Responsiveness of the International Knee Documentation Committee Subjective Knee Form

Background and PURPOSE: The International Knee Documentation Committee Subjective Knee Form was developed to measure change in symptoms, function, and sports activity in patients treated for a variety of knee conditions. Although previous research has demonstrated reliability and validity of the form, its responsiveness has not been evaluated. The purpose of this study was to determine responsiveness of the International Knee Documentation Committee Subjective Knee Form. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 1. METHODS: Patients who participated in the original validation study for the International Knee Documentation Committee Subjective Knee Form completed the form and a 7-level global rating of change scale that ranged from greatly worse to greatly better after a mean of 1.6 years (range, 0.5-2.3 years). Analyses included calculation of the standardized response mean and mean change in International Knee Documentation Committee Subjective Knee Form score compared to the patient's perception of change on the global rating of change scale. In addition, a receiver operating characteristic curve was plotted to determine the change in score that best distinguished patients who improved from those who did not. RESULTS: The overall standardized response mean was 0.94, which is considered large. With the exception of those who were slightly worse or unchanged, the mean change in the International Knee Documentation Committee Subjective Knee Form score compared to the patients' perceived global ratings of change was as expected (greatly worse, -15.1; somewhat worse, -8.4; slightly worse, 20.6; no change, 10.7; slightly better, 5.9; somewhat better, 18.1; greatly better, 38.7). The receiver operating characteristic curve analysis revealed that a change score of 11.5 points had the highest sensitivity, and a change score of 20.5 points had the highest specificity to distinguish between those who were or were not improved. CONCLUSION: The International Knee Documentation Committee Subjective Knee Form is a responsive measure of symptoms, function, and sports activity for patients with a variety of knee conditions.     

Ultrasonography of the Knee

Musculoskeletal ultrasonography (MSUS) is a radiologic modality that can help in the evaluation of the knee and its lesions. Both soft tissue and surface bony structures can be sonographically visualized. The extra-articular structures of the knee can be evaluated, specifically the ligaments, bursae, and tendons. Collateral ligaments and the extensor mechanism, especially quadriceps and patellar tendons, are readily visualized. The diagnosis of a Baker's cyst and its complications is a common indication. The intra-articular structures of the knee, with proper maneuvers and transducers, can also be evaluated. The femoral condylar and patella cartilage can be examined for traumatic or degenerative lesions. The anterior and posterior cruciate ligaments can be partially visualized directly, or evaluated indirectly. Loose bodies are readily detectable whether intra-articular or extraneous in a Baker's cyst. Synovial disease can be characterized without the use of radiographic contrast. MSUS can be used as a screening, diagnostic or follow-up radiologic tool in the diseases of the knee.     

Bracing the Unstable Knee

An athlete with knee ligament damage is often forced to quit or wear a brace. But which one? Before deciding, physicians and patients should gather information on several of the new functional braces on the market.     

MR Arthrography of the Knee

The role of magnetic resonance imaging (MRI) in the evaluation of musculoskeletal injuries has been well documented during the last decade. There remain several important clinical situations in which noncontrast MRI has been disappointing. In the knee, magnetic resonance arthrography (MRA) can supplement noncontrast MRI in the evaluation of specific conditions, such as postoperative meniscus and osteochondritis dissecans. MRA significantly increases accuracy in the diagnosis of meniscal retear, as is seen in cases in which there has been a meniscal resection of more than 25% or after meniscal suturing. Also, in the evaluation of osteochondritis dissecans, the addition of intra-articular contrast has proved beneficial. Aside from assessing the integrity of the articular cartilage surface and documenting loose bodies, the contrast allows the clinician to distinguish fibrovascular granulation tissue from fluid partially or completely surrounding the osteochondritic fragment. These topics are discussed in this article.     

Muscular Strength and the Knee

IN BRIEF: The diagnosis and treatment of acute ankle injuries present challenges to both primary care physicians and orthopedic specialists. Determining the position of the ankle when the injury occurred may help distinguish sprains from fractures so that unnecessary x-rays can be avoided. Stepwise rehabilitation restores function and diminishes the risk of reinjury. Physicians can stress functional measures of recovery to objectively assess readiness for return to play and balance the risks of incomplete rehabilitation against the desire for an early return to sports.     

Mapping Sensation Inside the Knee

‘Highlights’ presents summaries of sports medicine-related articles culled from more than 30 medical journals. Experts comment on what the new findings add to current medical thinking and on the implications for practice.     

Runner's Knee

A systematic approach to knee problems by anatomical location of symptoms helps the physician make a specific diagnosis. The aim is to keep the runner running, so treatment is conservative whenever possible.     

Translation and validation of the Dutch version of the International Knee Documentation Committee Subjective Knee Form

BACKGROUND: For knee-related surgery, there is a great demand for internationally useable subjective scoring systems. Before such measurements can be used, they should be translated and validated for the population they are used on. For the Dutch population, only the Western Ontario and McMaster Universities Osteoarthritis Index and Oxford 12 Questionnaire have been validated. However, these scores can only be used regarding osteoarthritis of the knee. In 2001, the International Knee Documentation Committee presented the Subjective Knee Form, which is a knee-specific rather than a disease-specific questionnaire. STUDY DESIGN: Cohort study (diagnosis/symptom prevalence); Level of evidence, 2. METHODS: The authors describe the translation procedure and validation of the Dutch Subjective Knee Form. After a forward-backward translation protocol, the reliability, validity, and content validity were tested. The responses of 145 consecutive knee patients on 2 questionnaires containing the Short Form-36, Western Ontario and McMaster Universities Osteoarthritis Index, Oxford 12 Questionnaire score, a visual analog scale, and the Dutch International Knee Documentation Committee Subjective Knee Form were used. Reliability was tested by measuring the test-retest reliability and internal consistency. Validity was tested by correlating the questionnaire to the other outcome measurements, and content validity was tested by measuring the floor and ceiling effects. RESULTS: The reliability proved excellent with an intraclass coefficient of 0.96 for test-retest. Internal consistency was strong (Cronbach alpha, .92). The construct, convergent, and divergent validities were good. The content validity was good; no floor or ceiling effect occurred. CONCLUSION: The validation procedure shows that the Dutch International Knee Documentation Committee Subjective Knee Form is an excellent evaluation instrument for Dutch patients with knee-related injuries.     

Examination of the Acutely Injured Knee

Diagnosing an acute ligament tear is difficult for physicians who don't regularly deal with the knee. This article outlines the procedures for differentiating treatable injuries from those requiring more specialized care.     

Knee instability: the orthopedic approach

Clinical management of knee ligament injuries ranges from simple observation to complex multiligament reconstruction. Radiographic evaluation, including magnetic resonance imaging, is an important part of the diagnostic regimen that may significantly alter the treatment plan. This article reviews the clinical presentation and evaluation of isolated and combined knee ligament injuries and presents the indications, utility, and clinical impact of radiographic imaging on surgical management.