. In this study, Cronbach's alpha was 0.845. There were significant correlations between mean total score of the Persian IKDC and all items of the SF36 (P < 0.05) except for MCS (P = 0.055).

CONCLUSION

Cronbach's alpha and correlation of IKDC Subjective Short Form and SF-36 demonstrated that the Persian version of IKDC has both strong reliability and validity. The Iranian version of IKDC has favourable validity and reliability and therefore can be used to assess Persian-speaking patients with cruciate ligament injuries.

LEVEL OF EVIDENCE

Level II.

Cross-cultural adaptation and validation of the International Knee Documentation Committee Subjective Knee Form in Greek

Background

Patient-reported outcomes require validation in a particular language and culture before administration for clinical use.

Materials and methods

A systematic translation of the IKDC Subjective Knee Form was initially tested in 30 patients with various knee pathologies to develop the first Greek version (IKDC/SKF-GR). It was then administered to another 80 patients. The test–retest reliability (n = 35) and internal consistency (n = 80) were examined. Construct validity was tested by correlating the IKDC/SKF-GR with the SF-36 subscales (n = 80) and content validity by measuring floor/ceiling effects. Responsiveness was measured in patients with meniscus pathology (n = 24).

Results

Patients filled the form without omissions/questions regarding the phrasing of items. Internal consistency was good (Cronbach’s α = 0.87) and test–retest reliability very good (ICC_2,1 = 0.95, SEM = 4.4 and SDC = 12.2). Correlations with the SF-36 subscales confirmed its construct validity. No floor/ceiling effects were recorded. The effect size was large (ES = 1.26).

Conclusions

The IKDC/SKF-GR has comparable measurement properties to the original form.

Level of evidence

Level II.

Translation and cross-cultural adaptation of the international knee documentation committee subjective knee form into Turkish

STUDY DESIGN

Clinical measurement.

OBJECTIVE

To translate and culturally adapt the International Knee Documentation Committee (IKDC) Subjective Knee Form into Turkish and to determine selected psychometric properties of the translated version.

BACKGROUND

The IKDC Subjective Knee Form is widely used to evaluate disability associated with knee injuries, but it has not yet been translated or culturally adapted for Turkish-speaking individuals.

METHODS

The IKDC Subjective Knee Form was translated into Turkish, consistent with published methodological guidelines. The process included 2 forward translations, followed by the synthesis of these translations, and 2 backward translations, followed by an analysis of the translations and creation of the final version. The measurement properties of the Turkish IKDC Subjective Knee Form (internal consistency, construct validity, and floor and ceiling effects) were tested in 103 patients (52 male; average ± SD age, 34.9 ± 11.9 years) with a variety of knee pathologies. Reproducibility was tested in 58 patients (28 male; age, 33.7 ± 10.6 years) over 3 to 14 days, and responsiveness was tested in 33 patients (23 male; age, 30.8 ± 8.0 years) with anterior cruciate ligament reconstruction. Cronbach alpha was used to assess internal consistency, and intraclass correlation coefficients were used to estimate the test-retest reliability. Construct validity was analyzed with the Turkish version of the Lysholm knee score, the Kujala Anterior Knee Pain Scale, and the Medical Outcomes Study 36-Item Short-Form Health Survey.

RESULTS

The Turkish version of the IKDC Subjective Knee Form showed excellent internal consistency (Cronbach coefficient α = .89) and test-retest reliability (intraclass correlation coefficient = 0.91). The correlation coefficients between the IKDC Subjective Knee Form and the Lysholm knee score and Kujala Anterior Knee Pain Scale were 0.64 and 0.89, respectively (P<.001). The highest correlations between the IKDC Subjective Knee Form and the Medical Outcomes Study 36-Item Short-Form Health Survey were observed in the physical functioning subscale and the physical component summary score (r = 0.69 and r = 0.70, respectively; P<.05); the lowest correlations were observed in the mental health subscale and mental component summary score (r = 0.13 and r = 0.05, respectively). We observed no floor or ceiling effects. The IKDC Subjective Knee Form demonstrated a large effect size with the group tested (2.09; 95% confidence interval: 1.61, 2.59).

CONCLUSION

The Turkish version of the IKDC Subjective Knee Form has sufficient reliability and validity to measure patient-reported outcomes for Turkish-speaking individuals with a variety of knee disorders.

Comparison of the ceiling effect in the Lysholm score and the IKDC subjective score for assessing functional outcome after ACL reconstruction

BACKGROUND

To compare the ceiling effect of the Lysholm and IKDC subjective scores for assessing functional outcome after ACL reconstruction and evaluated the correlation with the one-leg hop test.

METHODS

A total of 134 patients who underwent ACL reconstruction between 2007 and 2011 were enrolled in this study. All patients fulfilled the postoperative 6- and 12-month evaluations. The ceiling effect of the Lysholm and IKDC subjective scores was assessed, and the correlations between two scales and one-leg hop test were analysed.

RESULTS

For the entire sample, the ceiling effect for the Lysholm score was 14.9% and 30.6% at 6 and 12 months postoperatively. The values for the IKDC subjective score were 5.2% and 17.2%, respectively. In all subjects, the correlation coefficients [95% confidence intervals] between the IKDC subjective score and one-leg hop test at 6 and 12months (r=0.492, [0.34 to 0.62]; r=0.296, [0.12 to 0.46]) were higher than those for the Lysholm score (r=0.355, [0.18 to 0.51]; r=0.241, [0.06 to 0.41]), respectively.(p<0.05).

CONCLUSION

With regard to evaluating ACL reconstruction outcomes in patients, no significant difference between the IKDC subjective and the Lysholm scores exists in terms of the amount of ceiling effect and the correlation with the LSI. However, the concern that the ceiling effect of the Lysholm score was greater than the IKDC subjective score, should be addressed in assessing the patient's functional status postoperatively.

LEVEL OF EVIDENCE

III, retrospective comparative study.

Translation and validation of the korean version of the international knee documentation committee subjective knee form

PURPOSE

To perform a cross-cultural adaptation and to test the measurement properties of the Korean version of International Knee Documentation Committee (K-IKDC) Subjective Knee Form.

MATERIALS AND METHODS

According to the guidelines for cross-cultural adaptation, translation and backward translation of the English version of the IKDC Subjective Knee Form were performed. After translation into the Korean version, 150 patients who had knee-related problems were asked to complete the K-IKDC, Lysholm score, and Short Form-36 (SF-36). Of these patients, 126 were retested 2 weeks later to evaluate test-retest reliability, and 104 were recruited 3 months later to evaluate responsiveness. Construct validity was analyzed by investigating the correlation with Lysholm score and SF-36; content validity was also evaluated. Standardized mean response was calculated for evaluating responsiveness.

RESULTS

The test-retest reliability proved excellent with a high value for the intraclass correlation coefficient (r=0.94). The internal consistency was strong (Cronbach's α=0.91). Good content validity with absence of floor not ceiling effects and good convergent and divergent validity were observed. Moderate responsiveness was shown (standardized mean response=0.689).

CONCLUSIONS

The K-IKDC demonstrated good measurement properties. We suggest that this instrument is an excellent evaluation instrument that can be used for Korean patients with knee-related injuries.

Translation and cultural adaptation of the Turkish Lysholm knee scale: ease of use, validity, and reliability

BACKGROUND

The Lysholm knee scale, first published in 1982, is an eight-item questionnaire designed to evaluate patients after knee ligament injury. However, as a tool developed in English, its use as a validated instrument has been limited to English-language populations.

QUESTIONS/PURPOSES

The objectives of this study were to test the ease of use, reliability, and validity of a Turkish-language, culturally adapted version of the Lysholm knee scale.

METHODS

The Lysholm knee scale was translated into Turkish according to Guillemin's recommendations. Seventy patients (mean age, 36 years; range, 17-72 years) with different knee complaints were included, and the scale was completed twice by each participant at 3- to 14-day intervals to assess test-retest reliability based on the interrater correlation coefficient, whereas Cronbach's alpha evaluated internal consistency. External validity was evaluated with correlations between the Lysholm knee scale, Kujala Anterior Knee Pain Scale, and SF-36. The distribution of floor and ceiling effects was determined.

RESULTS

Patients completed the Turkish-language Lysholm questionnaire in approximately 3 minutes. The test-retest reliability was 0.82, with a Cronbach's alpha coefficient of 0.68. The Lysholm knee score was strongly correlated with the Kujala Anterior Knee Pain Scale (r = 0.78). The Turkish Lysholm knee scale showed high correlations with the SF-36 physical component score (r = 0.61) and a low association with the mental component domain (r = 0.14).

CONCLUSIONS

The Turkish version of the Lysholm knee scale is quickly administered, valid, and reliable, and can be used for patients with various knee disorders.

The Videoinsight® method: improving rehabilitation following anterior cruciate ligament reconstruction--a preliminary study

PURPOSE

The purpose of this randomized double blind controlled study was to investigate if the vision of contemporary art video according to the Videoinsight(®) method could produce better short-term clinical and subjective outcomes after anterior cruciate ligament (ACL) reconstruction.

METHODS

One-hundred and six patients treated with single-bundle ACL reconstruction plus extra-articular tenodesis were enrolled in this study and randomly assigned to Group A (53 patients) and Group B (53 patients). Group A received one art video that was established to produce positive and therapeutic "insight", while Group B received one art video with an "insight" unfavourable to the psychological recovery. All patients were instructed to watch the video 3 times a week for the first 2 months during the execution of the same rehabilitative protocol. Patients were evaluated pre-operatively and 3 months after surgery with Tegner, subjective International Knee Documentation Committee (IKDC), physical and mental SF-36 scores and Tampa Scale of Kinesiophobia (TSK). Time to crutches discharge was collected at final follow-up as well.

RESULTS

Five patients were lost to follow-up and 101 patients (Group A: 51 patients; Group B: 50 patients) were available at mean 3.0 ± 0.2 months follow-up. Age at surgery was 33.0 ± 17.0 years. The two groups were homogeneous regarding pre-operative demographic data, meniscal lesions and clinical outcomes. Significant improvements were observed in Group A compared to Group B at final follow-up for subjective IKDC (82.0 ± 13.8 vs. 71.0 ± 19.7, p = 0.0470), TKS (28.1 ± 6.0 vs. 32.0 ± 5.8, p = 0.0141) and time to crutches discharge (20.9 ± 5.0 vs. 26.5 ± 8.2 days, p = 0.0012). A positive significant correlation between TSK and time to crutches discharge (r = 0.35, p = 0.0121) was observed.

CONCLUSIONS

The Videoinsight(®) method combined to adequate rehabilitation could be an effective tool in order to improve short-term clinical and functional outcomes in patients who underwent ACL reconstruction.

What symptoms are more important for korean patients in knee osteoarthritis? Development and validation of the korean knee score

PURPOSE

The purpose of this study was to develop and validate a novel knee evaluation instrument, the Korean Knee Score (KKS), to reflect a floor life style with high knee flexion. In addition, we aimed to assess the importance of high knee flexion activity for Korean patients.

MATERIALS AND METHODS

The KKS was developed following the guidelines of the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine. During development step, generated items were asked to 50 patients to determine importance and obtain an impact score for each item. A total of 634 patients were included in the validation survey.

RESULTS

Forty one items were generated and impact scores of each item about floor life style were higher than other items. The KKS exhibited excellent reliability (intraclass correlation coefficient=0.931) and strong internal consistency (Cronbach's α=0.973). The content validity was good, with no ceiling or floor effect. The construct, convergent, and divergent validities were good. Moderate responsiveness was evident, with a standardized response mean of 0.74.

CONCLUSIONS

The KKS, has good validity, reliability, and responsiveness. The KKS includes items for floor life style, which are thought more important for Korean patients. The KKS can be used as a good evaluation questionnaire for Korean knee osteoarthritis patients.

Diagnostic accuracy and association to disability of clinical test findings associated with patellofemoral pain syndrome

PURPOSE

To investigate the diagnostic accuracy and association to disability of selected functional findings or physical examination tests for patellofemoral pain syndrome (PFPS) in patients with anterior knee pain.

METHODS

A sample of 76 consecutive patients with anterior knee pain was further subdivided into PFPS and other diagnoses. Routine physical examination tests were examined in a prospective, consecutive-subjects design for a cohort of patients with anterior knee pain. Diagnostic accuracy findings, including sensitivity, specificity, positive (PPV) and negative (NPV) predictive value, and positive (LR+) and negative (LR-) likelihood ratios, were calculated for each test. PPV and NPV reflect the percentage of time of positive or a negative test (respectively) accurately captures the diagnosis of the condition. LR+ and LR- reflect alterations in post-test probability when the test is positive or negative (respectively). Lastly, associations to disability (International Knee Documentation Committee (IKDC) subjective form) were calculated for each clinical finding.

RESULTS

Diagnostic accuracy analyses of individual functional assessment and situational phenomena suggest that the strongest diagnostic test is pain encountered during resisted muscle contraction of the knee (PPV=82%; LR+=2.2; 95% CI: 0.99-5.2). Clusters of test findings were substantially more diagnostic, with any two of three positive findings of muscle contraction, pain during squatting, and pain during palpation yielding the following values: PPV=89%; LR+=4.0 (95% CI: 1.8-10.3). No individual or clustered test findings were significantly associated with the IKDC score.

CONCLUSION

Combinations of functional assessment tests and situational phenomena are diagnostic for PFPS and may serve to rule in and rule out the presence of PFPS. Single findings are not related to disability scores (IKDC).

Reliability and validity of the International Knee Documentation Committee (IKDC) Subjective Knee Form

BACKGROUND

Patient-oriented questionnaires are important measures of clinical outcomes in medical practice but require systematic testing of reliability and validity. The International Knee Documentation Committee (IKDC) Subjective Knee Form is a patient-oriented questionnaire that assesses symptoms and function in daily living activities. The purpose of this study was to validate the IKDC Subjective Knee Form in a large patient population with various knee disorders.

METHODS

One thousand five hundred and thirty-four knee patients seen at a sports medicine clinic at a large medical center completed the IKDC Subjective Knee Form. Factor structure was determined by exploratory factor analysis with promax rotation, and internal consistencies of the identified subscales were calculated with Cronbach's alpha. Concurrent validity was assessed by correlating the IKDC Subjective Knee Form dimensions to the summary scales of the SF-12. Finally, item characteristics were analysed using graded response item response theory (G-IRT).

RESULTS

Exploratory factor analyses yielded a two-factor solution, and the dimensions were termed as follows: symptom and knee articulation (SKA), and activity level (AL). Confirmatory factor analysis confirmed the selection of 15 items within the study. Both SKA and AL demonstrated good internal consistency (0.87 for SKA; 0.88 for AL). Both SKA and AL demonstrated statistically significant correlations to the SF-12 total score, more substantively to the physical component summary scale than to the mental component summary scale of the SF-12.

DISCUSSION

G-IRT analyses revealed that nearly all questionnaire items demonstrated clear response patterns, with higher levels of the latent trait corresponding to more adaptive clinical endpoints concerning pain, symptoms, function, and sport activity.

CONCLUSIONS

The IKDC is a reliable and valid instrument worthy of consideration for use in a broad patient population.