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Journal ArticleDOI

The Knee injury and Osteoarthritis Outcome Score (KOOS): from joint injury to osteoarthritis.

03 Nov 2003-Health and Quality of Life Outcomes (BioMed Central)-Vol. 1, Iss: 1, pp 64-64
TL;DR: The KOOS is a valid, reliable and responsive self-administered instrument that can be used for short-term and long-term follow-up of several types of knee injury including osteoarthritis.
Abstract: The Knee injury and Osteoarthritis Outcome Score (KOOS) was developed as an extension of the WOMAC Osteoarthritis Index with the purpose of evaluating short-term and long-term symptoms and function in subjects with knee injury and osteoarthritis. The KOOS holds five separately scored subscales: Pain, other Symptoms, Function in daily living (ADL), Function in Sport and Recreation (Sport/Rec), and knee-related Quality of Life (QOL). The KOOS has been validated for several orthopaedic interventions such as anterior cruciate ligament reconstruction, meniscectomy and total knee replacement. In addition the instrument has been used to evaluate physical therapy, nutritional supplementation and glucosamine supplementation. The effect size is generally largest for the subscale QOL followed by the subscale Pain. The KOOS is a valid, reliable and responsive self-administered instrument that can be used for short-term and long-term follow-up of several types of knee injury including osteoarthritis. The measure is relatively new and further use of the instrument will add knowledge and suggest areas that need to be further explored and improved.

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Citations
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Journal ArticleDOI
TL;DR: The objectives of this study are to review the long-term consequences of injuries to the anterior cruciate ligament and menisci, the pathogenic mechanisms, and the causes of the considerable variability in outcome, and to strive toward a comparable level of quality of evidence in surgical treatment of knee injuries.
Abstract: The objectives of this study are to review the long-term consequences of injuries to the anterior cruciate ligament and menisci, the pathogenic mechanisms, and the causes of the considerable variability in outcome. Injuries of the anterior cruciate ligament and menisci are common in both athletes and the general population. At 10 to 20 years after the diagnosis, on average, 50% of those with a diagnosed anterior cruciate ligament or meniscus tear have osteoarthritis with associated pain and functional impairment: the young patient with an old knee. These individuals make up a substantial proportion of the overall osteoarthritis population. There is a lack of evidence to support a protective role of repair or reconstructive surgery of the anterior cruciate ligament or meniscus against osteoarthritis development. A consistent finding in a review of the literature is the often poor reporting of critical study variables, precluding data pooling or a meta-analysis. Osteoarthritis development in the injured joints is caused by intra-articular pathogenic processes initiated at the time of injury, combined with long-term changes in dynamic joint loading. Variation in outcome is reinforced by additional variables associated with the individual such as age, sex, genetics, obesity, muscle strength, activity, and reinjury. A better understanding of these variables may improve future prevention and treatment strategies. In evaluating medical treatment, we now expect large randomized clinical trials complemented by postmarketing monitoring. We should strive toward a comparable level of quality of evidence in surgical treatment of knee injuries. In instances in which a randomized clinical trial is not feasible, natural history and other observational cohort studies need to be as carefully designed and reported as the classic randomized clinical trial, to yield useful information.

2,014 citations

Journal ArticleDOI
Tuhina Neogi1
TL;DR: More insights are needed into pain mechanisms in OA to enable rational mechanism-based management of pain and to contribute to a substantial socioeconomic burden.

1,096 citations

Journal ArticleDOI
TL;DR: A stepwise approach to the management of osteoarthritis is presented, and central pain sensitisation can also occur, and psychosocial factors are important determinants of pain severity.

975 citations

Journal ArticleDOI
TL;DR: A multidisciplinary group of ACL expert clinicians and scientists are invited to review current evidence including data from the new Scandinavian ACL registries, critically evaluate high-quality studies of injury mechanics and consider the key elements of successful prevention programmes.
Abstract: The incidence of anterior cruciate ligament (ACL) injury remains high in young athletes. Because female athletes have a much higher incidence of ACL injuries in sports such as basketball and team handball than male athletes, the IOC Medical Commission invited a multidisciplinary group of ACL expert clinicians and scientists to (1) review current evidence including data from the new Scandinavian ACL registries; (2) critically evaluate high-quality studies of injury mechanics; (3) consider the key elements of successful prevention programmes; (4) summarise clinical management including surgery and conservative management; and (5) identify areas for further research. Risk factors for female athletes suffering ACL injury include: (1) being in the preovulatory phase of the menstrual cycle compared with the postovulatory phase; (2) having decreased intercondylar notch width on plain radiography; and (3) developing increased knee abduction moment (a valgus intersegmental torque) during impact on landing. Well-designed injury prevention programmes reduce the risk of ACL for athletes, particularly women. These programmes attempt to alter dynamic loading of the tibiofemoral joint through neuromuscular and proprioceptive training. They emphasise proper landing and cutting techniques. This includes landing softly on the forefoot and rolling back to the rearfoot, engaging knee and hip flexion and, where possible, landing on two feet. Players are trained to avoid excessive dynamic valgus of the knee and to focus on the "knee over toe position" when cutting.

740 citations

Journal ArticleDOI
TL;DR: In young, active adults with acute ACL tears, a strategy of rehabilitation plus early ACL reconstruction was not superior to a strategyof rehabilitation plus optional delayed ACL reconstruction, but the latter strategy substantially reduced the frequency of surgical reconstructions.
Abstract: Background The optimal management of a torn anterior cruciate ligament (ACL) of the knee is unknown. Methods We conducted a randomized, controlled trial involving 121 young, active adults with acute ACL injury in which we compared two strategies: structured rehabilitation plus early ACL reconstruction and structured rehabilitation with the option of later ACL reconstruction if needed. The primary outcome was the change from baseline to 2 years in the average score on four subscales of the Knee Injury and Osteoarthritis Outcome Score (KOOS) — pain, symptoms, function in sports and recreation, and knee-related quality of life (KOOS4; range of scores, 0 [worst] to 100 [best]). Secondary outcomes included results on all five KOOS subscales, the Medical Outcomes Study 36-Item Short-Form Health Survey, and the score on the Tegner Activity Scale. Results Of 62 subjects assigned to rehabilitation plus early ACL reconstruction, 1 did not undergo surgery. Of 59 assigned to rehabilitation plus optional delayed ACL r...

714 citations

References
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Journal ArticleDOI
TL;DR: A 36-item short-form survey designed for use in clinical practice and research, health policy evaluations, and general population surveys to survey health status in the Medical Outcomes Study is constructed.
Abstract: A 36-item short-form (SF-36) was constructed to survey health status in the Medical Outcomes Study. The SF-36 was designed for use in clinical practice and research, health policy evaluations, and general population surveys. The SF-36 includes one multi-item scale that assesses eight health concepts: 1) limitations in physical activities because of health problems; 2) limitations in social activities because of physical or emotional problems; 3) limitations in usual role activities because of physical health problems; 4) bodily pain; 5) general mental health (psychological distress and well-being); 6) limitations in usual role activities because of emotional problems; 7) vitality (energy and fatigue); and 8) general health perceptions. The survey was constructed for self-administration by persons 14 years of age and older, and for administration by a trained interviewer in person or by telephone. The history of the development of the SF-36, the origin of specific items, and the logic underlying their selection are summarized. The content and features of the SF-36 are compared with the 20-item Medical Outcomes Study short-form.

33,857 citations


"The Knee injury and Osteoarthritis ..." refers methods in this paper

  • ...Comparison of effect sizes of KOOS, WOMAC and SF-36 six months after surgical reconstruction of the ruptured anterior cruciate ligament....

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  • ...Convergent and divergent construct validity was determined in comparison to the SF-36 [9], and when applicable also to the Lysholm knee scoring scale [1]....

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  • ...0 0.5 1 1.5 2 Pain Sym ptom s AD L Sport/Rec Q O L KOOS WOMAC SF-36 Effect size Page 4 of 8 (page number not for citation purposes) out prior to a doctors visit or by mail....

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  • ...In the American validation study the questionnaires were either filled Effect sizes of KOOS, WOMAC and SF-36 six months after ACL-reconstructionFigure 2 Effect sizes of KOOS, WOMAC and SF-36 six months after ACL-reconstruction....

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  • ...Ware J. E., Jr. and Sherbourne CD: The MOS 36-item short-form health survey (SF-36)....

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Journal Article
TL;DR: WOMAC is a disease-specific purpose built high performance instrument for evaluative research in osteoarthritis clinical trials and fulfil conventional criteria for face, content and construct validity, reliability, responsiveness and relative efficiency.
Abstract: Within the context of a double blind randomized controlled parallel trial of 2 nonsteroidal antiinflammatory drugs, we validated WOMAC, a new multidimensional, self-administered health status instrument for patients with osteoarthritis of the hip or knee. The pain, stiffness and physical function subscales fulfil conventional criteria for face, content and construct validity, reliability, responsiveness and relative efficiency. WOMAC is a disease-specific purpose built high performance instrument for evaluative research in osteoarthritis clinical trials.

7,147 citations


"The Knee injury and Osteoarthritis ..." refers background or methods in this paper

  • ...One of the questionnaires, by Flandry et al. [3], was constructed to assess symptoms of anterior cruciate ligament (ACL) injury and the other, WOMAC Osteoarthritis Index [2], for assessing symptoms of knee OA Questions that most frequently received high responses, and were thus considered to reflect the most predominant symptoms, included those relating to pain, swelling, stiffness, and the ability to run, jump, kneel, and squat....

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  • ...Prior instruments such as the Lysholm knee scoring scale [1] have focused only on the short-term consequences and instruments such as the WOMAC Osteoarthritis Index [2] only on the long-term consequences....

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  • ...The KOOS was developed as an extension of the WOMAC Osteoarthritis Index with the overall purpose to evaluate short- and long-term symptoms and function after knee injury and OA....

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  • ...Prior instruments such as the Lysholm knee scoring scale [1] have focused only on the short-term consequences and instruments such as the WOMAC Osteoarthritis Index [2] only on the long-term consequences....

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  • ...To be able to calculate WOMAC scores from the KOOS, the questions from the WOMAC Osteoarthritis Index LK 3.0 [2] were included in their full and original form in the KOOS questionnaire (with permission, Nicholas Bellamy personal communication 1995)....

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Journal ArticleDOI
TL;DR: A new activity grading scale, where work and sport activities were graded numerically, was constructed as complement to the functional score, showing that the symptom-related score gave a more differentiated picture of the disability.
Abstract: Many different methods of evaluating disability after knee ligament injury exist. Most of them differ in design. Some are based on only patients' symptoms. Other include patients' symptoms, activity grading, performance in a test, and clinical findings. The rating in these evaluating systems can be either numerical, as in a score, or binary, with yes/no answers. Comparison between a symptom-related score and a score of more complex design showed that the symptom-related score gave a more differentiated picture of the disability. It was also shown that the binary rating system gave less detailed information than a score and that differences in a binary rating can depend on at what level the symptoms are regarded as "significant." A new activity grading scale, where work and sport activities were graded numerically, was constructed as complement to the functional score. When evaluating knee ligament injuries, stability testing, functional knee score, performance test, and activity grading are all important. However, the relative importance varies during the course of treatment, and therefore they should not all be included in one and the same score.

3,857 citations


"The Knee injury and Osteoarthritis ..." refers methods in this paper

  • ...Convergent and divergent construct validity was determined in comparison to the SF-36 [9], and when applicable also to the Lysholm knee scoring scale [1]....

    [...]

  • ...Prior instruments such as the Lysholm knee scoring scale [1] have focused only on the short-term consequences and instruments such as the WOMAC Osteoarthritis Index [2] only on the long-term consequences....

    [...]

Journal ArticleDOI
TL;DR: The KOOS proved reliable, responsive to surgery and physical therapy, and valid for patients undergoing anterior cruciate ligament reconstruction, and can be used to evaluate the course of knee injury and treatment outcome.
Abstract: There is broad consensus that good outcome measures are needed to distinguish interventions that are effective from those that are not. This task requires standardized, patient- centered measures that can be administered at a low cost. We developed a questionnaire to assess short- and long-term patient-relevant outcomes following knee injury, based on the WOMAC Osteoarthritis Index, a literature review, an expert panel, and a pilot study. The Knee Injury and Osteoarthritis Outcome Score (KOOS) is self-administered and assesses five outcomes: pain, symptoms, activities of daily living, sport and recreation function, and knee-related quality of life. In this clinical study, the KOOS proved reliable, responsive to surgery and physical therapy, and valid for patients undergoing anterior cruciate ligament reconstruction. The KOOS meets basic criteria of outcome measures and can be used to evaluate the course of knee injury and treatment outcome.

3,003 citations


"The Knee injury and Osteoarthritis ..." refers background or methods or result in this paper

  • ...Questions included in the subscales Sport and Recreational Function and knee-related Quality of Life were adopted, in their original form or with some modification, from other outcome measures used to assess ACL injury [3,4]....

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  • ...One of the questionnaires, by Flandry et al. [3], was constructed to assess symptoms of anterior cruciate ligament (ACL) injury and the other, WOMAC Osteoarthritis Index [2], for assessing symptoms of knee OA Questions that most frequently received high responses, and were thus considered to reflect the most predominant symptoms, included those relating to pain, swelling, stiffness, and the ability to run, jump, kneel, and squat....

    [...]

  • ...An expert panel comprised of patients referred to physical therapy because of knee injuries, orthopaedic surgeons, and physical therapists from both Sweden and the United States, was asked to identify shortand long-term symptoms and functional disabilities resulting from a meniscus or ACL injury....

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  • ...In a trial comparing two methods of reconstruction of the ACL, significant differences between groups were found in ADL, Sport/Rec and QOL at various postoperative time points [14]....

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  • ...As expected, larger effect sizes of the KOOS compared to the WOMAC was found in younger subjects (age 18–46) with knee injury [5]....

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Journal ArticleDOI
TL;DR: The Knee injury and Osteoarthritis Outcome Score (KOOS) is a valid, reliable, and responsive outcome measure in total joint replacement and may be at least as responsive as the WOMAC.
Abstract: The Knee injury and Osteoarthritis Outcome Score (KOOS) is an extension of the Western Ontario and McMaster Universities Osteoarthrtis Index (WOMAC), the most commonly used outcome instrument for assessment of patient-relevant treatment effects in osteoarthritis. KOOS was developed for younger and/or more active patients with knee injury and knee osteoarthritis and has in previous studies on these groups been the more responsive instrument compared to the WOMAC. Some patients eligible for total knee replacement have expectations of more demanding physical functions than required for daily living. This encouraged us to study the use of the Knee injury and Osteoarthritis Outcome Score (KOOS) to assess the outcome of total knee replacement. We studied the test-retest reliability, validity and responsiveness of the Swedish version LK 1.0 of the KOOS when used to prospectively evaluate the outcome of 105 patients (mean age 71.3, 66 women) after total knee replacement. The follow-up rates at 6 and 12 months were 92% and 86%, respectively. The intraclass correlation coefficients were over 0.75 for all subscales indicating sufficient test-retest reliability. Bland-Altman plots confirmed this finding. Over 90% of the patients regarded improvement in the subscales Pain, Symptoms, Activities of Daily Living, and knee-related Quality of Life to be extremely or very important when deciding to have their knee operated on indicating good content validity. The correlations found in comparison to the SF-36 indicated the KOOS measured expected constructs. The most responsive subscale was knee-related Quality of Life. The effect sizes of the five KOOS subscales at 12 months ranged from 1.08 to 3.54 and for the WOMAC from 1.65 to 2.56. The Knee injury and Osteoarthritis Outcome Score (KOOS) is a valid, reliable, and responsive outcome measure in total joint replacement. In comparison to the WOMAC, the KOOS improved validity and may be at least as responsive as the WOMAC.

879 citations


"The Knee injury and Osteoarthritis ..." refers background or methods or result in this paper

  • ...However, a more unexpected finding was that larger effect sizes were found for the KOOS compared to the WOMAC in elderly subjects (age 43–86) treated with a total knee replacement because of severe knee OA [8]....

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  • ...Fourthly, a validation study was carried out in subjects (age range 43– 86) treated with total knee replacement for OA [8]....

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  • ...The data from total knee replacement [8] (n = 105, mean age 71....

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