IKDC or KOOS? Which Measures Symptoms and Disabilities Most Important to Postoperative Articular Cartilage Repair Patients?

Abstract

Background:

The relevance of knee-specific subjective measures of outcome to patients has not been evaluated for cartilage repair procedures.

Purpose:

The aim of this study was to identify which instrument out of the Knee injury Osteoarthritis Outcome Score and the International Knee Documentation Committee Subjective Knee Form measures symptoms and disabilities most important to Postoperative articular cartilage repair patients.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

Data were collected from 58 participants of an Internet knee forum via a self-reported online questionnaire consisting of demographic and surgical data, the Tegner activity scale, and 49 consolidated items from the Knee injury Osteoarthritis Outcome Score and the International Knee Documentation Committee Subjective Knee Form. Item importance, frequency, and frequency-importance product were calculated.

Results:

Overall, the International Knee Documentation Committee Subjective Knee Form was the highest scoring instrument in all categories. However, 2 of the Knee injury Osteoarthritis Outcome Score subscales (“function in sport and recreation” and “knee-related quality of life”) scored higher on mean importance and frequency-importance product than the overall International Knee Documentation Committee Subjective Knee Form score.

Conclusion:

The International Knee Documentation Committee Subjective Knee Form provided the best overall measure of symptoms and disabilities that are most important to this population of postoperative articular cartilage repair patients. This brings into question the validity of using the Knee injury Osteoarthritis Outcome Score in shorter-term—less than 10 years—studies. Issues related to sports activity appear to be highly valued and very pertinent to evaluation of outcomes for this patient group.

Keywords

IKDC KOOS knee outcome measures cartilage repair

Get full access to this article

View all access options for this article.

References

Alford

Cole

. Cartilage restoration, part 1: Basic science, historical perspective, patient evaluation, and treatment options. Am J Sports Med. 2005;33(2):295–306.

Alford

Cole

. Cartilage restoration, part 2: Techniques, outcomes, and future directions. Am J Sports Med. 2005;33(3):443–460.

Amadio

. Outcomes measurements. J Bone Joint Surg Am. 1993;75:1583–1584.

Anderson

Irrgang

Kocher

Mann

Harrast

Committee

IKDC

. The International Knee Documentation Committee Subjective Knee Evaluation Form: Normative data. Am J Sports Med. 2006;34(1):128–135.

Bellamy

Buchanan

Goldsmith

Campbell

Stitt

. Validation study of WOMAC: A health status instrument for measuring clinically important patient-relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15(12):1833–1840.

Bentley

Biant

Carrington

. A prospective, randomized comparison of autologous chondrocyte implantation versus mosaicplasty for osteochondral defects in the knee. J Bone Joint Surg Br. 2003;85(2):223–230.

Bevilacqua

Gigante

Ricevuto

Cappella

Greco

. Membrane-seeded autologous chondrocyte implantation: Clinical and histological results at 24 months after surgery. J Bone Joint Surg Br. 2006;88(Suppl 111):427.

Briggs

Kocher

Rodkey

Steadman

. Reliability, validity, and responsiveness of the Lysholm knee score and Tegner activity scale for patients with meniscal injury of the knee. J Bone Joint Surg Am. 2006;88(4):698–705.

The British Psychological Society. Report of the Working Party on Conducting Research on the Internet. Guidelines for Ethical Practice in Psychological Research Online. Leicester, UK: The British Psychological Society; 2007.

10.

Bryant

Norman

Stratford

Marx

Walter

Guyatt

. Patients undergoing knee surgery provided accurate ratings of preoperative quality of life and function 2 weeks after surgery. J Clin Epidemiol. 2006;59(9):984–993.

11.

Cain

Clancy

. Treatment algorithm for osteochondral injuries of the knee. Clin Sports Med. 2001;20(2):321–342.

12.

Chow

Hantes

Houle

Zalavras

. Arthroscopic autogenous osteochondral transplantation for treating knee cartilage defects: A 2-to 5-year follow-up study. Arthroscopy. 2004;20(7):681–690.

13.

Clatworthy

Young

Deverall

Harper

. Treatment of full thickness articular cartilage defects with microfracture. J Bone Joint Surg Br. 2006;88(Suppl 11):316–317.

14.

Crawford

Briggs

Rodkey

Steadman

. Reliability, validity and responsiveness of the IKDC score for meniscus injuries of the knee. Arthroscopy. 2007;23(8):839–844.

15.

Delcogliano

Caporaso

Menghi

Rinonapoli

Chiossi

. Results of autologous osteochondral grafts in chondral lesions of the knee. Minerva Chir. 2002;57(3):273–281.

16.

Dozin

Malpeli

Cancedda

. Comparative evaluation of autologous chondrocyte implantation and mosaicplasty: A multicentered, randomized clinical trial. Clin J Sport Med. 2005;15(4):220–226.

17.

Drongowski

Coran

Wojtys

. Predictive value of meniscal and chondral injuries in conservatively treated anterior cruciate ligament injuries. Arthroscopy. 1994;10(1):97–102.

18.

Ess

. Ethical decision making and Internet research: Recommendations from the AoIR ethics working committee. Available at: http://www.aoir.org/reports/ethics.pdf. Accessed July 30, 2007.

19.

Fitzpatrick

Davey

Buxton

Jones

. Evaluating patient-based outcome measures for use in clinical trials. Health Technol Assess. 1998;2(14):i–iv, 1–74.

20.

Garratt

Schmidt

Mackintosh

Fitzpatrick

. Quality of life measurement: Bibliographic study of patient-assessed health outcome measures. BMJ. 2002;324(7351): 1417.

21.

Garratt AM, Brealey S, Gillespie WJ, DAMASK Trial Team. Patient-assessed health instruments for the knee: A structured review. Rheumatology. 2004;43(11):1414–1423.

22.

Gobbi

Nunag

Malinowski

. Treatment of full-thickness chondral lesions of the knee with microfracture in a group of athletes. Knee Surg Sports Traumatol Arthrosc. 2005;13(3):213–221.

23.

Guyatt

Bombardier

Tugwell

. Measuring disease-specific quality of life in clinical trials. CMAJ. 1986;134(8):889–895.

24.

Hambly

Bobic

Wondrasch

Van Assche

Marlovits

. Autologous chondrocyte implantation postoperative care and rehabilitation: Science and practice. Am J Sports Med. 2006;34(6):1020–1038.

25.

Hambly

Van Assche

Wondrasch

Bobic

Marlovits

. Current status and prospects for rehabilitation following cell-based cartilage repair. In: Zanasi

Brittberg

Marcacci

Nehrer

, eds. Basic Science and Clinical Repair of Articular Cartilage Defects: Current Status and Prospects. Bologna, Italy: Timeo Editore; 2006.

26.

Henderson

Tuy

Connell

Oakes

Hettwer

. Prospective clinical study of autologous chondrocyte implantation and correlation with MRI at 3 and 12 months. J Bone Joint Surg Br. 2003;85(7):1060–1066.

27.

Henderson

Lavigne

. Periosteal autologous chondrocyte implantation for patellar chondral defect in patients with normal and abnormal patellar tracking. Knee. 2006;13(4):274–279.

28.

Horas

Pelinkovic

Herr

Aigner

Schnettler

. Autologous chondrocyte implantation and osteochondral cylinder transplantation in cartilage repair of the knee joint. A prospective, comparative trial. J Bone Joint Surg Am. 2003;85(2):185–192.

29.

Irrgang

Anderson

. Development and validation of health-related quality of life measures for the knee. Clin Orthop Relat Res. 2002;402:95–109.

30.

Irrgang

Anderson

Boland

. Development and validation of the International Knee Documentation Committee Subjective Knee Form. Am J Sports Med. 2001;29(5):600–613.

31.

Irrgang

Anderson

Boland

. Responsiveness of the International Knee Documentation Committee Subjective Knee Form. Am J Sports Med. 2006;34(10):1567–1573.

32.

Irrgang

Harner

. Use of the International Knee Documentation Committee guidelines to assess outcome following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 1998;6(2):107–114.

33.

Irrgang

Snyder-Mackler

Wainner

Harner

. Development of a patient-reported measure of function of the knee. J Bone Joint Surg Am. 1998;80(8):1132–1145.

34.

Jakobsen

Engebretsen

Slauterbeck

. An analysis of the quality of cartilage repair studies. J Bone Joint Surg Am. 2005;87(10):2232–2239.

35.

Johnson

Smith

. Outcome measurement in the ACL deficient knee—what's the score? Knee. 2001;8(1):51–57.

36.

Juniper

Guyatt

Streiner

King

. Clinical impact versus factor analysis for quality of life questionnaire construction. J Clin Epidemiol. 1997;50(3):233–238.

37.

Knutsen

Engebretsen

Ludvigsen

. Autologous chondrocyte implantation compared with microfracture in the knee. A randomized trial. J Bone Joint Surg Am. 2004;86(3):455–464.

38.

Kreuz

Steinwachs

Erggelet

. Importance of sports in cartilage regeneration after autologous chondrocyte implantation: A prospective study with a 3-year follow-up. Am J Sports Med. 2007;35(8):1261–1268.

39.

Lahav

Burks

Greis

Chapman

Ford

Fink

, Clinical outcomes following osteochondral autologous transplantation (OATS). J Knee Surg. 2006;19(3):169–173.

40.

LaValley

Felson

. Statistical presentation and analysis of ordered categorical outcome data in rheumatology journals. Arthritis Rheum. 2002;47(3):255–259.

41.

Lohmander

Roos

. Knee ligament injury, surgery, and osteoarthrosis. Truth or consequences? Acta Orthop Scand. 1994;65(6):605–609.

42.

Marcacci

Berruto

Brocchetta

. Articular cartilage engineering with hyalograft(R) C: 3-year clinical results. Clin Orthop Relat Res. 2005;435:96–105.

43.

Marlovits

Singer

Zeller

Mandl

Haller

Trattnig

. Magnetic resonance observation of cartilage repair tissue (MOCART) for the evaluation of autologous chondrocyte transplantation: Determination of interobserver variability and correlation to clinical outcome after 2 years. Eur J Radiol. 2006;57(1):16–23.

44.

Messner

Maletius

. The long-term prognosis for severe damage to weightbearing cartilage in the knee: A 14-year clinical and radiographic follow-up in 28 young athletes. Acta Orthop Scand. 1996;67(2):165–168.

45.

Mithoefer

Gill

Giza

Mandelbaum

Peterson

Minas

. Treatment of full-thickness articular cartilage lesions of the knee in high-demand athletes with autologous chondrocyte transplantation. Orthopaedic Journal at Harvard Medical School. 2002(4):77–79. Available at http://www.orthojournalhms.org/ojhms2002/manuscripts/manuscripts-05.htm. Accessed April 21, 2008.

46.

Mithoefer

Williams

Warren

. Chondral resurfacing of articular cartilage defects in the knee with the microfracture technique. Surgical technique. J Bone Joint Surg Am. 2006;88 (Suppl 1) Pt 2:294–304.

47.

Oakes

Henderson

Lavigne

Valenzuela

Little

. Autologous chondrocyte implantation: Objective assessment of cartilage repair by second-look arthroscopy, indentometry, and biopsy. Journal of Science and Medicine in Sport. 2006;9(Suppl 1):5–6.

48.

Ochs

Muller-Horvat

Rolauffs

Fritz

Weise

Schewe

. Treatment of osteochondritis dissecans of the knee: 1 -step procedure with bone grafting and matrix-supported autologous chondrocyte transplantation [in German], Z Orthop Unfall. 2007;145(2):146–151.

49.

Ossendorf

Kaps

Kreuz

Burmester

Sittinger

Erggelet

. Treatment of posttraumatic and focal osteoarthritic cartilage defects of the knee with autologous polymer-based 3-dimensional chondrocyte grafts: 2-year clinical results. Arthritis Res Ther. 2007;9(2):R41.

50.

Paradowski

Bergman

Sunden-Lundius

Lohmander

Roos

. Knee complaints vary with age and gender in the adult population. Population-based reference data for the Knee injury and Osteoarthritis Outcome Score (KOOS). BMC Musculoskelet Disord. 2006;7:38.

51.

Paradowski

Englund

Roos

Lohmander

. Similar group mean scores, but large individual variations in patient-relevant outcomes over 2 years in meniscectomized subjects with and without radiographic knee osteoarthritis. Health Qual Life Outcomes. 2004;2:38.

52.

Paxton

Fithian

Stone

Silva

. The reliability and validity of knee-specific and general health instruments in assessing acute patellar dislocation outcomes. Am J Sports Med. 2003;31 (4):487–492.

53.

Podskubka

Povysil

Kubes

Sprindrich

Sedlacek

. Treatment of deep cartilage defects of the knee with autologous chondrocyte transplantation on a hyaluronic acid ester scaffolds (Hyalograft C) [in Czech], Acta Chir Orthop Traumatol Cech. 2006;73(4):251–263.

54.

Robertson

Fick

Wood

Linklater

Zheng

Ackland

. MRI and clinical evaluation of collagen-covered autologous chondrocyte implantation (CACI) at 2 years. Knee. 2007;14(2):117–127.

55.

Roos

. What is the patient's opinion of their knee? Experience from using the Knee injury and Osteoarthritis Outcome Score (KOOS). Presented at: International Cartilage Repair Society Congress; September 30, 2007; Warsaw, Poland (Session 5.1).

56.

Roos

Lohmander

. The Knee injury and Osteoarthritis Outcome Score (KOOS): From joint injury to osteoarthritis. Health Qual Life Outcomes. 2003;1(1): 64.

57.

Roos

Ekdahl

Lohmander

. Knee injury and Osteoarthritis Outcome Score (KOOS)-validation of a Swedish version. Scand J Med Sci Sports. 1998;8(6):439–448.

58.

Roos

Lohmander

Ekdahl

Beynnon

. Knee Injury and Osteoarthritis Outcome Score (KOOS)-development of a self-administered outcome measure. J Orthop Sports Phys Ther. 1998;28(2):88–96.

59.

Roos

Toksvig-Larsen

. Knee injury and Osteoarthritis Outcome Score (KOOS)—validation and comparison to the WOMAC in total knee replacement. Health Qual Life Outcomes. 2003;1(1): 17.

60.

Roos

Lauren

Adalberth

Roos

Jonsson

Lohmander

. Knee osteoarthritis after meniscectomy: Prevalence of radiographic changes after 21 years compared with matched controls. Arthritis Rheum. 1998;41(4):687–693.

61.

Rosa

Leopardi

di Vico

Lacono

Di Costanzo

. Autologous chondrocyte transplantation with arthroscopic technique: Our experience. J Bone Joint Surg Br. 2005;87(Suppl 11):198.

62.

Sackett

Rosenberg

Gray

Haynes

Richardson

. Evidence-based medicine: What it is and what it isn't BMJ. 1996;312(7023):71–72.

63.

Schipper

Clinch

Olweny

. Quality of life studies: Definitions and conceptual issues. In: Spilker

, ed. Quality of Life and Pharmacoeconomics in Clinical Trials. 2nd ed. Philadelphia, PA: Lippincott-Raven; 1996:11–23.

64.

Scorrano

Biggi

D'Antimo

Maffei

. Arthroscopic autologous chondrocyte implantation: 3-year follow-up. J Bone Joint Surg Br. 2005;87(Suppl 11):202.

65.

Shah

Kaplan

Meislin

Bosco

3rd . Articular cartilage restoration of the knee. Bull NYU Hosp Jt Dis. 2007;65(1):51–60.

66.

Steadman

Briggs

Rodrigo

Kocher

Gill

Rodkey

. Outcomes of microfracture for traumatic chondral defects of the knee: Average 11 -year follow-up. Arthroscopy. 2003;19(5):477–484.

67.

Stevens

van den Akker-Scheek

van Horn

. A Dutch translation of the Self-Efficacy for Rehabilitation Outcome Scale (SER): A first impression on reliability and validity. Patient Educ Couns. 2005;58(2):121–126.

68.

Tanner

Dainty

Marx

Kirkley

. Knee-specific quality-of-life instruments: Which ones measure symptoms and disabilities most important to patients? Am J Sports Med. 2007;35(9):1450–1458.

69.

Tegner

Lysholm

. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res. 1985;198:43–49.

70.

Vanlauwe

Almqvist

Bellemans

Huskin

Verdonk

Victor

. Repair of symptomatic cartilage lesions of the knee the place of autologous chondrocyte implantation. Acta Orthop Belg. 2007;73(2): 145–158.

71.

Visna

Pasa

Cizmar

Hart

Hoch

. Treatment of deep cartilage defects of the knee using autologous chondrograft transplantation and by abrasive techniques—a randomized controlled study. Acta Chir Belg. 2004;104(6):709–714.

72.

von Porat

Roos

. High prevalence of osteoarthritis 14 years after an anterior cruciate ligament tear in male soccer players: A study of radiographic and patient-relevant outcomes. Ann Rheum Dis. 2004;63(3):269–273.

73.

Wang

Ding

Wluka

. Factors affecting progression of knee cartilage defects in normal subjects over 2 years. Rheumatology (Oxford). 2006;45(1):79–84.

74.

Wood

Zheng

Robertson

Ackland

. A West Australian experience of collagen-covered and matrix-induced autologous chondrocyte implantation (ACI). J Bone Joint Surg Br. 2005;87(Suppl 111):323–324.