Health-related quality of life after anterior cruciate ligament reconstruction

The Relationship of Knee-related Quality of Life With Function, Psychological Factors, Strength, Performance, and Postural Stability After ACL Reconstruction: A Cross-Sectional Study

BACKGROUND

Patients after anterior cruciate ligament reconstruction (ACLR) have decreased health-related quality of life (QoL) compared with healthy control participants. Few studies have verified the predictors of QoL using Quality of Life Outcome Measure Questionnaire for Chronic Anterior Cruciate Ligament Deficiency (ACL-QoL), and no study has verified the relationship of psychological factors and knee function with ACL-QoL in patients after ACLR.

HYPOTHESIS

Knee functional status, muscle strength, performance in hop tests, postural stability, and psychological factors would be the predictors of QoL after ACLR.

STUDY DESIGN

Cross-sectional study.

LEVEL OF EVIDENCE

Level 4.

METHODS

A total of 131 participants who had undergone ACLR at least 6 months previously were evaluated. QoL was assessed using ACL-QoL; knee functional status, using International Knee Documentation Committee Subjective Knee (IKDC) and global rating scale (GRS); psychological readiness, using Anterior Cruciate Ligament Return to Sport after Injury Scale (ACL-RSI); kinesiophobia, using Tampa Scale for Kinesiophobia (TSK-17); knee strength, using isokinetic dynamometer; performance, using single-leg hop tests; and postural stability, using Biodex Balance System. Pearson's linear correlation and stepwise hierarchical multiple linear regression analyses were performed to verify the predictors of QoL.

RESULTS

ACL-QoL showed a moderate correlation with IKDC (r = 0.69), GRS (r = 0.55), ACL-RSI (r = 0.50), and TSK-17 (r = -0.49). ACL-QoL presented none to low correlations with the variables of muscle strength, postural stability, and performance in hop tests. The variables related to the knee functional status and psychological factors (IKDC, GRS, ACL-RSI, and TSK-17) were found to be the predictors of QoL (R2 = 0.56; P = 0.01).

CONCLUSION

Knee functional status, psychological readiness, and kinesiophobia were the predictors of knee-related QoL in patients after ACLR.

CLINICAL RELEVANCE

These results can assist clinicians in the therapeutic monitoring of the factors that may interfere with QoL in patients after ACLR.

The knee function of the soccer players after ACLR is comparable with non-injured controls: A case-control study

PURPOSE

Many studies report a high primary success rate of ACL reconstruction (ACLR), with an increased risk of decline in knee performance correlating with the time passed since surgery. Only one study has compared male soccer players after ACLR to a matched control group of uninjured players in terms of their return to sport and performance. The purpose of this cross-sectional case-control study was to determine the knee performance between soccer players after ACLR and control group matched by age, sex, and professional experience.

METHODS

All the male professional soccer players aged 18-36 years at the time of injury, who sustained an ACL tear while playing league soccer in Poland between January 2008 and December 2011 were contacted and compared with age and experience-matched healthy control group selected from professional football players. KOOS, IKDC-2000, Lysholm and SF-36 scales were used for comparison.

RESULTS

The average follow-up was 7.9 years (range 6-9 years). The ACL-injured soccer players scored significantly lower in IKDC and Lysholm scores compared with the reference group but still were classified as normal knee function in both scales. In all five dimensions of the KOOS and subscales of SF-36 no apparent differences were noted. In all scales in the study group, no correlation was observed between the player's age and follow-up time after ACLR.

CONCLUSION

After ACL reconstruction and successful return to professional sport, knee function is as good as uninjured team members in the midterm follow-up.

LEVEL OF EVIDENCE

III.

Surface-Related High School Football Game Injuries on Pad and No-Pad Fields

BACKGROUND

Artificial turf fields are increasingly being installed with lighter weight infill systems that incorporate a pad underlayer, which is reported to reduce surface shock and decrease injuries. At this time, the effects of a pad underlayer on football trauma are unknown.

HYPOTHESIS

Athletes would not experience differences in surface-related injuries between pad and no-pad fields.

STUDY DESIGN

Cohort study; Level of evidence, 2.

METHODS

Artificial turf fields were divided into 2 groups based on a pad underlayer or no-pad system, with 58 high schools participating across 3 states over the course of 7 seasons. Outcomes of interest included injury severity, head and knee trauma, injury category, primary type of injury, injury mechanism, anatomic location of trauma, tissue type injured, and elective imaging and surgical procedures. Data underwent multivariate analyses of variance (MANOVA) using general linear model procedures and were expressed as injury incidence rates per 10-game season.

RESULTS

Of 658 varsity games, 260 games were played on fields containing pads, and 398 games were played on no-pad fields, with 795 surface-related injuries reported. MANOVA indicated significant main effects by injury severity (F_3,791 = 11.436; P < .0001), knee trauma (F_9,785 = 2.435; P = .045), injury category (F_3,791 = 3.073; P < .0001), primary type of injury (F_10,785 = 2.660; P < .0001), injury mechanism (F_13,781 = 2.053; P < .001), anatomic location (F_16,778 = 1.592; P < .001), type of tissue injured (F_4,790 = 4.485; P < .0001), and elective imaging and surgical procedures (F_4,790 = 4.248; P < .002). Post hoc analyses indicated significantly greater incidences (P < .05) of substantial and severe injury, player-to-turf trauma, patellofemoral syndrome, neck strain, lower leg strain, and elective imaging and surgical procedures when games were played on padded turf fields. No differences in concussion rate from turf impact between pad and no-pad fields were observed.

CONCLUSION

In contrast to conventional wisdom, the addition of a pad under an artificial turf surface increases injury rates when compared with nonpadded fields across most injury categories. At this time, findings do not support the current trend of installing lightweight padded infill systems at the high school level of play.

No Difference in Outcome of Anterior Cruciate Ligament Reconstruction with "Bone-patellar Tendon-bone versus Semitendinosus-gracilis Graft with Preserved Insertion": A Randomized Clinical Trial

BACKGROUND

The type of graft for anterior cruciate ligament (ACL) reconstruction is still a topic of debate and there is still no clear consensus on the ideal graft for ACL reconstruction.

PURPOSE

This study was conducted to compare the outcome of ACL reconstruction surgery between hamstring tendon graft and bone-patellar tendon-bone (BPTB) graft.

MATERIALS AND METHODS

One hundred and sixty professional athletes were enrolled in the study. They were divided into two groups by computerized randomization. In Group I, ACL reconstruction was done using BPTB graft, and in Group II, ACL reconstruction was done using semitendinosus gracilis graft with preserved tibial insertion (STGPI). Postoperatively, patients were assessed for knee stability, Lysholm score, and WOMAC score.

RESULTS

Mean KT-1000 side-to-side difference at 1 year was 2.31 ± 1.68 mm in BPTB cohort and 2.52 ± 1.6 mm in STGPI cohort (P = 0.4); and at 2 years, it was 1.98 ± 1.62 mm in BPTB cohort and 2.23 ± 1.6 mm in STGPI cohort (P = 0.4). Mean Lysholm score at 2 years was 96.1 ± 5.81 in STGPI cohort and 97.3 ± 4.62 in BPTB cohort (P = 0.15). Mean WOMAC score at 2 years was 3.3 ± 2.76 in STGPI cohort and 2.84 ± 2.21 in BPTB cohort (P = 0.25). Graft rupture rate was 3.75%; 3 patients in each group had graft rupture. Kneeling pain was present in 15% (12/80) of patients with BPTB graft whereas none of the patients in STGPI cohort had kneeling pain.

CONCLUSION

There was no difference between two grafts in term of knee stability, visual analog scale score and functional outcome. However, hamstring tendon graft is associated with less donor site morbidity.

Monitoring changes in knee surface morphology after anterior cruciate ligament reconstruction surgery using 3Dsurface scanning

STUDY DESIGN

Prospective case series.

BACKGROUND

After surgical reconstruction of the anterior cruciate ligament, recovery to pre-injury levels of knee function is challenging. Postoperative edema and muscle atrophy are common roadblocks to full function and are evident in changes to the surface morphology of the knee. There are currently few accessible objective tools to accurately track these morphological changes.

OBJECTIVES

We aimed to determine if 3D surface scanning can be used to monitor changes in the external shape of the knee after surgery and throughout the rehabilitation process.

METHODS

Thirty participants had 3D surface scans taken of their knee, along with questionnaire-based functional outcomes prior to surgery (baseline), and at two-week, six-week, 12-week, and 26-week timepoints post-surgery. Volumetric changes relative to pre-op were assessed using generalized linear growth models for key anatomical regions and correlated with functional outcomes.

RESULTS

Significant swelling of the patella region compared to baseline was evident immediately after surgery (14%, p < 0.001), before returning to pre-operative levels. Changes in volume at this region were significantly associated with patient-reported functional outcomes. Reductions in volume of the regions corresponding to the vastus medialis and lateralis muscles were significant at 12 weeks post-surgery (p = 0.018 and 0.01 respectively) but returned to baseline levels at six months.

CONCLUSION

We demonstrate the use of 3D surface scanning as a method for capturing detailed measurements of knee surface morphology after surgery. Significant changes in external morphology are evident during the rehabilitation process.

Creating value in spine surgery: using patient reported outcomes to compare the short-term impact of different orthopedic surgical procedures

BACKGROUND CONTEXT

Society increasingly asks Medicine to create "value" for patients. As health-care costs rise, this question will become more important. Debate exists regarding the relative "value" of many surgical procedures, including spinal surgery. Comparison of the relative value that patients experience after different orthopedic procedures is theoretical, but informs the ongoing debate.

METHODS

The Patient Reported Outcome Measurement Information System (PROMIS) assessments for Physical Function, Pain Interference, and Depression are routinely collected in our orthopedic clinics. Patients who underwent lumbar discectomy (DSC) or arthroscopic anterior cruciate ligament reconstruction (ACLR) were retrospectively identified. Data relating to PROMIS domains, patient demographics, and other relevant encounter details were extracted. The primary outcomes were (1) preoperative PROMIS domain scores, (2) scores at a minimum of 40 days postoperatively for DSC patients and 133 days postoperatively for ACLR patients, and (3) the change in scores with surgery. Propensity score matching identified age-, sex-, race-, and comorbidity-matched groups from each cohort. Chi-square tests and nonparametric Kruskal-Wallis tests compared the distribution of outcomes and characteristics. Multivariate linear regression models with interactions between the matched cohort and operative phase estimated the change in the outcomes scores between the two cohorts and controlled for the baseline differences between them.

RESULTS

Before surgery, the DSC cohort had lower physical function, higher pain interference and higher depression scores as compared with the ACLR cohort. This pattern remained postoperatively, indicating less desirable outcomes for DSC patients. However, after controlling for their baseline scores, DSC patients experienced significantly greater improvements after surgery of 3.84 (95% CI 1.08-6.60; p=.01), -4.87 (95% CI -7.52 to -2.23; p<.001), and -2.95 (95% CI -5.70 to -0.21; p=.04) points in their physical function, pain interference, and depression scores, respectively, as compared with ACLR patients.

CONCLUSIONS

Based upon PROMIS assessments at short-term follow-up, DSC patients receive a larger benefit from surgery than ACLR despite the overall less desirable postoperative PROMIS scores in the DSC cohort. This result, while theoretical, informs the debate regarding the comparative value of DSC to patients.

No Difference in Outcome of Anterior Cruciate Ligament Reconstruction with "Bone-patellar Tendon-bone versus Semitendinosus-gracilis Graft with Preserved Insertion:" A Randomized Clinical Trial

BACKGROUND

The type of graft for anterior cruciate ligament (ACL) reconstruction is still a topic of debate and there is still no clear consensus on the ideal graft for ACL reconstruction.

PURPOSE

This study was conducted to compare the outcome of ACL reconstruction surgery between hamstring tendon graft and bone-patellar tendon-bone (BPTB) graft.

MATERIALS AND METHODS

One hundred and sixty professional athletes were enrolled in the study. They were divided into two groups by computerized randomization. In Group I, ACL reconstruction was done using BPTB graft, and in Group II, ACL reconstruction was done using semitendinosus gracilis graft with preserved tibial insertion (STGPI). Postoperatively, patients were assessed for knee stability, Lysholm score, and WOMAC score.

RESULTS

Mean KT-1000 side-to-side difference at 1 year was 2.31 ± 1.68 mm in BPTB cohort and 2.52 ± 1.6 mm in STGPI cohort (P = 0.4); and at 2 years, it was 1.98 ± 1.62 mm in BPTB cohort and 2.23 ± 1.6 mm in STGPI cohort (P = 0.4). Mean Lysholm score at 2 years was 96.1 ± 5.81 in STGPI cohort and 97.3 ± 4.62 in BPTB cohort (P = 0.15). Mean WOMAC score at 2 years was 3.3 ± 2.76 in STGPI cohort and 2.84 ± 2.21 in BPTB cohort (P = 0.25). Graft rupture rate was 3.75%; 3 patients in each group had graft rupture. Kneeling pain was present in 15% (12/80) of patients with BPTB graft whereas none of the patients in STGPI cohort had kneeling pain.

CONCLUSION

There was no difference between two grafts in term of knee stability, visual analog scale score and functional outcome. However, hamstring tendon graft is associated with less donor site morbidity.

Cost-utility analysis of dynamic intraligamentary stabilization versus early reconstruction after rupture of the anterior cruciate ligament

OBJECTIVES

The aim of this study was to evaluate the cost-effectiveness of the dynamic intraligamentary stabilization (DIS) technique in comparison with reconstructive surgery (ACLR) in the treatment of isolated anterior cruciate ligament (ACL) ruptures from the perspective of the community of insured citizens in Germany.

METHODS

Because of the specific decision problem at hand, namely that with DIS the procedure has to take place within 21 days after the initial trauma, a decision tree was developed. The time horizon of the model was set to 3 years. Input data was taken from official tariffs, payer data, the literature and assumptions based on expert opinion when necessary.

RESULTS

The decision tree analysis identified the DIS strategy as the superior one with 2.34 QALY versus 2.26 QALY for the ACLR branch. The higher QALY also came with higher costs of 5,398.05 € for the DIS branch versus 4,632.68 € for the ACLR branch respectively, leading to an ICER of 9,092.66 € per QALY. Results were robust after sensitivity analysis. Uncertainty was examined via probabilistic sensitivity analysis resulting in a slightly higher ICER of 9,567.13 € per QALY gained.

CONCLUSION

The DIS technology delivers an effective treatment for the ACL rupture at a favorable incremental cost-effectiveness ratio.

Knee Stability and Movement Coordination Impairments: Knee Ligament Sprain Revision 2017

The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). The purpose of these revised clinical practice guidelines is to review recent peer-reviewed literature and make recommendations related to knee ligament sprain. J Orthop Sports Phys Ther. 2017;47(11):A1-A47. doi:10.2519/jospt.2017.0303.

A two- and five-year follow-up of clinical outcome after ACL reconstruction using BPTB or hamstring tendon grafts: a prospective intervention outcome study

PURPOSE

The aim of the present study was to evaluate and compare objective and subjective outcome in patients 2 and 5 years after anterior cruciate ligament (ACL) reconstruction with either bone-patellar tendon-bone (BPTB) or hamstring grafts. The second aim was to report the prevalence of re- and contralateral ACL ruptures.

METHODS

Sixty-eight patients (BPTB, n = 34 and hamstring graft, n = 34) were evaluated preoperatively, 2 and 5 years after ACL reconstruction. Anterior knee laxity and rotational knee joint stability, muscle torque, hop length, anterior knee pain, activity level and self-reported knee function and quality of life were evaluated within and between groups. The prevalence of re- and contralateral ACL ruptures was also recorded.

RESULTS

No significant difference in anterior knee laxity, rotational knee joint stability, hop length anterior knee pain or knee function and quality of life were noted at the 5-year follow-up. No significant differences in concentric or eccentric quadriceps torque at 90°/s and 230°/s were found at any of the follow-ups between and within grafts. A significant group difference in hamstring torque 1.05 (0.02) for BPTB and 0.89 (0.02) for hamstring grafts, and in hop length (leg symmetry index) follow-up 0.94 (0.07) for BPTB compared to 0.99 (0.07) for hamstring grafts (P = 0.002) was found at the 2 year follow-up in favour of the BPTB graft, but not at the 5 year follow-up. A significant improvement over time, irrespective of graft, was found in the KOOS's subscales Sport/Rec and quality of life (P < 0.001). None of the patients, irrespective of group, returned to their pre-injury level of sport (P < 0.05). Over the five postoperative years, one man and eight women (13 %) (hamstring graft, n = 5 and BPTB graft, n = 4), sustained a total of 11 (16.2 %) new ACL ruptures: seven (10.2 %) re-ruptures and four (5.9 %) ruptures of the contralateral ACL.

CONCLUSIONS

At the 5-year follow-up, there were no significant differences in terms of anterior knee laxity, rotational knee joint stability, muscle torque, anterior knee pain, hop performance, quality of life or activity level between patients who had undergone reconstruction with BPTB or hamstring grafts. None of the patients, irrespective of group, had returned to their pre-injury level of activity. Eight out of the nine patients who had sustained a second ACL rupture were women.

Long-term clinical and radiographic results after delayed anterior cruciate ligament reconstruction in adolescents

BACKGROUND

The risk of further intra-articular damage associated with nonoperative or delayed anterior cruciate ligament (ACL) reconstruction must be considered against the risk of growth disturbance with early reconstruction and transphyseal drilling. Long-term follow-ups after the surgical treatment of ACL injuries in adolescents are rare.

PURPOSE

To evaluate results 10 to 20 years after ACL reconstruction in terms of the radiographic presence of osteoarthritis, clinical assessments, and health-related quality of life in patients who were adolescents at the time of surgery.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

Thirty-two adolescents (mean age, 15.2 years [range, 12-16 years]; 11 boys, 21 girls), with a symptomatic unilateral ACL rupture, underwent reconstruction using bone-patellar tendon-bone (n=10) or hamstring tendon (n=22) autografts at an almost skeletally mature age according to Tanner stage 4. Twenty-nine patients (91%) underwent clinical, radiographic, and health-related quality of life assessments after 10 to 20 years (mean, 175 months).

RESULTS

The mean time between the injury and index surgery was 11.6 months. The reconstructed knee had significantly more osteoarthritic changes compared with the noninvolved contralateral knee (P=.001). Preoperatively, the median Tegner activity level was 4 (range, 2-8), and the median Lysholm knee score was 75 (range, 50-90) points. At follow-up, the respective median values were 4 (range, 1-7) and 84 (range, 34-100) points (P=not significant [preoperatively vs follow-up]). The median finding for the single-legged hop test was 84% (range, 0%-105%) preoperatively and 93% (range, 53%-126%) at follow-up (P=.01). At follow-up, muscle strength measurements displayed more than 90% of the noninvolved leg in both extension and flexion. The manual Lachman test result was significantly improved at follow-up compared with preoperatively (P<.001). The 36-item Short Form Health Survey (SF-36) revealed scores comparable with those of healthy controls. The mean EuroQol (EQ-5D) score was 0.86±0.12. The Knee injury and Osteoarthritis Outcome Score (KOOS) values were lower in all dimensions compared with age-matched healthy controls.

CONCLUSION

In the long term, patients who were adolescents at the time of ACL reconstruction revealed significantly more radiographically visible osteoarthritic changes in their operated knee than in their noninvolved contralateral knee. Clinical outcomes and health-related quality of life are comparable with those of healthy controls.

Use of the short form health surveys as an outcome measure for anterior cruciate ligament reconstruction

PURPOSE

The purpose of the study was to report SF-36 data from a large cohort with anterior cruciate ligament (ACL) reconstruction surgery and compare between the SF-36 and SF-12.

METHODS

1,500 patients completed the SF-36 at a minimum 12 months following ACL reconstruction surgery. The items which make up the SF-12 were selected and subscale scores were calculated and compared with the SF-36. The physical and mental component summary scores were calculated for both versions and correlated with disease-specific outcomes and were compared between different patient groups. In addition, the percentage of patients with below average, average, or above average general health was tabulated.

RESULTS

Over 90% of the cohort scored in the average or above average range for both physical and mental health component summary scores. Correlations between SF-36 and SF-12 scores were above 0.8 for all subscales except general health. Mean differences between the two versions were small except for the bodily pain subscale for which the SF-12 was 8.17 points higher than the SF-36 (0-100 scoring). For both versions, disease-specific measures were more highly correlated with the physical component score than the mental component score. Both versions were able to similarly distinguish between primary and revision procedures and groups that were and were not participating in sports.

CONCLUSIONS

Following ACL reconstruction, patients generally have excellent health. The SF-12 provides a simple health outcome assessment following ACL reconstruction surgery and is an adequate alternative for the SF-36 for measures made at a single time point. The bodily pain subscale for the SF-12 may lack sensitivity, and disease-specific measures of pain should therefore also be included.

LEVEL OF EVIDENCE

I.

ACL reconstruction: do outcomes differ by sex? A systematic review

BACKGROUND

Anterior cruciate ligament (ACL) reconstruction is frequently performed to restore knee stability and function following ACL injury. Female sex is known to predispose to ACL injury; however, it remains unclear whether female sex predisposes to poor outcomes following ACL reconstruction. We hypothesized that male and female patients exhibit no differences in (1) graft failure risk, (2) contralateral ACL injury risk, (3) knee laxity, and (4) patient-reported outcome scores following ACL reconstruction.

METHODS

A systematic review of the literature was performed to identify studies in which results of ACL reconstruction were reported by sex at a minimum of two years. Study findings were reviewed, and meta-analysis was performed when data were sufficiently homogenous.

RESULTS

Thirteen studies were identified from the literature review. Meta-analysis revealed no difference in graft failure risk (eight studies), contralateral ACL rupture risk (three studies), or postoperative knee laxity on physical examination (six studies). There was no evidence of a clinically important difference in patient-reported outcomes according to sex.

CONCLUSIONS

Results of ACL reconstruction were similar in male and female patients. More high-quality studies are needed to further evaluate these findings.

A multisport epidemiologic comparison of anterior cruciate ligament injuries in high school athletics

BACKGROUND

The knee joint is the second most commonly injured body site after the ankle and the leading cause of sport-related surgeries. Knee injuries, especially of the anterior cruciate ligament (ACL), are among the most economically costly sport injuries, frequently requiring expensive surgery and rehabilitation.

OBJECTIVE

To investigate the epidemiology of ACL injuries among high school athletes by sport and sex.

DESIGN

Descriptive epidemiology study.

MAIN OUTCOME MEASURE(S)

Using an Internet-based data-collection tool, Reporting Information Online (RIO), certified athletic trainers from 100 nationally representative US high schools reported athlete-exposure and injury data for athletes from 9 sports during the 2007/08-2011/12 academic years. The outcome of interest in this study was ACL injuries.

RESULTS

During the study period, 617 ACL injuries were reported during 9 452 180 athlete exposures (AEs), for an injury rate of 6.5 per 100 000 AEs. Nationally, in the 9 sports studied, an estimated 215 628 ACL injuries occurred during the study period. The injury rate was higher in competition (17.6) than practice (2.4; rate ratio [RR] = 7.3, 95% confidence interval [CI] = 6.08, 8.68). Girls' soccer had the highest injury rate (12.2) followed by boys' football (11.1), with boys' basketball (2.3) and boys' baseball (0.7) having the lowest rates. In sex-comparable sports, girls had a higher rate (8.9) than boys (2.6; RR = 3.4, 95% CI = 2.64, 4.47). Overall, 76.6% of ACL injuries resulted in surgery. The most common mechanisms of injury were player-to-player contact (42.8%) and no contact (37.9%).

CONCLUSIONS

Anterior cruciate ligament injury rates vary by sport, sex, and type of exposure. Recognizing such differences is important when evaluating the effectiveness of evidence-based, targeted prevention efforts.

Donor-site-related functional problems following anterior cruciate ligament reconstruction: development of a self-administered questionnaire

PURPOSE

To develop a self-administered questionnaire for the evaluation of donor-site-related functional problems after anterior cruciate ligament (ACL) reconstruction with autograft harvested from the hamstring tendon or patellar tendon and to determine the content validity, reliability and preliminary factor structure of this new instrument.

METHODS

Seven physiotherapists with long clinical experience of rehabilitation after ACL reconstruction and 60 patients from the target population participated as experts in the developmental stages of the questionnaire. Content validity was determined and quantified with the content validity index (CVI). Test-retest reliability, internal consistency and factor structure were evaluated in another 64 patients reconstructed with an autograft.

RESULTS

The final questionnaire included 16 items on symptoms and function during activities of daily living and exercise. Excellent content validity on both item level (I-CVI ≥ 0.83, range 0.83-1.00) and scale level (S-CVI = 0.93) was found. The test-retest reliability was good, ICC = 0.94. Internal consistency was high, and Cronbach's α was 0.92 and 0.94 at each test occasion. The principal components analysis yielded a four-component structure.

CONCLUSIONS

The questionnaire "Donor-site-Related Functional Problems following Anterior Cruciate Ligament (ACL) Reconstruction" is a patient-reported questionnaire with high content validity and reliability for the evaluation of donor-site-related functional problems after ACL reconstruction, with autograft harvested from the hamstring tendon or patellar tendon. The results of this study support the use of this questionnaire as a standardized outcome measure for both research purposes and in clinical settings.

Knee instruments and rating scales designed to measure outcomes

In this article, the knee instruments and rating scales that are designed to measure outcomes are revised. Although the International Knee Documentation Committee Subjective Knee Form can be used as a general knee measure, no instrument is currently universally applicable across the spectrum of knee disorders and patient groups. Clinicians and researchers looking to use a patient-based score for measurement of outcomes must consider the specific patient population in which it has been evaluated. The Western Ontario and McMaster Universities Osteoarthritis Index is recommended for the evaluation of treatment effect in persons with osteoarthritis (OA). This is a generic health status questionnaire that contains 36 items, is widely used, and easy to complete. The Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire evaluates the functional status and quality of life (QoL) of patients with any type of knee injury who are at increased risk of developing OA; i.e., patients with anterior cruciate ligament (ACL) injury, meniscus injury, or chondral injury. So far, the KOOS questionnaire has been validated for several orthopedic procedures such as total knee arthroplasty, ACL reconstruction, and meniscectomy. The utilization of QoL questionnaires is crucial to the adequate assessment of a number of orthopedic procedures of the knee. The questionnaires are generally well accepted by the patients and open up new perspectives in the analysis of prognostic factors for optimal QoL of patients undergoing knee surgery.