Scientific Article   |    
Reliability, Validity, and Responsiveness of Four Knee Outcome Scales for Athletic Patients
Robert G. Marx, MD, MSc, FRCS(C); Edward C. Jones, MD, MA; Answorth A. Allen, MD; David W. Altchek, MD; Stephen J. O'Brien, MD; Scott A. Rodeo, MD; Riley J. Williams, MD; Russell F. Warren, MD; Thomas L. Wickiewicz, MD
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Investigation performed at the Center for Clinical Outcome Research and the Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY
Robert G. Marx, MD, MSc, FRCS(C)
Edward C. Jones, MD, MA
Answorth A. Allen, MD
David W. Altchek, MD
Stephen J. O’Brien, MD
Scott A. Rodeo, MD
Riley J. Williams, MD
Russell F. Warren, MD
Thomas L. Wickiewicz, MD
Center for Clinical Outcome Research (R.G.M. and E.C.J.) and Sports Medicine and Shoulder Service (R.G.M., A.A.A., D.W.A., S.J.O’B., S.A.R., R.J.W., R.F.W., and T.L.W.), Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for Dr. Marx: marxr@hss.edu

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. No funds were received in support of this study. Dr. Marx was supported by an American Academy of Orthopaedic Surgeons Health Services Research Fellowship and a Royal College of Physicians and Surgeons of Canada Detweiler Travelling Fellowship.

J Bone Joint Surg Am, 2001 Oct 01;83(10):1459-1469
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Background: Many patient-based knee-rating scales are available for the evaluation of athletic patients. However, there is little information on the measurement properties of these instruments and therefore no evidence to support the use of one questionnaire rather than another. The goal of the present study was to determine the reliability, validity, and responsiveness of four knee-rating scales commonly used for the evaluation of athletic patients: the Lysholm scale, the subjective components of the Cincinnati knee-rating system, the American Academy of Orthopaedic Surgeons sports knee-rating scale, and the Activities of Daily Living scale of the Knee Outcome Survey.

Methods: All patients in the study had a disorder of the knee and were active in sports (a Tegner score of 4 points). Forty-one patients who had a knee disorder that had stabilized and who were not receiving treatment were administered all four questionnaires at baseline and again at a mean of 5.2 days (range, two to fourteen days) later to test reliability. Forty-two patients were administered the scales at baseline and at a minimum of three months after treatment to test responsiveness. The responses of 133 patients at baseline were studied to test construct validity.

Results: The reliability was high for all scales, with the intraclass correlation coefficient ranging from 0.88 to 0.95. As for construct validity, the correlations among the knee scales ranged from 0.70 to 0.85 and those between the knee scales and the physical component scale of the Short Form-36 (SF-36) and the patient and clinician severity ratings ranged from 0.59 to 0.77. Responsiveness, measured with the standardized response mean, ranged from 0.8 for the Cincinnati knee-rating system to 1.1 for the Activities of Daily Living scale.

Conclusions: All four scales satisfied our criteria for reliability, validity, and responsiveness, and all are acceptable for use in clinical research.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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