Knee Outcome Survey-Activities Of Daily Living Scale Research Articles

Reliability and validity of the Turkish version of the patellofemoral pain severity scale in patients with patellofemoral pain syndrome

Purpose The aim of this study was to investigate the Turkish validity and reliability of the Patellofemoral Pain Severity Scale (PSS) in patients with patellofemoral pain (PFP) and to adapt it to Turkish. Materials and methods A pilot study was conducted with 10 patients. 123 patients underwent PSS test-retest at 24–48 h intervals. Construct validity, correlations of PSS with other scales Timed Up and Go Test (TUG), Stair Climbing and Descending Test (SCD), Anterior Knee Pain Scale (AKPS), Tegner Activity Scale (TAS), Lysholm Knee Scoring Scale (LDSS), Knee Outcome Survey Activities of Daily Living Scale (KOS-ADL) were evaluated. Results The content validity index value of the scale was 0.95. The overall internal consistency (Cronbach α: 0.88) was high. Item-total correlations of the scale were between 0.51 and 0.7. In the evaluation of the convergent validity of the PSS, it was found that there was a positive correlation between the PSSS and TUG and SCD, and a negative correlation between the PSS, TAS, LDSS and KOS-ADL (p = 0.000). Conclusions In this study, it was determined that the PSSS scale had good internal consistency, test-retest validity and adequate construct validity when compared with the KOS-ADL, LDSS and AKPS.

Mosaicplasty/Osteochondral Autograft Transfer Remains a Durable Solution for Symptomatic Chondral Defects of the Knee: Two to Ten-Year Follow-up Analysis

Objectives: Little to no long-term data exist following mosaicplasty/osteochondral autograft transfer (OATS). The purpose was to assess the long-term outcomes of osteochondral autograft transfer in terms of patient-reported outcomes, reoperation rates, and conversion to arthroplasty. Methods: Between September 1999 through April 2021, 63 patients who underwent mosaicplasty were queried from an institutional cartilage registry with patient reported outcome measures (PROMs), including the 36-Item Short Form Survey (SF-36), the Knee Outcome Survey Activities of Daily Living Scale (KOS-ADLS), and the International Knee Documentation Committee Subjective Knee Form (IKDC) for OATS surgical procedures from the practice of six fellowship-trained knee specialists. Inclusion criteria were patients treated with mosaicplasty with preoperative PROMs and minimum two-year follow-up. Exclusion criteria were prior ipsilateral surgical procedures, advanced osteoarthritis, revision cartilage procedures, inflammatory arthropathy, or loss to follow-up. The preoperative and minimum two-year clinical outcomes with respect to the SF-36 score, reoperation rates, and conversion to arthroplasty were analyzed Results: Mean age was 27.4 ± 12.4 years and 20/63 (31.7%) were female with a mean follow-up of 5.7 ± 3.2 years. The mean lesion size was 2.3 ± 1.6 cm2 requiring a mean of 2.2 ± 1.3 autograft plugs. Mean IKDC and KOS-ADL increased from 46.4 ± 15.1 and 64.4 ± 16.3 preoperatively to 70.4 ± 22.6 and 83.8 ± 11.7, respectively, at 10-year follow-up. A total of 69% and 67% surpassed the MCID and SCB1,2, respectively, for IKDC at 2-year follow-up; similarly, 60% and 33.3% surpassed MCID and SCB, respectively, for IKDC at 10-year follow-up. The overall reoperation rate was 28.6% at a mean of 43.8 years with partial meniscectomy, chondroplasty, and loose body removal most commonly performed. Two patients required arthroplasty conversion. Conclusions: OATS remains a durable knee preserving cartilage repair operation with low incidence of reoperation 10 years following index procedure.

Physical functioning in patients with end-stage knee osteoarthritis: A cross-sectional study in Jordan using self-reported questionnaire and performance-based tests.

Knee osteoarthritis (OA) is a debilitating condition that leads to functional limitations. Self-reported questionnaires and performance-based tests are tools commonly used for measuring physical function. (1) To evaluate the impact of end-stage knee OA on functional outcomes and examine the association between self-reported and performance-based measures of function in patients with end-stage knee osteoarthritis awaiting total knee arthroplasty (2) To explore the interrelationships among pain, strength, and overall physical function in this patient population. In this cross-sectional analysis, 33 patients with end-stage knee OA were recruited and completed the knee Outcome Survey-Activities of Daily Living Scale (KOS-ADLS) and executed performance-based tests including the Timed Up and Go, the 30-second chair stand test, and the Stair Climbing Test. Knee pain, and isometric hip and knee strength were evaluated. Patients perceived deficits in their physical functionwith a score of 35/100 on the KOS-ADLS and demonstrated functional limitations in all performed tasks. KOS-ADLs was weakly associated with TUG and 30s-CST (r=-0.301, p= 0.047, and r= 0.39, p= 0.014. respectively). Knee pain was linked with the KOS-ADL score and GRS score (r=-0.406, p= 0.010; r=-0.343, p= 0.027; respectively), while the strength of the affected side was correlated with the performed (p=< 0.001) and reported function outcomes (p= 0.007). Participants exhibit declines in both perceived and executed functional abilities. Self-reported and performance-based functional measures are weakly correlated within our study group, highlighting the importance of incorporating both measures in clinical practice for a comprehensive evaluation of physical function. Pain was linked to subjective aspect of physical function, while strength was connected to perceived and performed functional capacity. Implementing a tailored rehabilitation program targeting muscle weakness and pain holds the potential to mitigate functional decline in individuals awaiting total knee arthroplasty (TKA).

Translation and psychometric evaluation of the Persian version of Knee Outcome Survey-Activities of Daily Living Scale (KOS-ADLS)

BackgroundThe present study aimed to translate and validate the Knee Outcome Survey-Activities of Daily Living Scale (KOS-ADLS) in Iran.MethodsFollowing standard forward and backward translation procedure, content and face validity were tested by specialists and a sample of 32 patients. Then, in a cross sectional study, a sample of patients with knee disorders, recruited through simple sampling, completed the KOS-ADLS and the Short-Form Health Survey (SF-36) in their first visit to physiotherapy clinics in Tehran. Regarding construct validity, the Spearman’s correlation (rs) and one-way ANOVA were employed to evaluate the correlations between the Persian KOS-ADLS and SF-36 subscales (convergent validity) and known groups comparison, respectively. Test-retest reliability and internal consistency were evaluated by intraclass correlation coefficient (ICC) and the Cronbach’s α coefficient.ResultsIn total 101 patients were included in the study. The mean age of patients was 42.39 (SD = 9.2). The finding indicated that the KOS-ADLS had strong correlations with SF-36 physical functioning, bodily pain subscales, and also physical component summary while it had lower correlations with other subscales of the SF-36 as expected. The KOS-ADLS was able to differentiate between the subgroups of patients who differed in BMI. The acceptable level of intraclass correlation coefficient (ICC = 0.91) and Cronbach’s α coefficient (α = 0.91) was obtained for the Persian KOS-ADLS. Also no floor and ceiling effects were observed for the questionnaire.ConclusionsThe Persian version of KOS-ADLS was found to be a reliable and valid outcome measure for assessing daily living activities in patients who suffer from knee pathological conditions.

Translation, cross-cultural adaptation and validation of the Italian version of the knee outcome survey − activities of daily living scale

PurposeThe Knee Outcome Survey - Activities of Daily Living Scale (KOS-ADLS) is a joint-specific questionnaire measuring symptoms and functional limitations experienced by individuals with painful knee disorders. The original version of the KOS-ADLS has been shown to be reliable, valid and responsive to change. The purpose of this study was to perform a translation and cross-cultural adaptation of the KOS-ADLS into Italian and to assess its reliability and validity. MethodsIn accordance with standard procedures, the original version of the KOS-ADLS was translated and cross-culturally adapted into Italian (KOS-ADLS-I). Then, the KOS-ADLS-I was administered to 150 patients with knee disorders. A subsample of patients compiled the KOS-ADLS-I again after five/seven days later to evaluate test–retest reliability. Symptoms and function-oriented questionnaires were also completed to evaluate construct validity. Structural validity (Explanatory Factor Analysis [EFA]), internal consistency (Cronbach's alpha), test-retest reliability (Intraclass Correlation Coefficient [ICC]), measurement error (Standard Error of the Measurement [SEM], Minimal Detectable Change [MDC]), and construct validity (hypothesis testing) were assessed. ResultsThe cross-cultural adaptation procedure revealed no major problems. EFA revealed a unidimensional structure. Internal consistency was high (Cronbach's alpha = 0.976) and the test–retest reliability was excellent (ICC = 0.990, 95%CI: 0.980–0.995) with low measurement error (SEM = 2.6 points; MDC = 7.1 points). The construct validity resulted to be satisfactory, as 100% a-priori hypothesis were met. ConclusionsThe KOS-ADLS-I is a reliable and valid questionnaire for the assessment of symptoms and functional limitations in individuals with musculoskeletal knee disorders and it can be used in clinical practice and research.

Patient reported outcome measures in anterior cruciate ligament rupture and reconstruction: The significance of outcome score prediction.

Numerous anterior cruciate ligament (ACL) clinical outcome measures exist. However, the result of one score does not equate to the findings of another even when evaluating the same patient group. To investigate if statistically derived formulae can be used to predict the outcome of one knee scoring system when the result of another is known in patients with ACL rupture before and after reconstruction. Fifty patients with ACL rupture were evaluated using nine clinical outcome measures. These included Tegner Activity Score, Lysholm Knee Score, Cincinnati Knee Score, International Knee Documentation Committee (IKDC) Objective Knee Score, Tapper and Hoover Meniscal Grading Score, IKDC Subjective Knee Score, Knee Outcome Survey - Activities of Daily Living Scale (KOS-ADLS), Short Form-12 Item Health Survey and Knee Injury and Osteoarthritis Outcome Score. Thirty-four patients underwent an ACL reconstruction and were reassessed post-operatively. The mean total of each of the nine outcome scores appreciably differed from each other. Significant correlations and regressions were found between most of the outcome scores and were stronger post-operatively. The strongest correlation was found between Cincinnati and KOS-ADLS (r = 0.91, P < 0.001). The strongest regression formula was also found between Cincinnati and KOS-ADLS (R 2 = 0.84, P < 0.001). The formulae produced from this study can be used to predict the outcome of one knee score when the results of the other are known. These formulae could facilitate the conduct of systematic reviews and meta-analysis in studies relating to ACL injuries by allowing the pooling of substantially more data.

A Systematic Review of Psychometric Properties of Knee-Related Outcome Measures Translated, Cross-Culturally Adapted, and Validated in Arabic Language.

During the previous two decades, patient-reported outcome measures (PROMs) have been well tested, and the tools were validated in different languages across the globe. This systematic review aimed to identify the knee disease-specific outcome tools in Arabic and evaluate their methodological quality of psychometric properties of the most promising tools based on the COSMIN checklist and PRISMA guidelines. Articles published in English, from the inception of databases until the date of search (10 August 2022), were included. Articles without at least one psychometric property (reliability, validity, and responsiveness) evaluation, and articles other than in the English language, were excluded from the study. The key terms [“Arabic” AND “Knee” AND (“Questionnaire” OR “Scale”)] were used in three databases, i.e., PubMed, Scopus, and Web of Science (WoS) in the advanced search strategy. Key terms were either in the title or abstract for PubMed. Key words were in the topic (TS) for WoS. COSMIN (COnsensus-based Standards for the selection of health Measurement Instruments) risk of bias checklist was used to evaluate the methodological quality of psychometric properties of the Arabic knee-related outcome measures. A total of 99 articles were identified in PubMed, SCOPUS, and WoS. After passing inclusion and exclusion criteria, 20 articles describing 22 scales from five countries were included in this review. The instruments validated in the Arabic language are Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), knee injury and osteoarthritis outcome score (KOOS), knee outcome survey- activities of daily living scale (KOS-ADLS), Oxford knee score (OKS), anterior knee pain scale, osteoarthritis of knee and hip health-related quality of life (OAKHQoL) scale, Lysholm knee score (LKS), international documentation committee subjective knee form (IKDC), intermittent and constant osteoarthritis pain (ICOAP) questionnaire, Kujala patellofemoral pain scoring system (PFPSS), anterior knee pain scale (AKPS) and osteoarthritis quality of life questionnaire (OAQoL),. All were found to have good test-retest reliability (Intra Correlation Coefficient), internal consistency (Cronbach’s alpha), and construct validity (Visual Analog Scale, Short Form-12, RAND-36, etc.). Of 20 instruments available to assess self-reported knee symptoms and function, 12 were validated in the Saudi Arabian population. Among them, KOS-ADLS is the best PROM to be used in various knee conditions, followed by KOOS and WOMAC. The assessed methodological quality of evidence says that the knee Arabic PROMs are reliable instruments to evaluate knee symptoms/function.

Clinical Outcome Measures in Arthroscopic Meniscectomy: Clinician versus Patient Completed Knee Scores.

Objective The aim of the present study was to investigate the difference between clinician-completed and patient-completed outcome scores in detecting improvement following arthroscopic meniscectomy in patients with meniscal tears of the knee. Methods Thirty-four patients with meniscal tears were prospectively assessed using 9 clinical outcome measures. The five clinician-completed knee scores included the Tegner Activity Score, the Lysholm Knee Score, the Cincinnati Knee Score, the International Knee Documentation Committee (IKDC) Examination Knee Score, and the Tapper and Hoover Meniscal Grading Score. The four patient-completed knee scores included the IKDC Subjective Knee Score, the Knee Outcome Survey - Activities of Daily Living Scale (KOS-ADLS), the Short Form-12 Item Health Survey (SF-12), and the Knee Injury and Osteoarthritis Outcome Score (KOOS). Twenty-nine of the 34 patients underwent an arthroscopic meniscectomy and were reassessed with all 9 outcome scores upon their follow-up review. Results A significant longitudinal improvement was observed in 4 of the 5 clinician-completed scores (Tegner [ p < 0.001], Lysholm [ p = 0.004], Cincinnati [p = 0.002] and Tapper and Hoover [ p < 0.001], but not in the IKDC Examination [ p = 0.332]. However, the IKDC Subjective score ( p = 0.021) was the only patient-completed score to demonstrate significant improvement postoperatively. Conclusion Overall, clinician-completed scoring systems were found to be inconsistent with those of patient-completed instruments. The mode of administering outcome measures can have a significant influence on the outcome results both for research and for clinical practice. A combination of both a clinician-completed with a patient-completed instrument may be a more balanced approach to assessing and quantifying meniscus tears and the outcome following arthroscopic meniscectomy.

Outcome Analysis of Fixed Angle Locking Plate in Patella Fractures: A Single Centre Experience from North India.

Tension band wiring supposedly is the most commonly used technique for displaced patella fractures, but is not effective in comminuted fractures and osteoporotic bones. It often leads to loosening of wires, dislocation of fracture, hardware problem and failure of osteosynthesis, resulting in knee stiffness and post-traumatic osteoarthritis. The aim of the study is to evaluate clinical outcome in patients with acute patella fractures (< 3week) treated with unidirectional angle fixed low-profile titanium patella locking plate. Twenty patients who presented with displaced patella fractures, aged between 18-70years were included in the study. All fractures were reduced and fixed with unidirectional angle fixed stable low-profile titanium patella locking plate. Knee Range of motion and Knee Outcome Survey Activities of Daily Living Scale (KOS-ADL) was used to evaluate the outcome. We were able to achieve union in 19 out of 20 patients. One patient with comminuted patella fracture had failure of fixation, which was revised. Mean flexion at final follow-up was 124° (110°-130°) and none of the patients had extensor lag. The final radiograph revealed complete union in all patients. This technique offers an option of fixation in comminuted patella fracture and in osteoporotic individuals. It provides mechanical stability for fracture fixation resulting in anatomical reduction, good functional outcome, lower incidence of symptomatic implant or failure of osteosynthesis.

Clinical outcome measures in anterior cruciate ligament reconstruction: Clinician vs patient completed knee scores

IntroductionClinical outcome measures are important in both the conduct of clinical research and evaluation of knee surgery in every day clinical practice. A wide variety of validated outcome scores are available in the literature. The objective of this study was to investigate if there is a difference between clinician-completed and patient-completed outcome scores in detecting improvement following anterior cruciate ligament (ACL) reconstruction. MethodsFifty patients with ACL rupture were prospectively evaluated using nine clinical outcome measures. Five clinician-completed knee scores included Tegner Activity Score, Lysholm Knee Score, Cincinnati Knee Score, International Knee Documentation Committee (IKDC) Objective Knee Score and Tapper and Hoover Meniscal Grading Score. Four patient-completed knee scores included IKDC Subjective Knee Score, Knee Outcome Survey - Activities of Daily Living Scale (KOS-ADLS), Short Form-12 Item Health Survey (SF-12) and Knee Injury and Osteoarthritis Outcome Score (KOOS). Thirty-four of the 50 patients underwent an ACL reconstruction and were reassessed with all nine outcome scores upon their follow-up review 3 months post-operatively. ResultsA significant longitudinal improvement was observed of all five clinician-completed knee scores including Tegner (3.3–4.1 (p = 0.006)), Lysholm (71.7–85.3 (p < 0.001)), Cincinnati (62.6–75.9 (p < 0.001)), IKDC Objective (Abnormal to Nearly Normal (p = 0.001)) and Tapper and Hoover (Fair to Good (p < 0.001)). However, none of the four patient-completed knee scores revealed a statistically significant improvement post-operatively. ConclusionsResults of clinician-completed scores were found to be inconsistent with those of patient-completed instruments. It's important to consider the mode of administering outcome measures either for research or clinical practice as it can have a significant influence on the end results. The use of both a clinician-completed and a patient-completed instrument maybe the more prudent approach to assessing and quantifying ACL injuries and the outcome post-operatively. Ultimately, better methods of objectively evaluating surgical interventions of the knee are required.

Measures of Adult Knee Function.

Measures of Adult Knee Function.

Cross-Cultural Adaptation of the Greek Versions of the Lysholm Knee Scoring Scale and Tegner Activity Scale.

PurposeThe Lysholm Knee Scoring Scale (LKSS) and the Tegner Activity Scale (TAS) are widely used instruments for assessing knee function and activity level in various knee pathologies, especially knee ligament injuries. The purpose of this study was to translate and cross-culturally adapt the Greek versions of the Lysholm Knee Scoring Scale (Gr-LKSS) and Tegner Activity Scale (Gr-TAS) and assess their reliability and validity in Greek patients suffering from various knee problems.Materials and methodsTranslation of the LKSS and TAS questionnaires was done according to established international guidelines. Fifty-five patients (32 males and 23 females; mean age: 24 ±7 years; range: 17-54 years) with various knee pathologies completed the Gr-LKSS and Gr-TAS along with the Greek versions of International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, the Knee Outcome Survey Activities of Daily Living Scale (KOS-ADLS) and the Oxford Knee Score (OKS). Test-retest reliability was evaluated with the intraclass correlation coefficient (ICC) in 53 (96%) individuals, who completed the questionnaires again after 48-72 hours while abstaining from all forms of treatment. Internal consistency for the Gr-LKSS was measured using Cronbach’s alpha and criterion-related validity was evaluated with the Pearson's correlation coefficient (r) in relation to control questionnaires (IKDC, KOS-ADLS, OKS). The distribution of floor and ceiling effects were also determined.ResultsThere were no problems during the forward-backward translation and cultural adaptation of the Gr-LKSS and Gr-TAS. Criterion-related validity was confirmed with moderate to high associations of Gr-LKSS and Gr-TAS (after injury) with the IKDC and KOS-ADLS (Pearson’s r ranging between 0.61-0.71 and 0.64-0.73, respectively). However, weak correlations were yielded between both questionnaires with the OKS (r=0.14-0.19). The internal consistency for Gr-LKSS was high (Cronbach's alpha: 0.779) and the test-retest reliability was high for both questionnaires (Gr-LKSS: ICC=0.950; Gr-TAS before and after injury: ICCs of 0.877 and 0.876, respectively).ConclusionThe cultural adaptation and validity of Gr-LKSS and Gr-TAS were successfully accomplished. These questionnaires are recommended for use in the evaluation of soft tissue knee disorders in both clinical practice and research.

Comparing the Responsiveness of the Global Rating Scale With Legacy Knee Outcome Scores: A Delaware-Oslo Cohort Study

Background: The selection of patient-reported outcome measures (PROMs) is essential for obtaining meaningful information to treat a patient, determine a plan of care, and make clinical decisions; however, the process of selecting PROMs for clinical care is difficult, with the need to balance these multiple factors. Variation makes it difficult to compare data across providers and studies. Hypothesis/Purpose: The purpose was to determine the responsiveness of 4 PROMs via effect size and the presence of a ceiling effect in the 5 years after anterior cruciate ligament reconstruction (ACLR). We hypothesized that the single-item Global Rating Scale (GRS) would have an effect size and ceiling effect similar to the commonly used legacy PROMs. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Of the 300 participants, 218 had ACLR, completed postoperative progressive criterion-based rehabilitation early after surgery, and were followed for 5 years. We collected data based on the GRS, the Knee Outcome Survey–Activities of Daily Living Scale (KOS-ADLS), the International Knee Documentation Committee–Subjective Knee Form (IKDC-SKF), and the KOOS (Knee injury and Osteoarthritis Outcome Score) before and after training and at 6, 12, 24, and 60 months after ACLR. Results: The IKDC-SKF had the largest effect sizes and lowest ceiling effects. The GRS had a similar size and change in both effect size and ceiling effect when compared with the longer PROMs. The GRS and IKDC-SKF had a correlation of 0.72, and the GRS had a minimal detectable change of 2.9 or 4.8, depending on methodology. Conclusion: The GRS responded similarly to the IKDC-SKF, KOS-ADLS, and KOOS and was responsive to patient change. The ease of use and patient-specific nature of the question means that it may be appropriate to use the GRS in clinical care as a consistent measure throughout the course of rehabilitation.

Gait Asymmetry Can Predict Functional Performance Post ACL Reconstruction: A Pilot Study

Wearable inertial sensors are practical and inexpensive technology that can be used to detect gait asymmetries following anterior cruciate ligament reconstruction (ACLR). Specifically, individuals after ACLR walk with asymmetries in shank angular velocity (SAV) during landing, which may be indicative of abnormal knee joint loading. However, it is unknown whether these asymmetries in SAV detected at early stage of rehabilitation can predict functional performance at 6 months after ACLR. PURPOSE: To investigate whether SAV asymmetries during walking at 4 months after surgery can predict return-to-activity criteria at 6 months in individuals with ACLR. METHODS: Fourteen individuals (8 females; age= 27.79±7.9 y) with primary unilateral ACLR participated in the study. Participants were instructed to walk at a self-selected speed along a 12-meter straight walkway at 4 months after surgery. SAV peak was calculated bilaterally during landing as the first negative peak value after heel strike in the sagittal plane. The average SAV peak was calculated for each limb. At 6 months after surgery, participants completed return-to-activity criteria testing (isometric quadriceps index, single-legged hop tests, Knee Outcome Survey-Activities of Daily Living Scale (KOS-ADLS), and Global Rating Score (GRS)). Inter-limb symmetry (ACLR limb/uninjured limb*100) was calculated for SAV peak and functional measures. Linear regression models were used to determine whether SAV peak at 4 months would predict functional performance at 6 months following surgery. RESULTS: Asymmetry in SAV at 4 months was a significant predictor for asymmetries in the isometric quadriceps strength (r2=0.39, p=.02), single hop for distance (r2=0.36, p=.02), triple hop for distance (r2=0.34, p=.03), and triple-crossover hop for distance (r2=0.51, p=.001), but not for the 6-meter timed hop (r2=0.17, p=.14) at 6 months. Greater SAV asymmetry was a significant predictor for worse scores on the KOS-ADLS (r2=0.49, p=.006) and GRS (r2=0.46, p=.008). CONCLUSIONS: This pilot study showed that gait asymmetry detected by inertial sensors at early stage of rehabilitation can predict functional performance at 6 months after ACLR. Implementing these sensors in clinical practice may help clinicians to monitor gait on a regular basis during rehabilitation.

Does the presence of self-reported walking difficulty influence gait mechanics and muscular activations in individuals with knee osteoarthritis?

Does the presence of self-reported walking difficulty influence gait mechanics and muscular activations in individuals with knee osteoarthritis?

EFFECT OF EXERCISES PROGRAM ON KNEE FUNCTIONAL OUTCOMES FOR PATIENTS AFTER ARTHROSCOPIC ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

Background: Rupture of the anterior cruciate ligament (ACL) is a common cause of knee instability, requiring ACL reconstructions with about one million completed worldwide annually. Successful (ACL) reconstruction requires physical rehabilitation to help patients return to an active lifestyle. This study aimed toevaluate the effect of exercises program on knee functional outcomes for patients after arthroscopic anterior cruciate ligament reconstruction. Study design: Quasi experimental research design was conducted in this research. Study sample:Purposive sample of 60 adult patients of both sexes, who were diagnosed as a first-time primary unilateral anterior cruciate ligament injury and undergoing (ACL) reconstructionwere involved in the study and were divided randomly into two groups 30 patients for each group . Setting: The study was conducted at the knee arthroscopic surgery and stadium injuries unit at Mansoura University Hospital as well as the knee surgery outpatient clinic for patients follow up .Tools of the study: Five tools were utilized in this study: Tool I: Patient’s assessment structure interview sheet which consists of two parts: Part (1): Socio-demographic characteristics and health relevant data, Part (2): The patient’s knowledge and practice assessment sheet.Tool II: Manual muscle testing (MMT) Scale of the knee muscles. Tool III: Anterior Knee Pain Scale (AKPS) “ Kujala Scale”. Tool (IV): Goniometric Range of Motion Measurement (ROM). Tool (V): The Knee Outcome Survey Activities of Daily Living Scale (KOS-ADLS).Results:The result revealed that post program implementation, study group had a reduction in pain and improvement in knee muscle strength and knee function more than the control group and a statistically significant improvement was found in the total mean score of (KOS-ADLS) of the patient in the study group (70.57 ± 3.87) compared to patient in the control group (40.86 ± 3.37). Moreover the total mean score of knee flexion was significantly improved in the study group (109.0 ± 8.35) than the control group (77.0 ± 10.14). Furthermore the total score of knee extension was significantly better in study group in comparison with the control group. Conclusions:Exercises program after arthroscopic anterior cruciate ligament reconstruction had a significant positive effect on patient’s knee functional outcomes.

EFFECT OF EXERCISES PROGRAM ON KNEE FUNCTIONAL OUTCOMES FOR PATIENTS AFTER ARTHROSCOPIC ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

Background: Rupture of the anterior cruciate ligament (ACL) is a common cause of knee instability, requiring ACL reconstructions with about one million completed worldwide annually. Successful (ACL) reconstruction requires physical rehabilitation to help patients return to an active lifestyle. This study aimed toevaluate the effect of exercises program on knee functional outcomes for patients after arthroscopic anterior cruciate ligament reconstruction. Study design: Quasi experimental research design was conducted in this research. Study sample:Purposive sample of 60 adult patients of both sexes, who were diagnosed as a first-time primary unilateral anterior cruciate ligament injury and undergoing (ACL) reconstructionwere involved in the study and were divided randomly into two groups 30 patients for each group . Setting: The study was conducted at the knee arthroscopic surgery and stadium injuries unit at Mansoura University Hospital as well as the knee surgery outpatient clinic for patients follow up .Tools of the study: Five tools were utilized in this study: Tool I: Patient’s assessment structure interview sheet which consists of two parts: Part (1): Socio-demographic characteristics and health relevant data, Part (2): The patient’s knowledge and practice assessment sheet.Tool II: Manual muscle testing (MMT) Scale of the knee muscles. Tool III: Anterior Knee Pain Scale (AKPS) “ Kujala Scale”. Tool (IV): Goniometric Range of Motion Measurement (ROM). Tool (V): The Knee Outcome Survey Activities of Daily Living Scale (KOS-ADLS).Results:The result revealed that post program implementation, study group had a reduction in pain and improvement in knee muscle strength and knee function more than the control group and a statistically significant improvement was found in the total mean score of (KOS-ADLS) of the patient in the study group (70.57 ± 3.87) compared to patient in the control group (40.86 ± 3.37). Moreover the total mean score of knee flexion was significantly improved in the study group (109.0 ± 8.35) than the control group (77.0 ± 10.14). Furthermore the total score of knee extension was significantly better in study group in comparison with the control group. Conclusions:Exercises program after arthroscopic anterior cruciate ligament reconstruction had a significant positive effect on patient’s knee functional outcomes.

Polish Cross-Cultural Adaptation and Validation of the Knee Outcome Survey Activities of Daily Living Scale (KOS-ADLS) in Patients Undergoing Total Knee Arthroplasty.

BackgroundThe Knee Outcome Survey Activities of Daily Living Scale (KOS-ADLS) is a self-reported questionnaire used for the evaluation of the overall health of patients with knee dysfunctions. The purpose of this study was to perform a cross-cultural adaptation of the Polish version of KOS-ADLS and to evaluate its psychometric properties in patients at the end-stage of knee osteoarthritis who were qualified for a total knee replacement (TKR).Material/MethodsSeventy patients consecutively qualified for surgical TKR procedure participated in this study. To adapt the KOS-ADLS, the following scales and reference tests were used: Knee injury and Osteoarthritis Outcome Score (KOOS), Visual Analogue Scale (VAS), Time Up and Go test (TUG), and Five Times Sit to Stand test (5×STS). The studies were conducted 3 times: 2 weeks before surgery (first study), 6 to 13 days later (retest), and 6 months after surgery.ResultsThe Polish version of KOS-ADLS showed excellent reliability (ICC=0.89 SEM=2.68, MDC=7.43) and high responsiveness (ES=4.76, SRM=3.18). The internal consistency was poor in the first assessment (Cronbach’s alpha=0.68), but acceptable in the post-surgery evaluation (Cronbach’s alpha=0.86). There were fair and moderate correlations found between KOS-ADLS and VAS scales in the first examination, TUG, and 5×STS. Stronger correlations were observed between the results obtained in KOS-ADLS and KOOS.ConclusionsThe Polish version of the KOS-ADLS demonstrated good reliability, validity, and responsiveness for use in patients who have undergone TKR surgery.

Preoperative Outcome Scores are Predictive of Achieving the Minimal Clinically Important Difference After Treatment of Focal Cartilage Defects of the Knee with Osteochondral Grafts

Objectives:Osteochondral autograft transfer (OAT) and fresh osteochondral allograft transplantation (OCA) are popular cartilage restoration techniques that involve the single-stage implantation of viable, mature hyaline cartilage into focal chondral defects of the knee. Both techniques have demonstrated good results, as defined by statistically significant post-surgical improvements in patient-reported outcome measures. Recently, there has been greater focus on what represents a clinically relevant change in outcomes reporting, and commonly applied metrics for measuring clinical significance, such as the minimal clinically important difference (MCID) and substantial clinical benefit (SCB), have become the standard. Although a previous study defined a MCID in patients treated for articular cartilage defects in the knee (Greco et al, AJSM 2010), these patients were treated with various cartilage restoration procedures (e.g., debridement, microfracture, autologous chondrocyte implantation), and none were treated with OAT/OCA. Therefore, the purpose of this study was to define the MCID and SCB thresholds after OAT/OCA for the International Knee Documentation Committee subjective knee form (IKDC) and Knee Outcome Survey-Activities of Daily Living Scale (KOS-ADL) and to determine clinical and demographic patient factors predictive for achieving the MCID and SCB after OAT/OCA.Methods:A prospective institutional cartilage registry was reviewed to identify patients who underwent OAT/OCA. The IKDC and KOS-ADL were administered preoperatively and at a minimum of 2 years postoperatively. The MCID and SCB of these outcome scores were calculated using anchor-based methods. Receiver operative characteristic (ROC) analysis was used to determine the SCB using an anchor question, with the area under the curve (AUC) used to evaluate predictive ability. Multivariate analysis was performed to identify patient factors associated with achieving the MCID and SCB.Results:In total, 173 knees in 173 patients (mean age, 33.0 ± 13.2 years; 37.0% female) were identified. Patient demographics and clinical variables are listed in Table 1. Using the anchor-based method, the MCID for the IKDC and KOS-ADL were 17 ± 3.9 and 10 ± 3.7, respectively. Using the ROC method, the SCB for the IKDC and KOS-ADL were 32 (AUC 0.86) and 10 (AUC 0.76), respectively. Univariate analysis demonstrated no association between procedure (OAT or OCA) or lesion location and likelihood of achieving the MCID/SCB. In multivariate analysis, lower preoperative IKDC scores and higher preoperative Marx Activity Scale scores were predictive of achieving an MCID and SCB on the IKDC, and lower preoperative KOS-ADL scores, lower preoperative SF-36 pain subscale scores, and a history of 1 or less previous ipsilateral knee surgeries were predictive of achieving a MCID and SCB on the KOS-ADL (Table 2).Conclusion:In patients treated for focal cartilage defects of the knee with osteochondral grafts, these values can be used to define a clinically important change and substantial clinical benefit for future outcome studies. In this study population, higher preoperative activity levels and a history of 1 or less previous ipsilateral knee surgeries were predictive of achieving a clinically important change and substantial clinical benefit after OAT/OCA. These findings have implications for managing preoperative expectations of OAT/OCA surgery.Table 1.Patient Demographics and Clinical Variables of Included Patients (N = 173)Age, y33 ± 13.2 Mean ± SD56 (32.4) Age <40 y64 (37.0)Female sex25.8 ± 4.5Body mass index, kg/m2 1.3 ± 1.5No. of previous surgeriesChondral lesion characteristics Lesion location Medial femoral condyle79 (45.7) Lateral femoral condyle59 (34.1) Trochlea28 (16.2) Patella30 (17.3) Lesion area, cm2 4.3 ± 2.6Procedure Osteochondral autograft transfer75 (43.4) Osteochondral allograft transplantation98 (56.7)Concomitant procedures ACLR2 (1.2) Meniscus allograft transplantation7 (4.0) Realignment osteotomy17 (9.8)Data are reported as n (%) unless otherwise indicated. ACLR = anterior cruciate ligament reconstructionTable 2.Multivariable Logistic Models for Achieving MCID and SCBOdds Ratio (95% CI)P ValueAchieving MCID on IKDC Age (≥40 y/<40 y)1.01 (0.43-2.40)0.985 Sex (Female/Male)0.96 (0.43-2.18)0.923 Preoperative IKDC0.95 (0.92-0.98)0.001 Preoperative Marx Activity Scale1.11 (1.03-1.19)0.005Achieving SCB ON IKDC Age (≥40 y/<40 y)0.60 (0.24-1.40)0.244 Sex (Female/Male)0.69 (0.31-1.50)0.360 Preoperative IKDC0.95 (0.92-0.98)0.001 Preoperative Marx Activity Scale1.14 (1.07-1.23)<0.001Achieving MCID and SCB on KOS-ADL Age (≥40 y/<40 y)0.92 (0.40-2.12)0.845 Sex (Female/Male)1.46 (0.67-3.24)0.343 Previous Knee Surgeries (>1/≤1)0.32 (0.14-0.69)0.005 Preoperative KOS-ADL0.96 (0.93-0.99)0.009 Preoperative SF-36 Pain Subscale0.98 (0.96-1.00)0.043IKDC = International Knee Documentation Committee Subject Form; KOS-ADL = Knee Outcome Survey - Activities of Daily Living Scale; MCID = minimal clinically significant difference; SCB = substantial clinical benefit

Treating patella fractures with a locking patella plate - first clinical results

The standard treatment for patella fractures is tension band wiring. However, with tension band wiring anatomical reduction and rigid fixation can be challenging and the clinical outcome after patella fracture is often not satisfying. The purpose of this prospective clinical observation was to evaluate the clinical outcome in patients with patella fractures treated with an angular stable patella plate. Between 2011 and 2015 a total of 67 patients were treated with an angular stable patella plate. Outcome in these patients was evaluated by the Knee Outcome Survey Activities of Daily Living Scale (KOS-ADL) and range of motion of the knee joint was assessed. Complete follow up was obtained for 35 patients. In these patients, we found one implant-related complication. None of the patients reported any deficits in extension capabilities. The flexion was on average 127° (SD 21°). The patients classified the function of their knee in daily life on average with 77% (SD 24%) in comparison to their function before the trauma. Only kneeling or squatting was a problem in some patients. In conclusion, angular stable patella plating appears to be a promising alternative treatment for patella fractures. The patella plate provides increased mechanical stability for fracture fixation which appeared to result in a reduction of complications and improvement of functional outcome compared to tension band wiring. Especially patients with a multi-part or comminuted fracture or with osteoporotic bone are likely to benefit from the stability provided by the plate and the locking screws.